Percutaneous laser disc decompression: a 17-year experience

In this review, we analyze our effort to demonstrate the effectiveness of a new approach to the treatment of herniated disc disease using Nd:YAG laser energy introduced into a herniated disc under fluoroscopic control and local anesthesia. 2400 PLDD procedures (combined number of decompressions in cervical, thoracic, and lumbar discs were performed in the past 18(1/2) years in 1275 patients. The overall success rate according to the MacNab criteria was 89%. The complication rate (only infectious disciitis) was 0.4%; all 10 patients with complications were cured with appropriate antibiotics. The recurrence rate was 5%, and usually due to reinjury. There were no deaths, and no cases of nerve or cord damage. PLDD is a safe and effective outpatient procedure for the treatment of herniated disc disease with the advantages of relative non-invasiveness, usually immediate relief of back and sciatic pain, early return to work (generally 5-6 days), and a low complication and recurrence rate. It can also be repeated if necessary as many as five times.     

经皮激光汽化颈椎间盘减压术的临床应用

目的评价经皮激光汽化椎间盘减压术（percutaneous laser disc decompression,PLDD）治疗颈椎间盘突出症的临床应用效果和应用前景。方法2003年3月-2005年12月,对47例颈椎间盘突出症患者96个椎间盘实施PLDD治疗。男25例,女22例;年龄37-72岁,平均56岁。突出椎间盘节段：单节段3例,多节段44例。C3、420个、C4、527个、C5、631个、C6、718个。通过激光对髓核组织的汽化,凝固减少髓核组织,降低椎间盘压力。激光汽化1次治疗3个椎间隙者5例,2个椎间隙者39例,1个椎间隙者3例。结果42例获随访3-31个月,平均13个月。疗效评价参考丁亮华等评定标准,优18例（42.9%）,良14例（33.3%）,中6例（14.3%）,差4例（9.5%）,有效率90.5%,优良率76.2%,无并发症发生。结论PLDD能有效缓解颈椎间盘突出症的症状和体征,创伤小、安全、有效。     

经皮激光椎间盘减压术治疗颈性眩晕

目的探讨经皮激光间盘减压术治疗颈性眩晕的疗效及机制。方法2000年10月至2004年10月,我们使用Nd：YAG激光治疗机（波长1064nm）,对42例颈性眩晕患者进行了经皮激光间盘减压术,术后进行2个月以上随访,观察患者眩晕的改善情况。结果患者均获得随访,随访时间2—36个月,平均7．5个月。术后2个月时,28例眩晕消失（67％）,6例明显改善（14％）,无效者8例（19％）,优良率为81％,无神经损害、感染等并发症发生。结论经皮激光椎间盘减压术可使椎间盘内压降低,加之局部直接热疗,从而消除椎动脉痉挛,对治疗颈性眩晕有明显疗效。     

颈椎小关节阻滞术及PLDD术临床疗效观察

目的探讨颈椎小关节阻滞术和颈椎经皮激光间盘臧压术（percutaneous laser disc decompression,PLDD）对颈间盘膨出型同时伴有交感神经及周围神经刺激症状的颈椎病患者的临床疗效进行分析。方法2009年11月至2011年12月在哈尔滨医科大学附属第二医院骨三科对322例患者进行回顾性分析。随访至少3个月,最长2．9年,平均随访1．4年。术前常规给予X线片及颈椎MRI检查。分别行颈椎小关节阻滞术和颈椎PLDD术,术后均给予药物治疗,术后患者无一例并发症。在临床随访中以改良的Macnab标准进行评估。本次回访为颈椎病所致临床症状,包括交感神经及周围神经刺激症状。交感神经症状包括眩晕、头痛。周围神经刺激症状包括颈痛、不适及上肢疼痛、麻木等。根据l临床满意率进行评价。结果Logistic回归模型中进行多因素分析,在控制其他因素的前提下,颈椎小关节阻滞术与PI,DD术比较效果要差,其OR值为4．027,95％置信区间为2．349～6．910,也就是说PLDD术的疗效要比颈椎小关节阻滞术好。PLDD术优于颈椎小关节阻滞术治疗（P〈0．01）。结论经随访,颈椎PLDD术优于颈椎小关节阻滞术。     

