Radiological analysis of herniated disc size changes after percutaneous laser disc decompression

Symptomatic lumbar disc herniation is a major cause of low back pain and sciatica in adults, significantly affecting quality of life and creating economic burdens. Minimally invasive percutaneous intradiscal techniques, such as percutaneous laser disc decompression (PLDD), have been developed as alternatives to open surgery; however, their efficacy remains debated.

This study evaluated the effectiveness of PLDD in patients with lumbar disc protrusions and contained herniations by assessing quantitative changes in herniated disc area on axial and sagittal MR images.

A total of 58 patients with lumbar radiculopathy due to disc herniation underwent MRI two months after PLDD to evaluate changes in disc area. Axial and sagittal MR images with the greatest protrusion and neural compromise were analyzed, and patient pain severity, clinical outcomes, and satisfaction were recorded.

Results showed a statistically significant reduction in both axial and sagittal disc areas post-PLDD. The initial mean axial disc area of 0.51 cm2 (0.44-0.58) decreased to 0.29 cm2 (0.25-0.37), reflecting a median reduction of 35.9% (P < 0.0001). Similarly, the sagittal disc area decreased from a mean of 0.37 cm2 (0.33-0.43) to 0.19 cm2 (0.13-0.25), with a median reduction of 49.3% (P < 0.0001). All patients showed reductions in disc area, with a median reduction ratio of 52.7% (IQR: 45.2-56.2).

These findings suggest that PLDD is an effective option for reducing herniated disc size in carefully selected patients with contained disc herniations who have not responded to conservative treatment. Although not a substitute for open surgery, PLDD offers a statistically significant reduction in herniated disc size, making it a valuable therapeutic option for symptomatic contained lumbar disc herniation.