What is PLDD?
Percutaneous laser disc decompression (PLDD) is a type of surgery in which a laser probe is inserted into the intervertebral disc space and laser energy applied for achieving decompression and neuromodulation thereby relieving the pain. PLDD is a minimally invasive procedure that falls into the category of percutaneous intervertebral surgeries with the aim to significantly reduce the patient's pain and recover neurological deficit. It is performed under local anesthesia. By a specially designed laser, with a coefficient of absorbing energy adjusted for soft discus tissue, specific amount of heat is sent to achieve the evaporation of the water from the disc without additional thermal damage thus achieving decompression and creation of a stable intradiscal scar that will prevent herniation from reoccurring.
Treatment principle
The treatment principle of PLDD is based on the concept of the intervertebral disc being a closed hydraulic system. This system consists of the nucleus pulposus, containing a large amount of water, surrounded by the inelastic annulus fibrosus. An increase in water content of the nucleus pulposus leads to a disproportional increase of intradiscal pressure. A reduction of intradiscal pressure causes the herniated disc material to recede toward the center of the disc, thus leading to reduction of nerve root compression and relief of radicular pain (leg pain and/or back pain). In the PLDD, this mechanism is due to the application of laser energy evaporating a small amount of water in the nucleus pulposus. Laser energy is delivered by a laser fiber through a tiny needle placed into the nucleus pulposus. The needle is placed into the intervertebral disc under local anesthesia. Apart from evaporation of water, the increase in temperature also causes protein denaturation and subsequent renaturation (biochemical effect of laser energy into the nucleus pulposus). This causes a structural change of the nucleus pulposus, limiting its capability to attract water and therefore leading to a permanent reduction of intradiskal pressure.
Indications / selection criteria
PLDD procedure can be performed anywhere on the spine (cervical, thoracic, lumbar - except T1-T9 discs). Indications/clinical findings that could be suitable for PLDD procedure:
·Herniated disc (bulged, protruded and even extruded discs but with a good "bridge" between the extruded part and the parent disc)
·Spinal stenosis (where herniated disc is almost or more than 50% of the contributing factor)
·Discogenic pain (due to slipped disc or internal disc disruption)
·Sciatica (due to slipped disc)
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