A 980 nm Diode (Biolitec AG) Laser energy introduced via a 21G needle under C-arm or CT-Scan guidance and local anesthesia, vaporizes a small amount of nucleous polposus with a disc shrinkage and a relief of pressure on nerve root. The procedure in the disc herniation treatment over the years had several changes, not only related to the different types of lasers (Ho:YAG, Nd: YAG, Er:YAG), but also in the types of optical fibers employed and in the neuronavigation systems. In our department starting under C-arm, realized that the only way to visualize the nerve root and increase the total energy delivered in several points of disc herniation, was to use a CT-Scan guidance (Aquilion 64 Slices Toshiba).

Matherial and Method: A prospective study on 350 patients (470 cases) affected by contained and non contained disc herniation was performed. The patients had a PLDD (Percutaneous Laser Disc Decompression) under CT-Scan guidance. A control group of 200 patients (350 cases) affected both by contained and noncontained disc herniation had a PLDD under C-arm.

Results: The results showed a statistically significant difference (p< 0.05) in the effectiveness of the PLDD in Disc Herniation treatment. Non Contained disc herniation had a successful result in 88.5% of cases under Ct-Scan guidance vs 70% of cases under C-arm. No statistically significant (p > 0.05) difference was found in contained disc herniation group. The laser energy delivered under CT-Scan was on average 40% (S.D. 0.36) more than under C-arm, because the visualization of nerve root and the size of the disc herniation permits to apply laser energy on different points, in order to obtain a disc shrinkage over a bigger surface, without any damage on surrounding tissues.

In conclusion, CT-Scan guidance appear to be the best way to practice PLDD not only in terms of resolution, treating succesfully non contained disc herniation, but also because the visualization of the nerve root permits a safe application of the laser energy and the effectiveness of the procedure give a faster return to normal life.

In the last ten years, the percutaneous laser disc decompression and nucleotomy has been done worldwide in more than 60000 cases of herniated disc disease. Because water is the major component of the intervertebral disc, and in herniated disc disease pain is caused by the disc protrusion pressing against the nerve root, a small reduction of volume in a closed hydraulic space, such as an intact disc, results in a considerable fall of intradiscal pressure. 980 nm Diode laser is the optimal wavelength for laser disc decompression and nucleotomy, because 980nm is 5 times more absorbent in water than 810nm, and 2 times more absorbent than 1064nm.

A MULTIDIODE PL3D (INTERmedic) 980nm laser energy introduced through a 400 micron silica-silica fiber into a 21G needle under X-ray guidance and local anesthesia, vaporizes a small amount of nucleus polposus with a disc shrinkage and a relief of pressure on nerve root. The gas formed due to the vaporization of the nucleus is removed by a specific handpiece (Menchetti’s handpiece) connected to a smoke evacuation system, to minimize the postop muscle spasm. Most patients get off the table pain free and are back to work in 5 to 7 days.

Material and method: to date, 480 patients (600cases) suffering for relevant symptoms therapy-resistant 6 months on average before consulting our department, have been treated. Three hundred-twenty (67%) males and 160 (33%) females had a percutaneous laser disc decompression and nucleotomy. The average age of patients operated was 46 years (16 to 76). The level of disc removal was L2/L3 in 26 cases, L3/L4 in 58 cases, L4/L5 in 294 cases and L5/S1 in 222 cases. Two different levels were treated at the same time in 80 patients, and three different levels in 20 patients. In 44 cases the PL3D has been performed after an unsuccessful microsurgical approach with a relapse of the disc herniation.

Results: The sucess rate at a mean follow-up of 22 months was 91% with a complication rate of 0.5%. Because of the best absorption of the water content of the disc by the 980nm wavelength laser, compared to others lasers (810nm, 940nm, 1064nm), 980nm Diode laser requiring less laser energy with a less heat diffusion in surrounding tissue, reduces postoperative complication, and appears to be safe and effective, specifically designed for discectomy, and results in no peridural scarring or spinal microsurgical instability. Microsurgery if needed is not precluded.