Laser treatment for herniated disc — how to do a little blood?

Laser treatment of a herniated disc (laser vaporization of a disk)

Back pain that is often caused by a herniated disc is a problem that every year around the world facing 5 people out of 1000. Only 60% – 80% of cases of radicular pain was successfully treated by therapeutic methods. Other patients resort to surgical treatment.

Due to the significant number of cases and a long period of recovery, which is inherent in classical open surgery of the intervertebral disc, there is a constant search for less invasive (with least interference in human tissue) treatments.

Percutaneous laser vaporization of an intervertebral disk (CLVD) is one of the so-called «minimally invasive» methods of treatment. The idea of using laser treatment of hernias of the spine originated in the early 80-ies of the twentieth century.

First, the procedure of vaporization of the person made in February 1986, and by 2002, worldwide there were about 35 000 operations.

The principle CLVD based on the concept that considers the intervertebral disc as a «closed hydraulic system», which consists of the nucleus pulposus – contains a large amount of water loose substance surrounded by a fibrous ring (the dense skin). The increase of water content in the gelatinous nucleus leads to a disproportionate increase in the pressure inside the disc, which leads to «squeezing» of the content. Radicular pain, which accompany disc herniation are the result of compression of the nerve roots.

The decline in intra disk pressure causes the hernial content to retreat towards the center of the disc reducing nerve compression and pain relief. This mechanism is the basis of the vaporization, where the water from the nucleus pulposus is vaporized by means of fiber optic laser that with local anesthesia administered through a thin needle into the intervertebral disc.

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In fact, the procedure can be performed «blind» (under visual control what is happening inside disk through the endoscope), but as a rule the correct position is checked with fluoroscopy in two planes, sometimes a CT scan or, less often, magnetic resonance imaging.

In addition to the evaporation of water, increasing the temperature leads to a change in the structure of the nucleus pulposus, limiting its capability to attract water and thus prevents the increase intra disk pressure.

When can be used?

CLVD can be made in cases where the patient has a radiologically confirmed herniated disc, as well as the availability of appropriate radicular symptoms.

This intervention is not indicated for patients with severe neurological symptoms, eg, cauda equina syndrome (complex neurological disorders of the pelvis and legs), severe paresis (impairment of voluntary movements of individual muscles or limbs as a whole) or other violations that require urgent surgical intervention.

Contraindications to treatment of a herniated disc with a laser

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Since the principle CLVD based on the concept of «closed hydraulic system», this treatment is not applicable to hernias violation of the integrity of the fibrous ring (the presence of extrusion of disc prolapse content of nucleus pulposus beyond the annulus or sequestered herniation – the same variant in which pieces of loose cores are separated to fall into the spinal canal).

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Another contraindication can be the narrowing of intervertebral disc or vertebral anomalies that impede surgical access to the disk.

The effectiveness and advantages of the laser vaporization of a disk

According to studies, the success of the operation varies from 75% to 87%. 4.4% — 25% of cases there is a lack of therapeutic effect (pain syndrome remains) or recurrent hernia, which sometimes leads to the need for additional surgical treatment.

The most significant and most frequently described complication is spondylodiscitis (inflammation of the tissues of the intervertebral disc and (or) vertebra) aseptic and septic (microbial), whose frequency varies from 0% to 1.2%.

The potential medical and economic benefits of percutaneous laser vaporization of an intervertebral disk is quite high. The procedure is performed through a tiny hole in the skin, therefore, reduced surgical trauma, and the recovery period lasts for less.

Due to minimize surgical intervention rehabilitation usually possible for several days after treatment (of course, with certain restrictions in physical activity), making CLUD a good alternative to conventional surgery.

We are happy to the reviews left and to the successful experience of laser therapy of a herniated disc.