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From 1987 to 1997, 169 patients with herniated lumbar disk and radicular pain were treated by PLDD on an out-patient basis. There were 93 male and 76 female patients. The oldest was 71 years and the youngest was 12 years old. Mean age was 42 years. The longest follow-up was 6 years, the average follow-up 19 months . MacNab criteria were used to grade the response to treatment. The overall success rate was 76% according to MacNab's criteria with 55.6% of GOOD and 20.2% of FAIR. In four cases, the PLDD was performed at two levels. 11 patients with poor results or recurrence were later treated surgically with a satisfying success rate (68%). After 6-12 months, a reduction of disk herniation was observed with CT or MR imaging. These cases were evaluated a second time with a mean follow-up of 53 months, these long-term results were identical. The complications of PLDD under CT and fluoroscopic guidance are rare. The major complication of percutaneous nucleotomy is septic discitis. One patient suffered from a spondylodiscitis. Another suffered for six weeks from severe backache due to an aseptic discitis (three years follow-up). One patient was readmitted 24 hours after PLDD with severe recurrence of leg pain due to free fragment evacuation with upward migration. These data provide encouraging information substantiating the validity of percutaneous laser nucleotomy for contained lumbar disk herniation. The two most critical elements to successful PLDD are : proper patient selection and correct needle placement. Even if further random comparative studies are necessary to confirm these datas, PLDD is a valuable, minimally invasive alternative to conventional surgery for treating disk herniation.

 

GOOD Resumed preoperative function. Occasional backache or leg pain. No dependency-inducing medications. Appropriate activity. No objective signs of nerve root damage
FAIR May be nonproductive if unchanged from preoperative status. Intermittent episodes of mild lumbar radicular pain or low back pain. No dependency-inducing medications. Appropriate activity. No objective signs of nerve root damage
POOR Subjective : no productivity, continued pain behavior, medication abuse, inactive, compensation litigation focus. Objective : signs of continuing radiculopathy

Fig 1: Mac Nab's criteria.

 

Location Cases
L5-S1 87
L4-L5 71
L3-L4 11

Fig 2: location of disk herniation : 169 Cases.