经皮激光椎间盘减压术(PLDD)治疗颈椎间盘突出症(附19例报告)

目的探讨经皮激光椎间盘减压术(percutaneous laser disc decompression,PLDD)治疗颈椎间盘突出症的优越性。方法通过C形臂X线机监视进行椎间盘穿刺,应用Nd:YAG激光进行多点髓核照射气化19例,共29节段,通过3个月以上随诊,对疗效进行评价。结果本组PLDD治疗共19例,应用日本矫形外科学会颈椎病疗效判定标准(JOAScore),改善率为60%~87%,平均75.23%。结论PLDD治疗颈椎间盘突出症的疗效明显,避免了开放手术及其造成的痛苦,提高了手术的安全性,大大降低了手术和住院的费用,是适合我国国情的颈椎间盘突出症的微创手术方法。     

经皮激光椎间盘减压术治疗颈性眩晕

目的探讨经皮激光椎间盘减压术（PLDD）治疗颈性眩晕的机制和适应证。方法对58例颈性眩晕患者88个突出间盘行PLDD。结果随访6个月-2年,术后眩晕立即消除48例（82.8%）,明显改善5例（8.6%）,无效5例（8.6%）,无神经损害、感染等并发症发生。结论PLDD使椎间盘内压骤然降低,局部直接热疗可消除椎动脉痉挛,同时减少椎间盘内的炎性因子和化学介质的含量,对治疗颈性眩晕有明显疗效。     

经皮激光椎间盘减压术联合HANS疗法治疗颈椎间盘突出症

目的探讨经皮激光椎间盘减压术（percutaneous laser disc decompression,PLDD）联合经皮电刺激（HANS）治疗颈椎间盘突出症的临床早期疗效。方法选68例符合PLDD治疗适应证的颈椎间盘突出症患者,随机分为两组,分别采用PLDD联合HANS（A组）和单纯PLDD（B组）,在治疗前和治疗后1个月、6个月进行疗效评定。结果 （1）A组与B组术后1个月、6个月的优良率分别为77%和56%（P〈0.05）,86%和62%（P〈0.05）。结论 PLDD围手术期须重视颈椎旁软组织及神经功能障碍的治疗。PLDD术联合HANS疗法可明显提高治疗颈椎间盘突出症的早期疗效。     

经皮激光椎间盘减压术和双极射频髓核成形术治疗颈椎间盘突出症的疗效比较

目的比较经皮激光椎间盘减压术(PLDD)和双极射频椎间盘髓核成形术(PIRFT)治疗颈椎间盘突出症的临床疗效及安全性。方法回顾2007年1月至2010年12月的颈椎间盘突出症住院患者95例,共155个椎间盘。其中PLDD治疗39例(A组),双极PIRET治疗56例(B组)。观察术前和术后1周内的VAS评分,并根据改良的MacNab评价比较两组术后6个月内的疗效,同时记录两组患者的不良反应和并发症。结果所有患者均成功穿刺,A组有2例随访脱漏,另有1例患者因接受了其他微创手术,排除本研究。两组术后1、3、7 d VAS评分均明显低于术前(P<0.01),术后3、7 d B组患者VAS评分低于A组(P<0.01)。在术后180 d随访期内B组的MacNab评价均好于A组(P<0.01)。两组均未发生严重并发症。结论与PLDD比较,双极射频椎PIRFT治疗颈椎间盘突出症疗效更好、不良反应更少。     

经皮激光椎间盘减压术治疗腰椎间盘突出症的中期疗效观察

目的:观察经皮激光椎间盘减压术(PLDD)治疗腰椎间盘突出症(LDH)的中期疗效。方法:2003年1月～2007年5月,应用PLDD治疗且获得3年及3年以上随访的腰椎间盘突出症患者87例,其中男45例,女42例,年龄22～80岁,平均52岁。激光汽化总能量500～800J/椎间盘,平均644.8J/椎间盘。术前及术后不同时期应用JOA法评定疗效,同时应用NRS法对患者术前及末次随访时各主要症状(腰痛、下肢疼痛、下肢麻木)进行评分。另外,将患者按年龄分为≤55岁组和>55岁组,比较两组的疗效。观察是否出现并发症。结果:随访87例患者,随访时间为36.0～88.5个月,平均60.1个月,按JOA疗效评定方法,术后1个月、3个月、6个月、≥1年、≥2年、≥3年、≥4年、≥5年、≥6年的JOA优良率分别为55.17%、77.01%、81.61%、81.61%、85.06%、87.35%、85.71%、85.10%、84.21%,术后不同时期优良率与术后1个月比较,P<0.05,差异有统计学意义;末次随访时各主要症状NRS评分与术前比较,P<0.01,差异有统计学意义。术后3年以上,年龄≤55岁和>55岁组优良率比较,P>0.05,差异无统计学意义。所有患者均未见并发症发生。结论:PLDD治疗腰椎间盘突出症的中期疗效良好,术后3~6年以上疗效稳定,是治疗腰椎间盘突出症较好的微创方法。     

