Functional results of percutaneous laser discectomy

The purpose of the study was to evaluate laser disc decompression with the KTP 532 laser, used in conjunction with a percutaneous technique, in contained, small to moderately sized lumbar disc herniation. Sixty-three patients who had a contained herniated nucleus pulposus (HNP) and underwent percutaneous laser disc decompression were prospectively studied. Sixty-one were available for follow-up. Access to the disc space was attained with an 18-gauge probe, followed by dilating cannulas guided with an image intensifier. Discography was not performed. The power was set at 10 W, and laser pulses were delivered for 0.2 seconds, with an interval of 0.5 seconds. A total of 1250 J was delivered to the disc space. The average follow-up was 31.75 months (range, 20 to 45 months). Overall, 44 patients (72%) achieved relief of radicular pain, and 33 patients (54%) achieved relief of low back pain. Thirty-six of 61 patients (59%) returned to work by postoperative week 4. Fourteen patients failed treatment, experiencing persistent symptoms (with scores on the Andrews and Lavyne rating scale of < or = 3). In this study group, optimal results were obtained when symptoms were treated within 1 year of presentation. Results from a historical control group are provided for comparison.