Health Problem: Herniated discs, also referred to as slipped, ruptured, or bulging discs, are injuries of the intervertebral structures that provide shock absorption in the spine. Disc herniations occurring in the lumbar spinal region may lead to pain, numbness, and/or weakness in the lower back and legs. For most patients, pain is temporary and responsive to conservative treatments. However, some individuals may require invasive treatments for symptom relief.

Technology Description: Percutaneous laser disc decompression (PLDD) is a minimally invasive therapeutic option for lumbar disc herniation (LDH) refractory to conservative treatment. The goal of PLDD is to relieve intradiscal pressure and allow the herniated portion of the disc to return to its natural location, thus removing impingement on the spinal nerves and reducing associated pain and disability. A needle with a trocar is inserted into the herniated disc through the annulus fibrosus and into the nucleus pulposus. A glass fiber is then inserted into the treating needle and connected to a laser, which is then activated to provide pulsed energy (heat) to remove damaged disc material. The total energy applied ranges from 600 to 1700 joules, depending on factors, including patient height and disc height.

Controversy: Although PLDD is a less invasive alternative to open surgery or microdiscectomy for treatment of LDH, there is remaining skepticism surrounding the procedure, and some consider it to be experimental. There are a variety of minimally invasive procedures available that employ different imaging modalities (e.g., endoscopy or fluoroscopy) and ablative technologies (e.g., automated mechanical technology; lasers; radiofrequency ablation), and the comparative effectiveness and safety of PLDD versus these procedures is unclear.

Key Questions:

  • Is PLDD effective in relieving pain and improving function and quality of life in patients with LDH?
  • How does PLDD compare with alternative treatments for LDH?
  • Is PLDD safe for treatment of LDH?
  • Have definitive patient selection criteria been identified for PLDD?

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