Laser Percutaneous Lumbar Disc Decompression

Key words: semiconductor laser percutaneous lumbar disc herniation

Lumbar disc herniation is a common orthopedic. Since his diagnosis and report, recognized the formation of a variety of effective treatment methods and techniques. Since the seventies, percutaneous discectomy is widely used in the treatment of lumbar disc herniation to avoid an open surgery on the spinal stability and the legacy of the destruction of nerve root adhesions, complications such as epidural fibrosis. Percutaneous laser disc and gasification (PLDD) [1, 2, 3], with its small needle puncture, trauma, easy control of laser energy, safe and convenient operation and rapid recovery characteristics, making it minimally invasive lumbar disc herniation A new method of treatment. In our hospital from May 2001 -2003 taken in August in the treatment of semiconductor laser 112 cases of lumbar disc herniation, disc 149, based on Macnab [4] Evaluation criteria: the recent rate of 95.3 percent excellent, satisfactory outcome.

1 The clinical data and methods

1.1 General information on 112 cases of this group, between the plate 149, of which 66 cases of male, female 46 cases. Prominent positions in Table 1. Age 20-65 years old, the average age of 40.4 years old. Low back pain in varying degrees, with unilateral or bilateral lower extremity history. The shortest course of three months, the longest 12 years, an average of 23.8 months. By non-surgical treatment of poor or ineffective, and recurrent. Lumbar intervertebral disc with 36 cases of positive straight leg raising test, the corresponding decline of 19 cases of skin feel, the mother toe muscle strength decline in 15 cases, more cases showed only waist hip pain, have been considered by the CT / MRI or myelography confirmed disc prominent, and the average length of stay 4d. Preoperative indications for choice of at least two or more according to the results of imaging, imaging results must be in line with the clinical symptoms.

Table 1

Prominent parts of L2 / 3 L3 / 4 L4 / 5 L5/S1

Cases 7 13 78 51

Surgical methods are used for all operations of semiconductor laser, laser wavelength of 810nm, maximum power 30W, and fiber diameter 400/600um. The patient supine or side position, after the conventional skin disinfectant Shop Towel sterile, 2% lidocaine local infiltration anesthesia, lumbar spinous process in the middle lane next to open 8-10cm and 500-550 bed angle into the pin surface in the C-arm X DSA-ray machines or used under the guidance of 0.5mm-1mm puncture needle into the lesion side of the vertebral space, accurate needle positioning in the lateral intervertebral space is central. Pull out the core needle, into the optical fiber, nucleus pulposus vaporization. Laser energy is set to 15W, pulse duration 1.0S; interval 1.0S. According to patient's age, the degree of disc degeneration (water), prominent nucleus size, location and so the total energy of laser 2000-2500J, nucleus pulposus vaporization process, the vacuum suction can be several times so as to reduce the disc pressure, the entire surgical process for about 15 -30min.

2 results

112 cases of this group, patients were followed up after 1 month in 12 cases, 1-6 on 25 cases of 6-December 45, December -24 30 cases, postoperative assessment of efficacy, according to Macnab pm Grade: excellent in 69 cases, good in 38 cases, five cases can be. Postoperative day, effective 78 cases (69.5%), improvement in 28 cases (24.8%), 6 cases (5.7%, 0 cases of deterioration. 26 cases and ineffective in patients with improved pain and signs in the 2-8 weeks, significantly reduce or disappear, after two cases of low back pain symptoms without subjective feeling of improvement, but the straight leg raising test objective signs of improvement, we evaluated for the patients, 2 months later a small window nucleus removed.

Operative complications in this group of cases without neurologic, vascular, intestinal injury and the occurrence of bacterial spondylodiscitis. There are five cases of patients with lumbar intervertebral disc space at the same time 3 treatment, two cases from repeated lumbar puncture to puncture the side low back pain injury occur, treatment and recovery manager.

3 discussions

3.1 The principles of semiconductor disk laser, diode laser penetration depth 0.5mm, short pulse duration, a longer interval, so that cooling the surrounding tissue has a good safety. In the optical disc head and local organizations have a high fever due to vaporization temperature, the diameter of an area of approximately 0.7-0.8cm. Thereby reducing the disc pressure and reduce the size of nucleus, part of nucleus pulposus disc back to a high degree of satisfaction and reduce tension decreased so that the nerve root, pain relief. Kambin have been measured by the vaporization of intradiscal pressure after preoperative dropped to 24.07Kpa after 2.58Kpa, studies have found that disc could be back after 2-3 mm [5], this result with our cases on the part of CT review in line.

3.2 Laser impact on the surrounding tissue the process of laser vaporization temperature effect of surrounding tissue is a common concern, research has shown that: the body of specimens during laser disc, around the structure of the temperature changes only slightly more than in the 10C The biggest change in amplitude not more than 30 C [6]. Clinical application of the cases occurred in one cases of non-limb sensory-motor dysfunction and sphincter dysfunction. This shows that in the laser disc, the surrounding tissue is safe.

3.3 QI Qiang organizational change suggests that the animal experiments will enable the disc occurred in the laser vaporization, vapor cavity formation, two weeks after emergence of granulation tissue repair, after 8 flow into fibrous tissue, after 12 weeks, the disappearance of fibrous tissue, replaced by cartilage tissue [6]. Laser vaporization of the product after the water vapor and CO2 and the organization of carbonized debris, so that organizations generally will not cause chemical changes.

3.4 indications [5] (1) low back pain, upper and lower extremities were 2-3 months of conservative treatment is invalid. (2) Positive straight leg raising test. (3) The performance of the nervous system injury. Such as shallow paresthesia, decreased muscle strength, reflex abnormalities. (4) Due to medical disease, not suitable for long-term non-surgical therapy or who can not afford the traditional surgery. (5) Syndrome or lumbar segmental lumbar disc herniation. (6) Were confirmed by CT or MRI. Clinical symptoms and imaging diagnosis and the basic line.

Contraindication 3.5 (1) sequestered intervertebral disc prolapse. (2) Spinal stenosis. (3) Prominent disc calcification or ossification. (4) a clear narrow intervertebral space. (5), bleeding body, pregnant women and mental disorders, serious cardiovascular and cerebrovascular diseases. (6) Have the same level of surgery. (7) Other reasons.

3.6 PLDD advantages of (1) PLDD the treatment of lumbar disc herniation, due to the use of 0.5-1 mm diameter core with a small needle, a needle in place without cutting disc percutaneous aspiration level of expansion, thereby reducing the nerves, blood vessels, intestine opportunities for injury. Regression due to lower lumbar spine lesions, hypertrophic facet hypertrophy, disc degeneration, vertebral gap narrow puncture caused by the difficulties. L5/S1 puncture line of cases, in the regulation and direction into the needle point at the same time, due to the flexibility of small needle may be curved needle to avoid bone block, easy access to space, this was no case of puncture failure. (2) the use of local anesthesia, simple operation, less trauma and shorter treatment time. Laser energy can be controlled, safety, and the restoration of fast, easy to accept patients. Than open surgery, do not enter the spinal canal to maintain the integrity of the spinal canal and vertebral body relative stability, so as to avoid the result of lumbar instability, the legacy of chronic low back pain and epidural scar formation, nerve root adhesions. (3) compared with other minimally invasive treatment techniques, as laser vaporization, the heat produced disc, reducing wound bacterial spondylodiscitis from happening. Nucleus can control the scope of the vaporization of burning will help to further reduce the disc pressure. Can avoid the chemical dissolution of the allergic reaction caused by nuclear therapy and enzyme release into the atmosphere caused by nerve root and spinal cord damage.

4. Conclusions

PLDD is a safe, simple, minimally invasive, effective treatment for the involvement of intervertebral disc surgery is an effective complement to conventional surgery [1, 2].

References:

1. Dong, Xiao Xiangsheng. Percutaneous laser disc decompression progress [J]. Abroad Fascicle Clinical Radiology. 1999; 5:270-272.

2. WANG Chenguang, et al. Semiconductor laser percutaneous lumbar disc decompression evaporation of clinical research. Chinese Journal of Laser Medicine .2001; 10 (1) :31-34.

3. Huang xianglong, et al. Percutaneous laser lumbar disc decompression clinical applications. Chinese Journal of Radiology. 2000; 34 (3) :203-205.

4. Macnab I. Negative disc exploration: an analysis of the causes of nerve-root involvement in sixty-eight patients Bone Join surg (Am), 1971, 53:891.

5. Bi Wan-li, et al. CT-guided percutaneous laser disc decompression for the treatment of lumbar disc herniation clinical application. .2000 China Medical Imaging Technology; 16 (8):700-702

6. QI Qiang, et al. Laser vaporization of the animal experimental study of intervertebral disc. Chinese Journal of Surgery. 1994; 32 (3):187-189

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