Laser-assisted disc decompression: a clinical trial of the holmium:YAG laser with side-firing fiber.

In order to evaluate the efficacy of laser-assisted disc decompression (LADD) as an alternative treatment modality for nonsequestered herniated nucleus pulposus of the lumbar spine, we used the Holmium:YAG laser with Sidefire laser fiber on 223 consecutive patients who met inclusion criteria. Patients were evaluated by an independent interviewer postoperatively, and at 1 week, 3 months, 6 months, and 1 year. Ratings were based upon the modified Macnab criteria. All patients presented with leg pain with or without back pain that had failed a minimum of 6 weeks conservative treatment (e.g., rest, NSAIDs, physical therapy, epidural steroid injections). Patients were not considered for LADD if the primary source of neurologic findings was a result of scar tissue from a previous discectomy, lateral recess or central stenosis, or sequestered discs. At 1 year postoperative follow-up, the surgical success rate was 84%. For patients requiring an additional LADD procedure, results at 6 month follow-up yielded surgical success rates of 92.3% and 90% for additional level and index level LADD, respectively. LADD appears to be a viable treatment modality for nonsequestered herniated nucleus pulposus recalcitrant to conservative treatment. LADD may represent a more cost-effective and safer treatment alternative to traditional invasive surgical procedures and other percutaneous methods.