Cervical percutaneous laser disc decompression: Preliminary results of an ongoing prospective outcome study

Objective : This study identifies the efficacy of laser disc ablation and c ompares the relative efficacy of Holmium (2100): YAG and KTP532 laser wavel engths in the treatment of broad-based cervical disc protrusions presenting with cervical axial pain with compressive or noncompressive radicular symp toms. Background: A preliminary report on a prospective outcome study of ce rvical laser disc ablation and decompression in the management of cervical disc prolapse and discographically confirmed discogenic pain in association with radicular pain. Methods: Patients with chronic cervical pain and radi cular symptoms unresponsive to conservative treatment were assessed with ma gnetic resonance (MR) scans. Those with broad-based disc bulge or discal de generation were assessed with provocative discography to isolate the source of pain. Percutaneous laser disc decompression was performed as a day case procedure on 105 patients at 108 levels under X-ray control via the anteri or approach with side-firing probes in patients. Results: At a minimum foll ow up of 24 months, 51% of patients demonstrated a sustained significant cl inical benefit with an additional 25% in whom functional improvement was no ted. No difference in outcome was identified either with the wavelengths us ed or with laser annealing or painful discal tears. The cohort integrity of the study was 80%. Conclusion: The sustained nature of the benefit (mean 3 .5 years at final follow up) after long-term preoperative symptoms (mean 3. 9 years) in 76% patients rules out placebo effect. Benefits occurred indepe ndently of the wavelength of laser used.