Usefulness of carbon dioxide laser for recurrent lumbar disc herniation.
OBJECTIVE
During revision microdiscectomy for recurrent lumbar disc herniation (rLDH), the major concerns are approach-related complications, including dural tear and nerve root injury, because of adhesion scars and granulation tissue along the previous laminotomy site. In revision microdiscectomy of rLDH, carbon dioxide (CO2) laser can enable precise dissection and removal of adhesion scar. The purpose of this study was to evaluate the clinical usefulness of CO2 laser dissection in patients who had undergone revision microdisectomy of rLDH.


METHODS
Clinical and radiologic data were reviewed from 21 patients who underwent single lumbar level CO2 laser dissection followed by removal of rLDH between October 2006 and July 2010. They were followed up with plain radiographs, and their mean follow-up period was 30 months.


RESULTS
Patients' mean hospital stay after operation was 5.1 days. Pain scores on a visual analogue scale (VAS) for back and leg pain were improved from a preoperative mean of 4.7 and 7.6 to a postoperative mean of 3.5 and 3.0, respectively (p<0.001). Clinical outcomes based on the Oswestry Disability Index (ODI) were improved from a preoperative mean of 57.4-22.2% postoperatively (p<0.001).


CONCLUSIONS
Our results demonstrate that CO2 laser could be a useful surgical tool during revision microdisectomy of rLDH.
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea. mddavidk@dreamwiz.com
Jin-Sung
JS
Kim
Hyeong Seok
HS
Oh
Sang-Ho
SH
Lee
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004185:Disability Evaluation; D017586:Diskectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010147:Pain Measurement; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012008:Recurrence; D012042:Registries; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome