moderate success. Most of the lasers in the past employed for
treatment of lumbar disc herniations have had success rates of
about 70% but were often prohibitively expensive and are very
bulky. They also consume a high amount of power that may
necessitate 220V availability and a ventilated room..
Diode lasers have been available for many years but were not used
in spinal medicine due to the very low power output of the lasers.
Recently, the technology of multiple diodes has been harnnassed
and has been used successfully in Europe for a relatively
inexpensive laser disc decompression.
The cardinal safety feature in laser technology applied around the
spine is the absorbance by water of the laser beam. A high
wavelenth laser such as the 2010 nm Holmium YAG laser has an
absorption which is extremely high in water. Since most tissues
contain substantial amounts of water, this fact limited the tissue
penetration to about 400 micrometers for the Holmium YAG laser.
While this makes the laser very safe, it also requires large amounts
of power to destroy disc tissue. High power lasers become
exponentially expensive as the power increases and also require a
significant amount of laser time to complete the task. On the other
hand, a Neodymium YAG laser, has a low absorption by water and
therefore has a very large penetration depth within the tissues. The
increased penetration gives less control over the depth of tissue
vaporization and may therefore cause an increase in risk from
overpenetration of tissues not intentionally targeted by the laser. A
compromise between these extremes is the PL3D multidiode laser
operating at 980nm. It's absorbance is between the Holmium and
Neodymium YAG lasers making it ideal for a discectomy procedure.
Recently, a 600 patient study was completed using the PL3D
laser (presented at ISMISS 2005) and had the following outcomes:
1. The total laser time was approximately 3-4 minutes (compare to
25-45 min for Holmium YAG in LASE)
2. VAS pain scores decreased from 8.2 to 2.7.
3 81% had good to excellent satisfaction scores (McNab criteria)
4. EMG reveals resolution of symptoms
Advanced Pain Management is working with the European
manufacturer to bring this exciting technology to the US. The
discectomy is performed under local anesthesia with sedation and
takes approximately 15 min to complete.
