Laser disc decompression in the management of lumbar disc herniation: A systematic review and meta-analysis

Laser therapy has emerged as a promising, minimally invasive treatment option for managing pain and improving function in patients with lumbar disc herniation (LDH). Yet, the efficacy of laser therapy across different treatment modalities remains unclear. This systematic review and meta-analysis evaluates the efficacy of various laser therapy modalities and explores their potential application across patient subgroups.

A systematic review was conducted, screening 19,644 studies. A total of 31 studies were included in the qualitative synthesis, with 10 included in the meta-analysis. Random-effects models were used to calculate pooled standardized mean changes (SMCs) for each modality. Heterogeneity was assessed using I², publication bias was analyzed through funnel plots and Egger's tests.

The pooled SMC across 2 modalities was 2.32 (95% CI: -0.75, 5.39), indicating a point estimate suggestive of a large effect but with extreme imprecision and uncertainty, as the CI crossed the line of no effect. Percutaneous laser disc decompression (PLDD) had a larger effect size (SMC = 3.54, 95% CI: -2.87 to 9.94) compared to epidural laser disc decompression (ELDD) (SMC = 2.00, 95% CI: 1.67 to 2.33). Qualitative findings indicated that both low-level laser therapy (LLLT) and high intensity laser therapy (HILT) may also effectively reduce Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores.

This study suggests that laser therapy may reduce postoperative pain and improve functional status in patients with LDH, although evidence regarding consistent reduction in disc herniation size remains limited. However, significant heterogeneity, methodological inconsistency, and low study power were present among the included studies. PLDD showed the highest pooled effect size among all laser therapies. Future work should compare laser therapy and surgical approaches.