title: Percutaneous laser disc decompression: clinical experience at SCTIMST and long term follow up.
abstract: BACKGROUND
  Low backache (LBA) is now increasing in younger population due to misdirected spinal kinetics secondary to improper posture, heavy load lifting and motorbike driving. Hence minimally invasive procedures are increasingly sought after. Among these, PLDD is currently popular and in use. We present our long term follow-up in the use of Nd:YAG laser for PLDD.
  
  
  OBJECTIVE
  To evaluate the efficacy of PLDD in treatment of contained herniation of lumbar discs & long term follow up results.
  
  
  METHODS
  Forty patients with contained lumbar disc herniation on MRI and who did not respond to 6 weeks conservative treatment were subjected to PLDD. L4-5 disc was treated in 31, L5-S1 in 12 and L1-2 and L3-4 in one each. Nd:YAG laser at 1064 nm was used for the procedure. Total laser energy of 1500-2000 Joules was delivered at the disc space depending upon the size.
  
  
  RESULTS
  There was immediate pain relief in 32/40 (80%). According to MacNab criteria good to fair response was seen in 37/40 (92%) and 3 patients (7.5%) responded poorly to this treatment. On follow up which ranged from 1 to 7 years, 34/40 (85%) had pain relief with no need for further treatment.
  
  
  RESULTS
  Significant pain at local puncture site was experienced by 8 (20%), pain during lasing was experienced by one. One patient developed muscular spasm.
  
  
  CONCLUSIONS
  Percutaneous laser disc decompression is a safe, relatively noninvasive and effective treatment modality for contained, nonsequestered, herniated lumbar disc disease in carefully selected patients.
authors.affiliation: Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India. gupta@sctimst.ker.nic.in
authors.forename: Arun K
authors.initials: AK
authors.lastname: Gupta
authors.forename: Narendra K
authors.initials: NK
authors.lastname: Bodhey
authors.forename: R S
authors.initials: RS
authors.lastname: Jayasree
authors.forename: T R K
authors.initials: TR
authors.lastname: Kapilamoorthy
authors.forename: C
authors.initials: C
authors.lastname: Kesavadas
authors.forename: T
authors.initials: T
authors.lastname: Krishnamoorthy
authors.forename: Bejoy
authors.initials: B
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D001416:Back Pain / Q000209:etiology; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D018579:Patient Selection; D012189:Retrospective Studies