Spinal stenosis is usually categorized as either a postnatal developmental disorder or one that is caused by congenital abnormalities, that is a primary one. It can also be acquired as a result of deteriorating changes or as outcomes of surgery, trauma or even a local infection. Degenerative lumbar spinal stenosis can happen anywhere – the foramina, lateral recess, the central canal or even every and any combination of these locations. Hence spinal stenosis treatment is important.
In 1934, Barr and Mixter described the clinical treatment for rupturing the intervertebral disc. Ever since that time, the surgical procedures becoming open have become quite common in practice. Disc herniations are usually categorized as either being non-contained or contained.
As for contained disc herniation, the consequences of open surgical discectomy for the same have not been favorable. Keeping this in view, several minimally invasive techniques were developed, one of which is percutaneous lumbar laser disc decompression.
The idea of using lasers for the treatment of herniations of the lumbar disc was conceived in the early 1980’s. After a series of laboratory experiments, Choy and colleagues carried out the first percutaneous lumbar laser disc decompression on a patient in February 1986. This procedure, fortunately, received FDA approval in 1991. Since then, many laser spine institutes locations have been performing percutaneous lumbar laser disc decompressions as well as laser surgery spinal stenosis worldwide.
Clinical evidences
A prospective uncontrolled study by Duarte and Costa published in 2000 evaluated the efficacy of percutaneous lumbar laser disc decompression performed under CT guidance and local anesthetic. An appropriate selection criterion was employed. Utilizing MacNab criteria to include functional recovery, pain reduction and absence of drug dependency, the study results showed that 67% of patients experienced good results and 9% acceptable outcomes.
Laser decompression technology has shown a relatively stable success rate over time. In another observational study report by Knight and Goswami in 2002, the authors reported good or satisfactory results in 80% of patients with lumbar disc herniations.
In a case-control study report by Zhao and coworkers, published in 2005, the authors found that 82% of patients with a “good” indication experienced either a good or excellent treatment response, which favorably compared to 56% of patients who had less than a good indication.
Based on the evidence from a large number of similar observational studies, laser disc decompression appears to provide considerable relief in properly selected patients with lumbar disc herniation.