23rd Anniversary of Percutaneous Laser Disc Decompression (PLDD).
OBJECTIVE
In mid-February 1986, Peter Ascher and Daniel Choy performed the first percutaneous laser disc decompression (PLDD) procedure at the Neurosurgical Department, University of Graz, Graz, Austria. It was planned to deliver 1000 J of energy with an Nd:YAG laser to a herniated L4-L5 disc causing sciatica. At 600 J the procedure was terminated because the pain was gone.


BACKGROUND
Since then PLDD has spread all over the world, with procedures being performed on the entire spine except for T1-T4 because these discs do not permit percutaneous access with a needle. The success rate has ranged from 70-89%, and the complication rate, chiefly discitis, ranges from 0.3-1.0%. When successful, average time to return to normal activities is 1 wk. Long-term follow-up at 23 y yields a recurrence rate of 4-5%.


METHODS
Laser surgeons active in PLDD were canvassed to obtain their best clinical data.


RESULTS
PLDD patients treated with the Nd:YAG laser, the diode laser, and the combination Ho:YAG laser and endoscope were included.


CONCLUSIONS
The McNab results for the three groups indicate that PLDD is safe, effective, and minimally invasive.
Choy
Daniel S J
DS
Laser Spine Center, New York, New York 10075, USA. dchoy@nyc.rr.com
Hellinger
Johannes
J
Hellinger
Stefan
S
Tassi
Gian Paolo
GP
Lee
Sang-Ho
SH
D019299:Decompression, Surgical; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods*; D012585:Sciatica / Q000209:etiology / Q000601:surgery