Image-guided percutaneous laser disk decompression for herniated lumbar disks: a 4-year follow-up in 200 patients.

Objective: The purpose of this study was to describe the long-term effect of image-guided percutaneous laser disk decompression (PLDD).

Background data: PLDD has been reported to be an alternative method to treat herniated lumbar disks. It has proved to be effective on a short-term basis. Although the procedure has been used for several years, few articles report on the long-term effect of the intervention.

Materials and methods: Two hundred patients, who were treated with image-guided PLDD for herniated lumbar disks, were observed over a period of 4 +/- 1.3 years. Treatments were carried out under CT/fluoroscopy guidance with local anesthesia on an outpatient basis with an Nd:YAG laser of 1064 nm.

Results: At follow-up, back pain was eliminated or reduced in 73% of the patients. Regarding sensorimotor impairment, PLDD did have a positive effect on 74% of the patients. In the majority of patients, the number of sick days and consumption of pain medication was reduced. In one patient, diskitis occurred as a complication of PLDD; 74% of the patients said they were satisfied with the outcome of the therapy; and 81.5% of the patients would have required another PLDD in cases of disk herniation.

Conclusion: From our clinical results, we conclude that image-guided PLDD is an effective and secure method to treat contained herniated lumbar disks. Advantages of the procedure include the minimally invasive approach on an out-patient basis and the low complication rate.