György Berényi1,2*, Norbert Lekka1,2, Zoltán Nagy1, Gábor Czigléczki1,2 and Péter Banczerowski1,2
1Department of Neurosurgery, National Institute of Clinical Neurosciences, Hungary
2Department of Neurosurgery, Semmelweis University, Hungary
Introduction: Percutaneous Laser Disc Decompression (PLDD) is a minimally invasive, non-open surgical technique, which uses laser energy to vaporize the nucleus pulposus in a percutaneous way. This technique has been used for over 30 years, but the safety and efficacy of PLDD is still often a concern of both physicians and patients. Some authors even go so far as to doubt that it has benefits at all. Our goal with this retrospective study was to add our clinical experience to this debate. Materials and Methods: We retrospectively reviewed the data of 141 patients, who had undergone percutaneous laser disc decompression between 2013 and 2017 at the National Institute of Clinical Neurosciences in Hungary. All patients were operated by the same surgeon, according to the same protocol. The demographic and clinical data of the patients were analyzed. Of the demographic data, we used age and sex for the analyses. Clinical data included the level(s) of the lesion, the number of days from the onset of the symptoms to the intervention, the number of days spent in hospital directly related to the intervention, the frequency and nature of (intra- and postoperative) complications and their management and the frequency of cases when re-operation or any further intervention became necessary because of the failure of PLDD to completely resolve the symptoms. To judge immediate outcome, we used the original Macnab criteria. Short- and long-term VAS scores were also analyzed. The effect of the previously mentioned factors on VAS scores was also analyzed. Results: The data of altogether 141 patients were analyzed. Of them, 58 were male (41%) and 83 were female (59%). The mean age was 49.43 years. In 81.89% of the cases, L4-5 and L5-S1 segments were affected. In 15 cases, multiple segments were affected. Classification according to the Macnab criteria was possible in 130 cases. The immediate outcome was excellent in 73 cases (56.2%), good in 15 cases (11.5%), fair in 5 cases (3.9%) and poor in 37 cases (28.5%). The recurrence rate was 15%. All complications, observed in 2.1% of the cases, were reversible. Significant improvement of the VAS scores was observed at the 6-week postoperative follow-up, which did not improve further by the 6-month follow-up. 30% to 63% of those showing significant improvement maintained the excellent outcome for at least 2 years. Neither the demographic variables, nor time from the onset to symptoms and PLDD, nor time from the diagnosis to PLDD, nor the applied amount of energy had a significant effect on the VAS scores. Conclusion: Our findings, therefore, corroborate the results of other studies and support the idea that PLDD is a safe, efficient and virtually complication-free method for the treatment for lumbar disc herniation, regardless of age and sex, if the patient met the selection criteria. We propose that this method is a logical next minimally invasive surgical step if at least one month’s conservative treatment fails.
Berényi G, Lekka N, Nagy Z, Czigléczki G, Banczerowski P. Surgical Outcomes of Percutaneous Laser Disc Decompression in Lumbar Disc Herniation: Six Years’ Experience from Hungary’s Largest Neurosurgical Center. Clin Surg. 2020; 5: 2888.