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Percutaneous laser disc decompression (PLDD) is an entirely new approach to the treatment of herniated intervertebral disc d- ease. The traditional laminectomy and discectomy procedure was first performed at the Massachusetts General Hospital in 1934. In the intervening 69 years, science has moved forward with m- netic resonance imaging, sequencing of the human genome, ion propulsion, landing men on the moon and robots on Mars, the laptop computer, global positioning system navigation, black hole theory, string theory, and the successful cloning of animals. And yet, the same soft tissue destroying, scar-inducing, pos- rior wall weakening, and spinal instability inducing cutting - eration is still being taught and performed. Advances in ort- pedics and neurosurgery occur slowly. Percutaneous laser disc decompression is minimally invasive; it can be performed as an outpatient procedure, requires no g- eral anesthesia, and has a high success rate, a low recurrence rate, and a low complication rate. By the middle of 2002, some 35,000 PLDD procedures had been performed worldwide. This book covers the history of the development of PLDD, laser physics, anatomy and pathophysiology of the herniated disc, the physics and mechanical principles that form the basis of PLDD, patient selection, radiographic considerations, the neurologic - amination, a step-by-step description of the PLDD procedure, the complications of PLDD and their treatments, special cases amenable to PLDD, postoperative care, and rehabilitation pro- dures. In short, this is a compendium of PLDD from A to Z.
List of contents
Introduction: Percutaneous Laser Disc Decompression.- Principles of Lasers.- Anatomy and Pathophysiology of Intervertebral Discs.- Familial Incidence of Disc Herniation. Epidemiologic and Genetic Evidence: A Hypothesis Suggesting That Laminectomy and Discectomy Are Counterproductive.- Patient Selection.- The Neurologic Examination.- The Role of Radiology in Percutaneous Laser Disc Decompression.- Magnetic Resonance Imaging of the Lumbothoracic Spine Under Compression.- Initial Consultation and First Interview.- The Percutaneous Laser Disc Decompression Procedure.- Complications of Percutaneous Laser Disc Decompression and Their Treatments.- Postprocedure Physical Therapy.- Complicated Disc Herniations Responding to Percutaneous Laser Disc Decompression.- Unexpected Results in Patients Treated with Percutaneous Laser Disc Decompression.- Endoscopic Laser Foraminoplasty: A Treatment Concept and Two-Year Outcome Analysis.- Role of Percutaneous Laser Disc Decompression in the Treatment of Discogenic Back Pain.- Clinical Experience in 2088 Percutaneous Laser Disc Decompression Procedures.- Percutaneous Laser Disc Decompression: A 10-Year Follow-Up of Clinical Data.
Summary
This practical guide, beautifully illustrated with line drawings and images throughout, covers the basic science, laser physics, patient selection, diagnostic maneuvers and useful imaging methods of PLDD. In addition, step-by-step instructions are given on needle placement, how to enter difficult discs, and delivery of laser energy. Also included are chapters on possible complications and how to manage them, when to consider a repeat procedure, as well as long term rehabilitation.
