23rd Anniversary of Percutaneous Laser Disc Decompression (PLDD)

Objective: In mid-February 1986, Peter Ascher and Daniel Choy performed the first percutaneous laser disc decompression (PLDD) procedure at the Neurosurgical Department, University of Graz, Graz, Austria. It was planned to deliver 1000 J of energy with an Nd: YAG laser to a herniated L4-L5 disc causing sciatica. At 600 J the procedure was terminated because the pain was gone. Background Data: Since then PLDD has spread all over the world, with procedures being performed on the entire spine except for T1-T4 because these discs do not permit percutaneous access with a needle. The success rate has ranged from 70-89%, and the complication rate, chiefly discitis, ranges from 0.3-1.0%. When successful, average time to return to normal activities is 1 wk. Longterm follow-up at 23 y yields a recurrence rate of 4-5%. Methods: Laser surgeons active in PLDD were canvassed to obtain their best clinical data. Results: PLDD patients treated with the Nd: YAG laser, the diode laser, and the combination Ho: YAG laser and endoscope were included. Conclusions: The McNab results for the three groups indicate that PLDD is safe, effective, and minimally invasive.