The use of targeted percutaneous laser disc decompression under the guidance of puncture-radiating pain leads to better short-term responses in lumbar disc herniation

摘要

OBJECTIVE: Traditional percutaneous laser disc decompression (PLDD) eliminates nucleus pulposus in the center of lumbar discs. Targeted PLDD is an alternative technique that involves elimination and decompression of the target area located 5-8 mm in the front of the herniated disc. We aimed to compare the efficacy of targeted PLDD with traditional PLDD in the treatment of lumbar disc herniation and evaluate the usefulness of guidance by puncture-radiating pain on clinical outcomes of PLDD. PATIENTS AND METHODS: We treated 61 patients with lumbar disc herniation. Patients were stratified into control group, which included patients who underwent traditional PLDD, and study group in patients underwent targeted PLDD. Clinical outcomes and efficacies were evaluated at different time points using the visual analog scale (VAS) and modified MacNab criteria. RESULTS: Patients in the study group demonstrated significantly greater decreases in the VAS scores compared with those in control group. These differences were observed on Day 3, and 1 and 3 months after the treatment. Further, VAS scores were markedly lower in the patients whose treatment was guided by the puncture-radiating pain. Thus, at 1 month after the operation, 64.1% of those patients showed excellent or good outcomes based on MacNab criteria, which was almost twice the percentage seen in patients who did not experience the puncture-radiating pain (36.4%). CONCLUSIONS: Targeted PLDD is an effective, minimally invasive, and safe technique for lumbar disc herniation, and this technique achieves better short-term postsurgical outcomes than traditional PLDD. Puncture-radiating pain is an important prognostic indicator for better short-term responses to the treatment.