From the Guidelines
Percutaneous laser disc decompression (PLDD) is a beneficial treatment option for cervical degenerative changes, offering a minimally invasive alternative to traditional open surgery with a success rate of 70-80% for carefully selected candidates. The primary benefit of PLDD is pain relief through the reduction of intradiscal pressure by vaporizing a small portion of the nucleus pulposus, which decreases pressure on nerve roots 1. PLDD is performed under local anesthesia as an outpatient procedure, requiring only a small needle insertion guided by fluoroscopy or CT imaging. Patients typically experience shorter recovery times compared to open surgery, often returning to normal activities within days rather than weeks or months. The procedure leaves minimal scarring, has a lower risk of infection, and causes less trauma to surrounding tissues.
Key Considerations
- PLDD is particularly beneficial for patients with contained disc herniations who have not responded to conservative treatments like physical therapy and medication but aren't yet candidates for major surgery.
- However, it's essential to note that PLDD may not be suitable for all types of cervical degenerative changes, particularly in cases with severe spinal stenosis, free disc fragments, or significant structural instability.
- The effectiveness of PLDD varies among patients, and careful selection of candidates is crucial to achieve optimal outcomes.
- Recent studies have highlighted the importance of imaging in assessing spinal fusion and detecting adjacent segment degeneration, with CT being the most sensitive and specific modality for this purpose 1.
- The use of provocative injections in the cervical spine to identify a pain source is controversial, and there is limited evidence to support using cervical provocative discography or anesthetic facet or nerve blocks 1.
From the Research
Cervical PLDD for Degenerative Changes
- The benefit of cervical PLDD (Percutaneous Laser Disc Decompression) for degenerative changes is not directly mentioned in the provided studies, which primarily focus on anterior cervical discectomy and fusion (ACDF) and other surgical interventions for cervical disc disease 2, 3, 4.
- However, the studies discuss the treatment of cervical degenerative disc disease, which may involve similar principles and goals as PLDD, such as relieving symptoms and improving functional outcomes 2, 3, 4.
- A study on cervical disc degeneration highlights the importance of considering the mechanical, neurological, and vascular consequences of the condition, which may be relevant to the application of PLDD or other treatments 5.
- Another study discusses the use of a multimodal conservative approach, including manual therapy and intermittent mechanical cervical traction, in a geriatric population with degenerative cervical radiculopathy, which may be an alternative or complementary approach to PLDD 6.
- The provided studies do not specifically address the benefits of PLDD for degenerative changes, but they do discuss the treatment of related conditions and the importance of considering the underlying pathology and individual patient needs when selecting a treatment approach 2, 3, 5, 4, 6.