LASER DISC DECOMPRESSION - THE IMPORTANCE OF PROPER PATIENT SELECTION

Study Design. The value of adherence to selection criteria for laser d isc decompression (LDD) was evaluated. A total of 204 patients who und erwent LDDs were identified. Follow-up information could be obtained f or 164 (80.8%) patients. Results were compared based on the selection criteria. Summary of Background Data. Laser disc decompression is a re latively new procedure. Few reports concerning outcome of LDD exist; a nd none deal specifically with patient selection. Objective. This stud y compared the results of LDD performed among patients who met appropr iate selection criteria with those who did not. Also, the value of dis cography in patient selection for LDD was investigated. Methods. Two i ndependent reviewers extracted data from patient charts. From this inf ormation, each patient was assigned to one of three groups: 1) those w ho met all selection criteria for LDD (leg pain, positive physical exa mination finding such motor, sensory, or reflex deficits, and/or strai ght leg raise, contained disc herniation confirmed by discography); 2) those who did not meet the selection criteria (had a normal physical examination, the presence of stenosis, spondylolisthesis, extruded dis c fragment, leakage of discographic dye from the outer annulus, multip le prior lumbar surgeries); or 3) those who could not be assigned to e ither of the first two groups for reasons such as discography not bein g performed or inadequate physical examination data recorded in the ch art. At 1 year follow-up, each patient was sent a questionnaire assess ing outcome. Successful outcome was defined to be no subsequent lumbar surgery, the patient felt that LDD had helped, and if the patient was working before symptom onset, he was able to work at the time of foll ow-up. Results. Among the 41 patients who met all selection criteria, the success rate was 70.7% (29/41); among patients who did not meet al l the criteria, the success rate was only 28.6% (12/42); significantly less than in the first group (P < 0.005). Among patients who could no t be assigned definitively to either of the first two groups, the succ ess rate was 55.6% (45/81). Also, the success rate among patients with discographic confirmation of a contained disc herniation was signific antly greater than among those who either did not have discography per formed or extravasation of contrast was noted (70.7% vs. 44.4%, P < 0. 035). Conclusions. These results emphasize the importance of strict ad herence to appropriate selection criteria to obtain satisfactory resul ts from LDD.