Percutaneous endoscopic laser annuloplasty for discogenic low back pain.
BACKGROUND
Laser-assisted spinal endoscopy (LASE) kit has been used for percutaneous intradiscal decompression to evaporate and shrink the posterior and central nucleus for improvement of leg and radicular pain due to contained disc herniation. Percutaneous endoscopic laser annuloplasty (PELA), a new minimally invasive technique, uses LASE to directly coagulate the inflamed disc granulation tissue associated with annular tears. The small diameter of the endoscope including Ho:YAG laser, irrigation, and light, plus the extreme posterolateral approach into the posterior annulus, enables one to minimize damage to normal nuclear tissue. The authors sought to demonstrate the safety and efficacy of PELA for controlling discogenic low back pain (DLBP) due to abnormal disc tissues, new vessels, and nerves in the central torn posterior annulus.


METHODS
Clinical outcomes of PELA were investigated in patients having DLBP with an annulus-torn degenerative disc or contained disc herniation. Thirty patients treated at a single level and achieving a mean follow-up of 9.7 months were analyzed. Outcomes were assessed using the visual analog scale (VAS) for back pain, the Korean Oswestry Disability Index (KODI), and the modified Macnab's criteria.


RESULTS
The mean back pain VAS score improved from 8.0 to 2.4, and the mean KODI score improved from 79.0 to 22.4 (P < .001). Results by the modified Macnab's criteria also showed a good outcome, with a success rate of 90.0%. There were no serious complications observed during follow-up.


CONCLUSIONS
Percutaneous endoscopic laser annuloplasty using the Ho:YAG laser provides favorable outcomes for carefully selected groups of patients with DLBP.
Lee
Sang-Ho
SH
Department of Neurosurgery, Seoul Wooridul Hospital, Seoul 157-822, Korea. shlee@wooridul.co.kr
Kang
Han Sug
HS
D000328:Adult; D015331:Cohort Studies; D017587:Diskectomy, Percutaneous; D004724:Endoscopy; D005260:Female; D006801:Humans; D007403:Intervertebral Disc; D053685:Laser Therapy; D017116:Low Back Pain / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000150:complications* / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult