Clinical Application of Percutaneous Laser Disk Decompression

Key words:

Diskectomy, percutaneous; Laser surgery; Radiology, interventional

In recent years, the author of semi-conductor laser therapeutic apparatus using percutaneous laser disc decompression (percutaneous laser disk decompression, PLDD) treatment of lumbar disc herniation, has achieved some results. Automatic aspiration of the technology and compared to excision, a simple, safe, injury, etc., are presented below.

Materials and Methods

1. Clinical data:

100 cases collected by the hospital to be diagnosed as clinical lumbar disc herniation by CT or MRI in patients with a clear diagnosis for PLDD treatment, follow-up of 6 to 18 months. 100 cases of patients, male 56 cases, 44 cases of women aged 17 ~ 72 years old, the average age of 48.5 years old.

Course of disease and clinical performance: the initial incidence of 2 months to 20 years, clinical low back pain with radiation leg pain, inability to walk, limp, the affected muscle atrophy, limb cold.

Physical examination: unilateral or bilateral limb elevation test positive, the level of the corresponding disc next to the spinous process tenderness. After pre-treatment CT or MRI examination. L4 ~ 5 of them were 65 cases of disc herniation, L5 ~ S1 disc herniation, 35 cases have been more than six weeks of conservative treatment is invalid or the result is not significant.

Semiconductor Laser Therapeutic Apparatus used: wavelength 980 nm, the end of the maximum output power 15 W. Optical fibers: 400 nm; 18G needle 2, a long 15 cm; Y-type switch 1.

Selected for the following conditions have PLDD indications:

(1) clinically diagnosed as lumbar disc herniation, with recent (within 3 months) CT or MR for the diagnosis of lumbar disc herniation were clear;

(2) 6 weeks of conservative treatment fails;

(3) the extent of leg pain than back pain;

(4) positive straight leg raising test;

(5) of sensory, motor response, tendon reflexes were diminished.

And for the following contraindications:

(1) there is a serious clinical bleeding tendency and who can not be corrected;

(2) spondylolisthesis;

(3) disc was broken from the Free State;

(4) spinal stenosis (bony, ligament thickening, calcification).

(5) Marking the level of the history of trauma or surgery has been the history of lumbar intervertebral disc or Chemonucleolysis history;

(6) significant stenosis in the vertebral space;

(7) clear mental disorder;

(8) pregnant women.

2. Operation Methods: Patients from lateral position (side up) in the DSA machine tools, positioning under fluoroscopy puncture, topical 2% lidocaine anesthesia 5 ml (from the skin to the superficial muscle layer), with 18G, length 15 cm of the needle away from the open side of vertebral spinous process centerline 8 ~ 14 cm Department (L4 ~ 5 to 8 ~ 12 cm, L5 ~ S1 for 10 ~ 14 cm), under the supervision of the perspective from the rear side into the needle, needle sagittal direction of the trunk surface and 45 ° ~ 60 ° angle. Needle is located in the best position of the corresponding intervertebral space after the 1 / 3 the level of the Agency (Figure 1), after the success of lateral puncture, rotating C-arm, is situated to the perspective, the spinous process at the level of the needle puncture nucleus, the L5 ~ S1 disc iliac wing due to stop before the needle into the needle bent into approximately 160 ° around (Figure 2), after the correct position, pull out the needle puncture needle core, will be 0.4 mm thick needle through the fiber-optic delivery into, and beyond the top needle 0.5 cm, the use of Y-shaped lock switch and then to the end of the output power 15 W, pulse time of 1 s, interval time of 5 s on the nucleus points to 1 point or more laser decompression. Operation, when patients have a bulging waist flu, with space needle by Y-switch liposuction, each disc to the energy by about 1 200 ~ 1 300 J (L3 ~ 4, L5 ~ S1), 1 300 ~ 1 500 J (L4 ~ 5), the whole process about 20 ~ 30 min.

Results

100 cases of 100 patients with intervertebral disc, the success rate of puncture was 100%, follow-up period was 6 to 18 months. Reference MacNab [1] to evaluate the standard cure, 72% efficient. Of which 22 patients were cured and 50 cases of effective, 28 cases were followed up for 6 months without improvement in symptoms was considered null and void, without any complication. According to the affordability of different patients, respectively after 3,6 months or 1,3,6,12-month CT or MRI follow-up visit, some cases (24/100) 1 month for only the performance of the Department of nucleus density circular lower three months after the performance of some patients to varying degrees for the disc back to Steiner (49/100), part of cases (23/100) had no significant disc back satisfied, but to improve symptoms in varying degrees.

Discussion

Principle PLDD through laser vaporization of the nucleus pulposus for cutting, as well as the solidification of the part of disc nucleus pulposus to reduce intradiscal pressure and volume, so as to achieve the purpose of treatment of lumbar disc herniation. In recent years the use of laser disc decompression has been in clinical and medical skills to gradually extend the awareness of staff and patient acceptance, more in line with the interventional radiology Development trends and operation of micro-trauma of the requirements, should be promoted as a new method for the treatment of disc herniation.

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