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disk ablation

Laser disk ablation

When satisfactory needle position is obtained, the laser procedure begins. The laser is turned on to produce 15-20 watts with 0.5 to 1 second pulses and 4 to 10 second intervals depending on patient comfort. Recommended laser doses for PLDD range from 1200 to 1500 joules for L1-L2, L2-L3, L3-L4 and L5-S1 levels and 1500 to 2000 joules for L4-L5. Using this technique with these short exposure times, there is no heating of the adjacent bone structures. A CT scan is performed every 200 joules at the disk level to visualize the vaporized area. The patient must be able to communicate and respond to pain during the entire procedure. General anesthesia is therefore absolutely contraindicated. If pain occurs, the intervals between pulses are increased and aspiration is applied to reduce pressure within the disk.


Fig 29: laser ablation


Fig 30: CT control of laser ablation