Venkatesh Hosur Ananthashayana MD, Presenter: Nothing to Disclose

Deepnarayan Srivastava, Abstract Co-Author: Nothing to Disclose

Sanjay Sharma MD, Abstract Co-Author: Nothing to Disclose

Sanjay Thulkar, Abstract Co-Author: Nothing to Disclose

R MALHOTRA, Abstract Co-Author: Nothing to Disclose

Vijay Kumar, Abstract Co-Author: Nothing to Disclose

1. To evaluate the role of image guided Percutaneous Laser Disc Decompression in patients with low back pain due to disc herniation. 2. Role of magnetic resonance imaging in the evaluation of pre and post procedural morphology of the intervertebral disc and to determine a possible mechanism of action of the procedure in relief of symptoms.

We performed a prospective, single centre study of 32 patients who underwent Percutaneous Laser Disc Decompression for chronic discogenic low back pain. Patients with contained lumbar disc herniation on MRI who did not respond to 6 weeks of conservative treatment were included. All procedures were performed under fluoroscopic guidance using a Flat panel DSA unit with 3D rotational X-ray imaging facility along with  980nm Diode laser system and 360µm PLDD laser fibre. Follow-up clinical outcomes were assessed by modified MacNab criteria at 1, 3 & 6 month.  We prospectively reviewed the pre and postoperative MR images of all the patients.

According to modified MacNab criteria, excellent to fair response was seen in 18 out of 32 patients with overall success rate  of 56%. In a group of patients with disc herniation smaller than 1/3 of the spinal canal diameter (20/32), success rate was 65% and another group of patients with disc herniation more than 1/3 of the spinal canal diameter (12/32), success rate was 35%. Only 2 of the 18 patients who had a successful result had a reduction in the size of the herniated segment. Subchondral marrow changes were identified in 8 of 32 Percutaneous Laser Disc Decompression patients.

Preoperative imaging studies and selection of patients with disc herniation smaller than 1/3 of the spinal canal diameter predict the clinical outcome of Percutaneous Laser Disc Decompression. Postprocedural subchondral marrow changes were not associated with inflammation of the adjacent disc space and did not affect surgical outcome. Lack of morphological changes in the disc indicates that a chemical or humoral change rather than a mechanical change accounts for the success of the Percutaneous Laser Disc Decompression.

Percutaneous Laser Disc Decompression (PLDD), a valid alternative for those selected patients with contained lumbar disc herniation, who do not respond to conservative treatment, avoiding in many cases need for surgery.  

Hosur Ananthashayana, V, Srivastava, D, Sharma, S, Thulkar, S, MALHOTRA, R, Kumar, V, Percutaneous Laser Disc Decompression: Clinical Outcome and MR Evaluation.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14018179.html