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RSNA: Laser Disc Decompression Provides Effective Pain Relief in Selected Patients By W. A. Thomasson CHICAGO, IL -- December 8, 2003 -- Percutaneous laser disc decompression can provide effective relief of radiculopathic pain in selected patients, it was announced December 3rd here at the Radiological Society of North America Annual Meeting. The number of patients suitable for this procedure, however, may be rather limited. The preferred initial therapy for disc-associated lower-back pain is rest and NSAIDs, noted Hugues Brat, MD, Ambroise Pare, Mons, Belgium. Patients with evidence of sensory or motor neuropathy then proceed to surgery. In between, however, is a group of patients who do not obtain pain relief from 6 weeks of conservative treatment yet do not have indications for surgical decompression. For such patients, laser disc decompression may be considered. The study, led by Dr. Brat and colleagues, reported on pain relief in 40 consecutive patients treated with PLDD. Inclusion criteria were imaging evidence of a contained lumbar-disc hernia with corresponding clinical findings, pain persisting throughout more than 6 weeks of conservative treatment, and a residual disc height of at least 4 mm with no intra-discal gas. "Exclusion criteria were numerous," Dr. Brat said. An independent observer rated patients into the 3 Macnab criteria of good response (no pain), fair response (intermittent pain without medication dependence), and poor response (continuous pain leading to physical dependence on pain-relief medication). The participants comprised 28 men and 12 women, ranging in age from 24 to 72 (mean age 43 years); they had had pain for an average of 9 months. At follow-up evaluation, a mean of 7.5 months after treatment, 32 subjects reported a good response, 5 a fair response, and 3 a poor response. Even on the day following treatment, subjects with a good or fair response had very little pain (mean 1.0 on a 10-point scale). By contrast, the subjects with a poor response experienced only modest pain relief on the first day (5.3, from a pretreatment level of 9) and almost all of that relief had disappeared at follow-up. Dr. Brat attributed these 3 treatment failures to improper patient selection, re-emphasising that the treatment is suitable only for certain patients. Dr. Brat concluded that PLDD is a minimally invasive treatment with a greater than 80% efficacy for pain relief. PLDD allows a quick return home from the hospital and then a quick return to work -- 92.5% of the patients were back at work within 3 weeks. PLDD does not limit later surgical options, and could represent a good alternative to surgery for some patients with persistent pain but no evidence of neuropathy. [Study Title: CT-guided Percutaneous Laser Disc Decompression (PLDD): Prospective Clinical Evaluation. Abstract K24-1066] E-mail this page to a friend or colleague! To print, use this version