Daniel S J Choy1, Arpad S Fejos. 1. Columbia University College of Physicians and Surgeons, Laser Spine Center, New York, USA. Dchoy@NYC.rr.com
Abstract
OBJECTIVE: This is a report on 178 herniated cervical discs in 93 patients treated with percutaneous laser disc decompression (PLDD) using the Nd:YAG laser at the Laser Spine Center from November 1994 to October 2003. MATERIALS AND METHODS: Patients with MRI documented disc herniations in the cervical spine who had failed conservative treatment and were sufficiently symptomatic to require surgical intervention were included in the study. A Seldinger needle was inserted under fluoroscopic guidance and local anesthesia into the offending cervical disc from an anterolateral approach until the tip was just beyond the annulus. Through an optical fiber connected to an Nd:YAG laser, 300 joules were delivered to the disc. A dressing was applied and the patient sent home, to return to work the following day. RESULTS: According to the MacNab criteria, 90% of the patients improved. All of them were permitted to return to work the following day. One complication (0.6%) occurred: a retro-esophageal abscess that responded to incision and drainage. CONCLUSION: PLDD of cervical disc herniations is effective and relatively non-invasive, and has a low complication rate. Because of the complexity of vital adjacent anatomic structures, it should only be performed after intensive training by a qualified interventionist with appropriate experience.
OBJECTIVE: This is a report on 178 herniated cervical discs in 93 patients treated with percutaneous laser disc decompression (PLDD) using the Nd:YAG laser at the Laser Spine Center from November 1994 to October 2003. MATERIALS AND METHODS:Patients with MRI documented disc herniations in the cervical spine who had failed conservative treatment and were sufficiently symptomatic to require surgical intervention were included in the study. A Seldinger needle was inserted under fluoroscopic guidance and local anesthesia into the offending cervical disc from an anterolateral approach until the tip was just beyond the annulus. Through an optical fiber connected to an Nd:YAG laser, 300 joules were delivered to the disc. A dressing was applied and the patient sent home, to return to work the following day. RESULTS: According to the MacNab criteria, 90% of the patients improved. All of them were permitted to return to work the following day. One complication (0.6%) occurred: a retro-esophageal abscess that responded to incision and drainage. CONCLUSION: PLDD of cervical disc herniations is effective and relatively non-invasive, and has a low complication rate. Because of the complexity of vital adjacent anatomic structures, it should only be performed after intensive training by a qualified interventionist with appropriate experience.