Back pain is one of the most common symptoms, that millions of people around the world face. One of the main causes of back pain is lumbar disc disease, where the rubbery discs between the vertebrae break or bulge. Traditionally, treatment for lumbar disc has been done through open surgery, which requires large incisions and remove all of the lamina.

One of the modern treatments of disc disease is percutaneous laser disc decompression. which is called PLDD.

In this article, we explore the revolutionary treatment for laser disc surgery. We will discuss the advantages, the procedure, the recovery process, and the associated risks of this minimally invasive technique.

An abnormal disc causes pain through three main mechanisms:

  1. Due to the volume of the herniated lumbar disc within the spinal canal which got pressure on the nerve root, after disc herniation,the space for the nerve roots reduces and there is no enough room for the nerve root so it limits the nerve root movement within the spinal foramen . Basically the nerve root should be free within the framing and, when we walk, the nerve roots move within the foramens which are the openings between the vertebrae.
  2. The second mechanism causing pain in a ruptured disc is the pressure on the nerve roots.In the case of a ruptured disc, pressure is exerted on the weakest point, where it has torn. This leads to unequal distribution of pressure throughout the disc. 
  3. When a disc ruptures, substances are released that stimulate white blood cells to exit the blood vessels, causing inflammation and increased pressure around the nerve roots. This explains why some large discs cause little pain, while smaller discs can cause severe pain.

What is Laser?

Laser is actually amplified light that can cut through materials. After the discovery of Laser, this technology was used in medicine .The laser beam can cut through materials such as stone or metal, and many delicate tasks performed on metal objects are actually done using lasers.laser beam became rapidly popular in surgery, particularly in spinal procedures. Since 1991, when laser manufacturers received FDA certification for disc treatment, over one million people in the U.S. have undergone this procedure, with no significant complications reported.

Advancements in Laser Disc Surgery

In recent years, laser disc surgery has been considered as an innovative alternative to traditional open surgery. This technique uses advanced laser technology to target and treat damaged lumbar discs with remarkable precision, eliminating the need for large incisions or significant tissue disruption.

How Laser Disc Surgery Works? 

During laser disc surgery, a highly focused laser beam is used to remove or shrink the damaged disc material. The surgeon does not need to make an incision. In this procedure a needle is put into the space through the intervertebral under fluoroscopy. The laser energy is then directed toward the affected disc through fiber optics, vaporizing or draining the bulging or compressed disc material.

Advantages of Laser Disc Surgery

Laser disc surgery offers several advantages over traditional open surgery:

  • Minimally invasive: In this procedure there is no need for incision, So less tissue damage and less scarring and pain.
  • No bleeding: that is not bleeding in this procedure 
  • Shorter recovery time: The minimally invasive nature of the procedure leads to quicker and more immediate return to daily activities.
  • Lower risk of infection: because of the heat produced by the laser beam, the risk of infection is significantly reduced.
  • Precise targeting: Laser technology allows for highly precise targeting of the damaged disc, minimizing the risk of damage to surrounding tissues.
  • Reduced anesthesia risks: Laser disc surgery is usually performed under local anesthesia, reducing the risks associated with general anesthesia.

These special advantages make laser disc surgery an attractive option for those seeking an effective and minimally invasive treatment for lumbar disc disease.

Complications of Laser Surgery

No significant complications have been reported following laser disc surgery. However, in rare cases, infection in the disc or nerve root injury due to needle insertion have been reported.

Can a person who has previously undergone laser disc surgery use this method again?

If someone has had successful laser surgery for a year or two and then experiences disc disease again, there is no contraindication for performing the procedure for the second time. However, if a person experiences recurrent disc issues within six months after laser surgery, open surgery may be required.

Laser Disc Surgery Procedure

Laser disc surgery includes several stages, from preoperative preparation to postoperative care.

Preoperative Stage

Before the surgery, you are transferred to the preoperative area, where medical staff prepares you for the procedure. This may include changing into a hospital gown, setting up an IV line, and discussing any issues or questions with the surgical team.

