Percutaneous Laser Disc Decompression| PLDD or Percutaneous Laser Assisted Dissectomy is the minimally invasive interventional technique for treating cervical, dorsal (except for the T1-T8 segment) and lumbar disc hernias.
PLDD is performed under local anaesthesia. The nucleus pulposus of the affected intervertebral space is targeted by the laser beam which is carried by a 300 or 400 micron optical fiber inserted into a thin 18-20 gauge needle which is perfectly positioned at the desired site under c-arm fluroroscope control.
From a clinical point of view, the denaturation and subsequent partial vaporization of the nucleus pulposus causes the affected nerve to decompress. The objective of the PLDD procedure is to reduce the excessive pressure exerted by the disk herniation on the nerve root.
PLDD was created in the nineties in the USA by Prof Daniel Choy with a Nd Yag lamp laser system and shortly afterwards it was imported into Italy by his student Dr. Gian Paolo Tassi who perfected it through the use of various diode lasers which had been developed over the last twenty years. So far thousands of patients have been treated around the world since the beginning of prof. Choy’s clinical trial. Numerous publications in international scientific journals have documented the excellent results, minimal invasiveness, reliability, safety and stability of the procedure.
After treatment, with can last from 30 to 60 minutes, a 24 hour period of rest is recommended. The next day the patient can gradually begin walking; work can gradually be resumed in 15 to 30 days (depending on the type of job performed).
There are no cutaneous incisions with PLDD and also there are no muscle, joint, ligament or bone lesions. These are the inevitable consequences of the micro-surgical approach, both orthopaedic and neurosurgical, which could be followed by peri-radicular adhesions, vertebral instability, post-operative muscle pains, etc. In the few patients where PLDD laser treatment did not give the expected results, the surgical procedure is not barred in any way.
Considering the minimal invasiveness, the reported complications of PLDD are practically absent; septic complications are always possible even with traditional surgery.
The LASEmaR® 1000, thanks to its specific 980nm wavelength, the dedicated software and percutaneous introducer kits of the special optical microfibers, is the ideal tool for PLDD.
MRI of a patient with extruded hernia L4 - L5
Courtesy of: G.P. Tassi M.D.
