PPLD procedures

The percutaneous laser decompression is a surgical procedure used for the treatment of  disc herniation since ten yrs ago;
The procedure, following the ISLASS protocol, consists of a 21G atraumatic tip chiba needle guided by C-arm fluoroscopy, or CT-scan percoutaneousely inserted into the herniated disc under local anesthesia and ev seduction (Figg.1-3). Diode Laser 980nm (Biolitec-AG, Diode laser 980nm), 1500J of total energy, was delivered through a disposable 360µm Silica Fiber Optic; The power parameters were 12 W with exposure time 0.60 sec in a pulsed wave, with 2-3 seconds pauses for heat dissipation. A smoke evacuation system specifically designed and worldwide patented (Menchetti's handpiece) connected to the needle permits to eliminate the gas formation during the treatment, by reducing the postoperative muscle contracture.  It's possible to concentrate the energy delivered in a few mm2, with an adsorbition peak more than 90%, without dissipation on surrounding tissues.The one single level treatment has a duration of 20 minutes and the patient stays in hospital 1 (day surgery) or 2 days. An antibiotical therapy is applied for the following 4 days, and the return to the daily activities is reached into 7-10 days.

The procedure appear to be now days a safe and valid alternative to the microsurgery, with a rate of success of 80%, particularly under CT-Scan guidance, in order to visualize the nerve root and also apply energy on several points of disc herniation. This permits to have a shrinking concentrated in a bigger area, realizing a minimal invasiveness on the spine to be treated, and avoiding the potential complications related to the microdiscectomy (recurrence rate of more than 8-15%, peridural scar in more than 6-10%, dural sac tear, bleeding, iatrogenic microinstability), and does not preclude traditional surgery, if needed.