Surgical Procedure

Once prepared, you are taken to the operating room. The general steps of the procedure are as follows:

  • Anesthesia administration: The type of anesthesia may be either general anesthesia or local sedation, depending on the case and the surgeon’s recommendation. usually it’s done under sedation.
  • Needle insertion: The surgeon put a needle in the designated disc space . then pass the fiber optic.
  • Laser treatment: The surgeon carefully guides the laser needle to the affected disc and applies laser energy to vaporize or drain the bulging or compressed disc material.
  • Completion and closure: After the procedure, the laser needle is removed.
  • Postoperative Care: After the surgery, you are moved to the recovery area where medical staff monitors your vital signs and ensures your comfort. Depending on the surgeon's advice and your specific situation, you may be discharged on the same day or stay for observation.

Laser Surgery for Disc Herniation

When is Laser Surgery for a Disc Performed?

Laser surgery is typically performed for mild to moderate disc issues and is not suitable large herniated discs .

Does Laser Surgery Use a Surgical Knife, and Is the Patient's Back Incised?

No, laser surgery does not involve a surgical knife, and there is no incision. In fact, a laser is used with a needle and fiber optic technology to enter the disc space.

How Does Laser Surgery Reduce Disc Pressure?

The laser creates a small cavity inside the disc, and studies have shown that even a small 1mm by 1mm by 1 mm cavity inside the disc can reduce internal disc pressure by up to 312 kilopascals. Essentially, laser surgery reduces the internal pressure of the disc by nearly half.

Can Laser Surgery Be Performed in a Clinic?

No, laser disc surgery is best performed in an operating room, as it requires a fluoroscopy machine.

What is Fluoroscopy?

Fluoroscopy is an imaging device used during the procedure to continuously monitor the position of the needle without needing to take films.

Can Laser Surgery be Used for Large Disc Herniations?

Laser surgery is not suitable for large or severely herniated discs, especially if they cause significant impairment, such as difficulty walking or incontinence. Open surgery is recommended in such cases.

Advantages of Laser Surgery Over Open Surgery

Laser surgery does not require general anesthesia; patients typically receive local anesthesia or sedatives, making it a less invasive option with a quicker recovery time.

Recovery Time and Postoperative Considerations

Laser disc surgery is a quick procedure that generally does not require a hospital stay. Most patients can resume normal activities almost immediately, although it is usually recommended to avoid heavy activities for about a week.

As a spine surgeon, I am often asked by patients whether laser disc surgery can perform the same function as traditional disc decompression surgery.

The general public tends to view lasers as a modern and luxurious tool. In fact, a laser is a concentrated beam of light that can be used to cut soft tissues. The use of laser technology in the eye surgery has revolutionized the treatment of refractive errors and retinal diseases, and generally, it has transformed the field of ophthalmology. This led spine surgeons to wonder if this technology could be used in the treatment of spinal diseases, including herniated discs. After years of research and experimentation in spinal laboratories, scientists concluded that this new technology could indeed be applied to treat spinal disorders.

For years, electrocautery has been used to treat and cut soft tissues in spinal surgeries. However, the limitation of electrocautery is that it cannot be directed into the disc through the skin. The heat generated by electrocautery is not easily controlled, whereas the heat generated by a laser can be carefully controlled. Moreover, electrocautery cannot be guided through the skin to reach the disc, but the laser can be directed into the disc with the help of optical fibers. Therefore, laser light is a reliable and effective technology for cutting tissues inside the body through the skin without making a large incision.

In laser disc surgery, instead of removing the damaged part of the disc, the center of the disc is heated, causing the disc to shrink and move away from the nerve, which reduces the patient's pain. Essentially, laser disc surgery is a minimally invasive procedure. Laser treatment for lumbar discs has become more popular in Tehran in recent years. The cost of laser disc treatment is lower than that of open surgery. This technique is a minimally invasive disc surgery.