Gupta Arun K, Bodhey Narendra K, Jayasree R S, Kapilamoorthy T R K, Kesavadas C, Krishnamoorthy T, Thomas Bejoy
Department of Imaging Sciences & Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India.
Neurol India. 2006 Jun;54(2):164-7.
Low backache (LBA) is now increasing in younger population due to misdirected spinal kinetics secondary to improper posture, heavy load lifting and motorbike driving. Hence minimally invasive procedures are increasingly sought after. Among these, PLDD is currently popular and in use. We present our long term follow-up in the use of Nd:YAG laser for PLDD.
To evaluate the efficacy of PLDD in treatment of contained herniation of lumbar discs & long term follow up results.
Forty patients with contained lumbar disc herniation on MRI and who did not respond to 6 weeks conservative treatment were subjected to PLDD. L4-5 disc was treated in 31, L5-S1 in 12 and L1-2 and L3-4 in one each. Nd:YAG laser at 1064 nm was used for the procedure. Total laser energy of 1500-2000 Joules was delivered at the disc space depending upon the size.
There was immediate pain relief in 32/40 (80%). According to MacNab criteria good to fair response was seen in 37/40 (92%) and 3 patients (7.5%) responded poorly to this treatment. On follow up which ranged from 1 to 7 years, 34/40 (85%) had pain relief with no need for further treatment.
Significant pain at local puncture site was experienced by 8 (20%), pain during lasing was experienced by one. One patient developed muscular spasm.
Percutaneous laser disc decompression is a safe, relatively noninvasive and effective treatment modality for contained, nonsequestered, herniated lumbar disc disease in carefully selected patients.
由于姿势不当、重物搬运和骑摩托车等导致脊柱动力学方向错误，下背痛（LBA）在年轻人群中的发病率正在上升。因此，微创治疗方法越来越受到青睐。其中，经皮激光椎间盘减压术（PLDD）目前很受欢迎且正在应用。我们展示了使用钕钇铝石榴石（Nd:YAG）激光进行PLDD的长期随访结果。
评估PLDD治疗包容性腰椎间盘突出症的疗效及长期随访结果。
40例经磁共振成像（MRI）诊断为包容性腰椎间盘突出症且对6周保守治疗无反应的患者接受了PLDD治疗。其中31例治疗L4 - 5椎间盘，12例治疗L5 - S1椎间盘，各有1例分别治疗L1 - 2和L3 - 4椎间盘。手术采用波长为1064 nm的Nd:YAG激光。根据椎间盘大小，在椎间盘间隙输送的总激光能量为1500 - 2000焦耳。
32/40（80%）的患者疼痛立即缓解。根据MacNab标准，37/40（92%）的患者反应良好至尚可，3例（7.5%）患者对此治疗反应不佳。在1至7年的随访中，34/40（85%）的患者疼痛缓解，无需进一步治疗。
8例（20%）患者在局部穿刺部位出现明显疼痛，1例患者在激光治疗期间出现疼痛。1例患者发生肌肉痉挛。
经皮激光椎间盘减压术对于精心挑选的包容性、非游离性腰椎间盘突出症患者是一种安全、相对无创且有效的治疗方式。
