Nonendoscopic Nd-YAG 1064 nm PLDN in the treatment of thoracic discogenic pain syndromes.

Objective: The purpose of the present study was to discover new minimal invasive treatments of discogenic thoracic pain caused by protrusions or extrusions using the promising method of nonendoscopic Nd-YAG 1064 nm PLDN in the lumbar and cervical regions. Because early symptoms of chronic thoracic discogenic pain syndromes have not been characterized, interventional therapy is usually started late and involves a high complication rate.

Materials and methods: A prospective controlled clinical study was undertaken by neurologists using Nd-YAG 1064 nm PLDN to treat 42 patients with thoracic disc protrusions and extrusions. Patients with discogenic pain syndromes and MRI-confirmed disc pathology with spinal canal impairment were enrolled; 68 discs were treated. Maximal Nd-YAG laser 1064 nm dose was 1,000 watts per segment. Disc puncture was performed by dorsolateral approach. Monitored parameters were VAS, McNab score, subjective condition, neurological findings and peripheral EMG. A different, independent neurologist examined each case before and after surgery.

Results: At 6 weeks after treatment, 41 patients had a successful outcome; only one with a clinical suspicion of spondylodiscitis was dissatisfied. In all others, clinical parameters improved. EMG leaks had disappeared. Combined spastic paresis improved in 2/4 cases. Complications were one pneumothorax, one pleuritis and one suspected spondylodiscitis.

Conclusion: Pain relief and decompression of spinal structures is effective and immediate by disc vaporization, shrinkage, nociceptor destruction and discogenic kinius denaturation. Nonendoscopic percutaneous Nd-YAG 1064 nm PLDN is a highly effective method for the treatment of thoracic disc disorders with minimally invasive access and is recommended prior to any open surgery.