经皮激光椎间盘减压术后影像学变化的中期随访

目的 观察经皮激光椎间盘减压术(PLDD)后中期随访影像学变化,评价该手术的安全性和有效性.方法 回顾性分析经PLDD治疗的22例颈腰椎病患者的临床资料,其中男性10例,女性12例;年龄44～73岁,平均58岁;随访时间36～54个月,平均41.5个月.椎间盘分布:颈椎12例27个,腰椎10例22个;其中C_(3～4)3个,C_(4～5)8个,C_(5～6)10个,C_(6～7)个,L_(2～3)2个,L_(3～4)2个,L_(4～5)9个,L_5S_1 9个.在侧位x线片应用手术椎间隙高度与椎体高度比值观察手术前后病变椎间隙高度变化;在MRI横断面上,应用椎间盘突出指数观察手术间盘突出情况的变化,并对结果进行统计学分析.结果 术后末次随访病变椎间盘椎间隙前缘高度、中心高度及后缘高度较术前无明显变化(P>0.05).颈椎间盘病变节段突出指数术前为0.10～0.54,术后末次随访为0.06～0.39,差异有统计学意义(P<0.05);腰椎间盘病变节段突出指数术前为0～0.71,末次随访为0～0.48,差异有统计学意义(P<0.01).结论 PLDD术后对椎间隙高度没有明显影响,该手术能有效促进椎间盘突出物的缩小.从影像学上分析,PLDD是治疗颈腰椎病的一种安全有效的微创手术.     

经皮激光椎间盘汽化减压术治疗腰椎间盘突出症的中期疗效分析

目的探讨经皮激光椎间盘汽化减压术（percutaneous laser disc decom pression,PLDD）治疗单纯腰椎间盘突出症的临床疗效。方法2001年5月～2006年12月,应用PLDD治疗单纯腰椎间盘突出症122例,采用半导体激光仪,局部麻醉,俯卧位,术中在C形臂X线机透视定位下调整进针角度和深度,光纤由浅入深插入烧灼,每次汽化1s,脉冲间隔5s,一般汽化3次,平均汽化总量不超过1500J,随访术后临床效果。结果122例随访6～60个月,平均36.5月,按MacNab疗效评定标准,优60例,良39例,可15例,差8例。优良率81.1%（99/122）。无并发症发生。结论PLDD具有创伤小、恢复快、安全有效等优点,是治疗单纯腰椎间盘突出症的较好方法。     

CT导引下经皮激光椎间盘减压术治疗腰椎间盘突出症

目的探讨CT导引下经皮激光椎间盘减压术的临床应用。方法经皮激光椎间盘减压术治疗腰椎间盘突出症患者19例,28个椎间盘。为保证操作的精确性和安全性,术中所有操作均采用CT导引。术后随访1～4月,平均2月。结果按MaCnab疗效评定标准,19例中优10例,良5例,可2例,差2例,无一例有并发症发生。结论CT导引下经皮激光椎间盘减压术具有侵入小、效果佳、恢复快等优点,尤其是对Ls～S1椎间盘突出症的治疗,提供了简单安全有效的治疗新途径。     

