What is a Percutaneous Laser Discectomy?
The percutaneous laser discectomy is achieved by passing a side firing laser probe into specific regions of a lumbar or cervical disc under X-Ray control. The laser energy is then directed at the degenerate tissues to vapourise the unwanted disc material, reduce inflammation in the disc and to reduce pressure upon nerves passing over the disc protrusion. The laser discectomy is described in greater detail under the surgical procedure section.
When do we use a KTP Laser Discectomy?
The Percutaneous Laser Discectomy is used in this unit to remove broadbased disc protrusions.
Our experience indicates that a KTP/532 laser discectomy should be performed in patients with:
- Wide based disc protrusion
- Protrusion occupying less than 30% of the antero-posterior (radiographic) diameter of the spinal canal
- Weight bearing lumbar disc height of 4 mm or more
- Dynamic retrolisthesis of 3 mm or less
- Contained disc (except when treating Leaks)
- Disc unadulterated by prior surgery
When do we use a Holmium Laser Discectomy?
Our experience in indicates that The Holmium wavelength can be used for laser discectomies where a thermoplastic effect is sought. This means that the heat caused by the laser is used to shrink the posterior wall. The depth of “cut” is 0.4 mm with this wavelength should only be used where the probe can be approximated closely to the degenerate material to be ablated. This wavelength has many useful attributes for use in the techniques outlined below such as the F.E.I.D. and E.L.F. procedures.
The Holmium wavelength has a thermoacoustic effect upon tissues and should be used in an “vented” environment where suction is present. The advent of the “Doubled Pulse” Holmium laser system has made the Holmium much more comfortable for the patient and now allows us to use higher energy levels to shorten operation times.
Our experience indicates that a Double pulsed Holmium laser discectomy should be performed in patients with:
- Wide based disc protrusion
- Protrusion occupying less than 30% of the antero-posterior (radiographic) diameter of the spinal canal
- Weight bearing lumbar disc height of 4 mm or more
- Dynamic retrolisthesis of 3 mm or less
- Contained disc (NOT to be used when treating Leaks)
- Disc previously addressed by surgery with preserved height otherwise this should be treated by F.E.I.D. or E.L.F.
What are the usual outcomes of a Laser Discectomy?
Our Initial results and those in the U.S.A. suggest that, in properly selected patients, Laser Discectomy using the KTP/532 Surgical Laser System is a safe and effective alternative to open operative discectomy. Our early studies suggest that 92% of patients with primary compressive nerve root symptoms are satisfied with the results of laser discectomy one year after surgery and 87% are satisfied by the end of the second year and 85% at the end of year 3.
In those patients who have had previous open surgery the disc structure has been altered by scarring. In this situation the KTP/532 Laser discectomy is less effective However the problem of cases who had undergone prior surgery has been addressed more effectively by the more advanced techniques outlined below. The Advantages of the Laser Discectomy over conventional surgery include;
- Performed as an out patient procedure
- Do not preclude alternative surgical options
- Reduced risk of complications
- Usually provide immediate relief of symptoms
- Reduced soft tissue injury
- No bone is sacrificed
- No epidural fibrosis [scarring about the cord] as a result of the surgical procedure.
