Percutaneous diode laser irradiation for lumbar discogenic pain: a clinical study

Lasers in Spine Surgery

Laser spine surgery has been a focus of intense interest in the lay press and among patients. On the Internet, a host of purported benefits to laser surgery exists. Lasers have long been used in pain management procedures such as percutaneous diskectomy. However, a few published articles are available on lasers in conventional spine surgery. From our review of the literature, the purported advantages of lasers, such as reduced inflammation and degeneration, are not been supported by preclinical research. The available clinical studies do not show a notable advantage for laser surgery. Moreover, the low enrollment, nonblinded, retrospective studies that are available are heavily subject to bias. The documented advantages of laser spine surgery described in the research studies are not consistent with the public's impression of its purported benefits. Furthermore, laser-specific complications are present about which patients should be informed. On the basis of the current research, we conclude that lasers add distinct potential complications without any corresponding clinical benefit. Because of the public interest, we feel that this is an important topic for the general orthopaedic community.

One-year follow-up results of intradiscal diode laser, radiofrequency, and pulsed radiofrequency therapies: a retrospective study

This study aims to investigate the efficacy of three different percutaneous intradiscal therapies in patients with chronic low back pain (CLBP) due to lumbar disc herniation (LDH). Medical files of a total of 120 patients who received percutaneous intradiscal therapy were retrospectively analyzed. All patients were divided into three groups: group L: diode laser (n = 40), group R: radiofrequency (RF) (n = 40), and group P: pulsed radiofrequency (PRF) (n = 40). The visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were calculated at 1, 3, 6, and 12 months for all patients. One-year follow-up results were as follows: group L: pre-treatment (PreT) VAS 5.6 ± -1, ODI 37.6 ± -4.7, post-treatment 12th month (PT12) VAS 2.8 ± -1.4, ODI 14.1 ± -7.1; group P: PreT VAS 6.0 ± 1, ODI 37.5 ± 5.9, PT12 VAS 3.1 ± 1.3, ODI 20.3 ± 17.0; and group R: PreT VAS 5.6 ± 1.0, ODI 37.9 ± 4.7, PT12 VAS 3.3 ± 1.4, ODI 27.2 ± 14.1. In each of the three groups, there was a statistically significant reduction in the VAS and ODI scores at 1, 3, 6, and 12 months, compared to the baseline values (p < 0.05). The highest reduction in the VAS and ODI scores was observed in group L, whereas the lowest reduction was in group R. We consider that in groups with patient selection criteria at our study; diode laser, RF, and PRF, which are administered using the percutaneous intradiscal route for CLBP patients diagnosed with LDH, may be used as an alternative treatment option.

Evaluation of different laser wavelengths on ablation lesion and residual thermal injury in intervertebral discs of the lumbar spine

Laser discectomy or nucleotomy is an increasingly important method for less invasive procedures of column, but the ideal kind of laser is still not established. As the wavelength is an important parameter for water absorption, this study was performed to investigate the action of the laser emission in the near infrared (808 to 1908 nm) region in the context of surgical procedures for percutaneous intervertebral disc decompression (nucleotomy). Forty intervertebral discs from pigs lumbar spines were irradiated with laser (λ = 808, 980, 1470 and 1908 nm), 1-s on/off time cycles, for 120 cycles and 10 W of power (808, 980, and 1470 nm) or 240 cycles and 5 W of power (1908 nm), with total power of 1200 J, and subjected to microscopic evaluation through hematoxylin-eosin (HE) staining in order to measure the ablation lesions and the residual thermal injury. Ten other discs were not irradiated and worked as controls. The ablation lesions were measured (in mm) at 1.08 ± 1.25, 1.70 ± 0.63, 2.23 ± 1.02, 1.37 ± 0.39, and 0.94 ± 0.41 (median ± SD) for the control, 808, 980, 1470, and 1908 nm groups, respectively. The difference between 1908 nm and all the other groups was statistically significant (p < 0.05). The residual thermal injury was less evident in 1908 nm laser and sharper in 980 nm laser wavelengths. The laser at a wavelength of 1908 nm was considered the most efficient for the vaporization of the nucleus pulposus, followed by the laser wavelengths of 1470, 808, and 980 nm, and proved to be useful for laser nucleotomy procedure.