经皮激光椎间盘减压术治疗颈性眩晕的临床研究

目的探讨经皮激光椎间盘减压术治疗颈性眩晕的疗效及机制。方法对31例颈性眩晕患者36个突出间盘行经皮激光椎间盘减压术，观察术后3个月以上的疗效。结果28例术后眩晕立即消除(90％)，明显改善者2例(7％)，无效者1例(3％)，无神经损害、感染等并发症发生。结论导致颈性眩晕的主要原因是颈椎间盘突出、颈椎失稳，激惹交感神经诱发椎动脉痉挛。钩突关节肥大并非是主要致病因素。经皮激光椎间盘减压术使椎间盘内压骤然降低，加之局部直接热疗，从而可消除椎动脉痉挛，对治疗颈性眩晕有明显疗效。     

Percutaneous tracheostomy in patients with cervical spine fractures--feasible and safe

The aim of this study is to evaluate the short and long-term results of percutaneous tracheostomy in patients with documented cervical spine fracture. Between June 2000 and September 2005, 38 consecutive percutaneous tracheostomy procedures were performed on multi-trauma patients with cervical spine fracture. Modified Griggs technique was employed at the bedside in the general intensive care department. Staff thoracic surgeons and anesthesiologists performed all procedures. Demographics, anatomical conditions, presence of co-morbidities and complication rates were recorded. The average operative time was 10 min (6-15). Two patients had minor complications. One patients had minor bleeding (50 cc) and one had mild cellulitis. Nine patients had severe paraparesis or paraplegia prior to the PCT procedure and 29 were without neurological damage. There was no PCT related neurological deterioration. Twenty-eight patients were discharged from the hospital, 21 were decannulated. The average follow-up period was 18 months (1-48). There was no delayed, procedure related, complication. These results demonstrate that percutaneous tracheostomy is feasible and safe in patients with cervical spine fracture with minimal short and long-term morbidity. We believe that percutaneous tracheostomy is the procedure of choice for patients with cervical spine fracture who need prolonged ventilatory support.     

经皮腰椎间盘摘除术和经皮激光椎间盘减压术的疗效比较

目的对比分析经皮腰椎间盘摘除术（autoed percutaneous lumbar diskectomy,APLD）和经皮激光腰椎间盘减压术（percutaneous laser disc decompression,PLDD）对腰椎间盘突出症的治疗效果和治疗机理,以便选择最佳治疗方法。方法选择符合治疗标准的腰椎间盘突出症261例,其中APLD组183例,PLDD组78例,两治疗组采用统一的病例选择标准,疗效判别标准和随访3个月以上。治疗过程均在C型臂X线机透视下完成。结果PLDD组有效率96．1％,无效率3．9％：APLD组有效率95．1％,无效率4．9％。两治疗组的有效率和无效率无明显统计学差异（P〉0．05）,但PLDD组术后即时疼痛减轻率高及总体恢复时间短。结论APLD和PLDD同为包容性腰椎间盘突出症安全有效的治疗方法,但必须严格掌握禁忌证、适应证以及规范的操作;PLDD具有手术更简便迅速、即时疼痛减轻率高,创伤小和术后恢复时间短的优点。     

经皮激光椎间盘减压术治疗颈性眩晕的中期疗效观察

目的:观察分析经皮激光椎间盘减压术治疗颈性眩晕的中期临床疗效。方法:2002年9月至2006年12月收治35例颈性眩晕患者,男14例,女21例,年龄35～79岁,平均59.1岁。均使用Nd:YAG激光治疗机(波长1064nm)行经皮激光椎间盘减压术治疗,随访观察治疗效果。应用数字评分法(NRS)评价眩晕及伴随症状的改善情况,应用改良Macnab评价标准进行优良率和有效率的评估。结果:患者术中及术后均未见神经损伤、感染等并发症发生。随访24～66个月,平均41.8个月。末次随访时,35例患者的眩晕及伴随症状的平均NRS评分较术前明显下降(P0.01)。患者总体疗效依据改良MacNab评价标准,优18例,良7例,可5例,差5例,总体优良率为71.43%,总体有效率为85.71%。60岁组和≤60岁组患者比较,优良率分别为75.0%和68.4%,有效率分别为81.25%和89.47%,两组比较差异无统计学意义(P0.05);男性组和女性组患者比较,优良率分别为85.71%和61.90%,有效率分别为85.71%和85.71%,两组比较差异无统计学意义(P0.05)。结论:应用经皮激光椎间盘减压术治疗颈性眩晕创伤小,安全性高,中期疗效较满意,不同年龄组及不同性别组患者的中期临床疗效均无明显差异。     

