Initially radial tears were considered a mere chance finding on the M.R.I. scan but Viviprudence (Aware State Feedback) indicates that they represent an important often long-lasting and painful pathology. These intradiscal tears and annular collections can be treated by KTP laser discectomy where advanced physiotherapy has been tried for an extended period and failed however our studies indicate that alone the use of Laser Disc Decompression can only produce a 50% success rate with wide based protrusions. For more effective treatment Endoscopic Laser Foraminoplasty (ELF) is required to remove the perineural scarring produced around the nerve as a reaction to the irritative breakdown products.
Spinal Probing & Discography
The problem is that annular leaks fail to be detected by the M.R.I. scan in 2 out of 3 cases. Where there is no annular bulge spinal probing and discography are the only methods for their simple detection.
KTP or Holmium Laser Discectomy
We have treated these leaks with therapeutic discograms and KTP and Holmium laser disc decompression (LDD). The simplest treatment is the KTP or Holmium laser discectomy utilising the thermoplastic effect on the annulus to shrink the tear margins and anneal the fibres therein supplemented with a blood patch serially laminated on to the tear to reinforce the seal. This has been termed Posterior wall reconstruction. This technique has to be combined with advanced physiotherapy to correct malposture.
Our outcome studies indicate that it takes about 3 – 4 months for the seal to mature and the leak to heal, The flare may be prolonged in to the second or third postoperative months. Results to date reveal a 50% success rate at review at 24 months with LDD with better results with ELF.