Percutaneous laser uncleotomy for lumbar disc herniation ; basic studies and clinical results

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Percutaneous laser nucleotomy has been studied in authors' laser laboratory. This investigation is composed of basic studies (three parts) and the short term clinical results. Basic study 1. Dog discs were used and intradiscal pressures (IDP) and MRI findings were investigated. IDP and MRI signals were dicreasing according to laser irradiations but there were no correlations between IDP and MRI signals. Basic study 2. Goat lumbar discs were used and the heat distributions were evaluated. The temperature at the center of the nucleus pulposus rose high but the edge of the discs indicated no dangerous thermal distribution. Basic study 3. Chronic histological changes after laser irradiation were observed by light microscopic observation. These histological changes are the same as the changes of conventional study. After confirming the safety through these animal studies, we have started clinical trials of PLN for lumbar disc herniation. Results demonstrated this procedure was hopeful as an alternative to open surgery in case patient selection was carefully performed. The mechanism of pain-relief with PLN is speculated as the reduction of intra-discal pressure and/or the shrinkage of the herniated mass. The early series of PLN provided a relatively low rate of success (50%), however the procedure is relatively simple to perform, and has less associated postoperative complication. PLN is an effective, safe, short-time consuming, and less invasive treatment for protruded lumbar disc herniation in case patient selection is carefully performed. The success rate will increase with more meticulous patient selection, and it may become a more practical choice of treatment for lumbar disc herniation. Further investigation is necessary to detect the relationship between the anatomical appearance of disc and PLN outcome.