title: Percutaneous diode laser irradiation for lumbar discogenic pain: a clinical study.
abstract: The present study evaluated the efficiency of laser irradiation for treating discogenic low back pain. Discogenic low back pain is believed to result from the degeneration and disruption of outer fibers of the intervertebral disc annulus, leading to a cycle of persistent inflammation, damage to the disc matrix, and sensitization of developed annular nociceptors. We selected 11 patients as subjects on the basis of clinical findings and the results of provocative disc blockade. The patients underwent percutaneous irradiation of affected lumbar discs with a diode laser. The mean total irradiation energy per disc was 740 ± 2.51 J, with a range of 610 to 960 J. The patients' responses were assessed with the Oswestry Disability Index (ODI) and a visual analogue scale (VAS) to determine the average level of pain. The patients' mean ODI scores at 1 day, 3 months, 6 months, 12 months, 18 months, and 24 months after laser irradiation were 18.63 ± 11.22, 13.6 ± 4.53, 12.5 ± 5.5, 11.8 ± 5.25, 10.5 ± 2.27, and 10.5 ± 2.27, respectively, versus a mean pre-treatment ODI score of 50.27 ± 9.35. Their mean VAS scores at the same post-treatment intervals were 3.09 ± 2.36, 2.4 ± 0.97, 2.7 ± 1.16, 2.1 ± 0.74, 2.1 ± 0.81, and 2.1 ± 0.88, respectively, versus a mean pre-treatment VAS score of 7.64 ± 1.21. The post- versus pre-treatment scores for both the ODI and VAS indicated a statistically significant clinical benefit across the full 24-month follow-up period after laser irradiation. The efficacy of laser irradiation in treating such pain may come from a thermal effect and reductions of intradiscal pressure, of the concentrations of irritant substances, and of the numbers of nociceptors in the affected region.
authors.affiliation: Department of Neurosurgery, Osaka University Medical School, Japan. kiwatsuki@nsurg.med.osaka-u.ac.jp
authors.forename: Koichi
authors.initials: K
authors.lastname: Iwatsuki
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yoshimine
authors.forename: Masao
authors.initials: M
authors.lastname: Umegaki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Yu-Ichiro
authors.initials: Y
authors.lastname: Ohnishi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ishihara
authors.forename: Takashi
authors.initials: T
authors.lastname: Moriwaki
mesh_terms: D003287:Contrast Media; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000601:surgery*; D007472:Iohexol; D053685:Laser Therapy / Q000379:methods*; D054023:Lasers, Semiconductor; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae; D008297:Male; D010147:Pain Measurement; D011859:Radiography; D013129:Spinal Puncture; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D007472:Iohexol