Percutaneous endoscopic laser discectomy

BACKGROUND: The aim of the present paper was to systematically review the literature on percutaneous endoscopic laser discectomy (PELD) with respect to the safety and efficacy of the procedure. Where possible the procedure was compared with open discectomy. METHODS: Studies on PELD were identified using MEDLINE (1984 to December 1999), EMBASE (1974 to December 1999) and Current Contents (1993 to Week 1, 2000). A number of search terms were used: PELD; PLDD (percutaneous laser disc decompression); and laser and (spine or lumbar) and (disc* or disk*). The Cochrane Library was searched from 1966 to issue 4, 1999, using the search terms 'discectomy' or 'discotomy'. Live human studies of patients with lumbar disc prolapses for whom surgery was appropriate were included. Cadaver studies were also included. A surgeon and reviewer independently assessed the retrieved articles for their inclusion in the review. RESULTS: Only 12 papers were identified that related to PELD. The level of evidence for safety and efficacy was low; there were no controlled, blinded or randomized studies. The highest level of evidence came from time series studies. No quantitative analysis could be undertaken for the present review. CONCLUSIONS: Given the extremely low level of evidence available for this procedure it was recommended that the procedure be regarded as experimental until results are available from a controlled clinical trial, ideally with random allocation to an intervention and control group.     

经皮激光椎间盘减压术治疗神经根型颈椎病中期疗效观察

 目的观察经皮激光椎间盘减压术(percutaneous laser disc decompression, PLDD)治疗神经根型颈椎病 2~8年的随访结果, 分析影响 PLDD疗效的因素。方法对我: 2002年 12月至 2009年 6月应用 PLDD治疗的 58例神经根型颈椎病患者进行连续随访。男 32例, 女 26例;平均年龄 51.8岁(26~74岁)。采用日本整形外科学会(Japanese Orthopedic Association, JOA)神经根型颈椎病疗效评定标准(20分法)和数字分级法(numeric rating scales, NRS)评价所有患者的术后疗效;比较不同性别、年龄及病程各亚组患者术后 2年的 JOA评分优良率。结果患者术后 1个月、3个月、6个月、1年、2年、4年、6年和 8年的 JOA评分优良率分别为 37.9%、51.7%、65.5%、81.0%、82.8豫、80.9%、72.4%和 72.7%, 术后 6个月至 8年的各时间点与术后 1个月比较, 差异均有统计学意义(P约 0.05)。术后末次随访各疼痛症状(颈痛、肩痛、上肢疼痛)的 NRS评分均较术前下降, 差异有统计学意义(P约 0.05)。病程臆18个月患者术后 2年 JOA评分优良率(93.3%)高于病程跃18个月患者(71.4%), 差异有统计学意义(P约 0.05)。结论 PLDD治疗神经根型颈椎病的中期疗效可靠、稳定, 患者的病程长短可能会影响术后疗效。     

经皮激光汽化减压术对造影结果不同的腰椎间盘突出症的疗效对比

目的对比经皮激光汽化减压术（PercutaneousLaserDiscDecompression,PLDD）对两种椎间盘造影结果的腰椎间盘突出症的疗效,结合文献探讨椎间盘造影及PLDD的临床应用。方法自2010-01—2013-05行PLDD治疗的单节段腰椎间盘突出症患者58例进行回顾性分析,术前造影阴性的16例为A组,阳性者42例为B组;激光烧灼总能量控制在300～600J,汽化减压并反复抽吸;对2组患者术前、术后即刻和随访时的临床表现、直腿抬高角度及JOA评分进行比较。结果A组与B组在术前、术后即刻和随访时直腿抬高角度及JOA评分均无显著差别。结论椎间盘造影阴性并不能完全排除椎间盘源性腰腿痛;椎间盘造影结果不同的两组腰椎间盘突出症患者在PLDD的中期疗效上无显著差异。     

Persistent local pain after posterior spine surgery for thoracic lesions

Many surgeons have investigated local pain associated with posterior spine surgery for cervical or lumbar lesions. However, little information is available concerning local pain after posterior thoracic spine surgery. This prospective study was, thus, performed to investigate the frequency and clinical features of local pain after posterior spine surgery for thoracic lesions. In 29 consecutive patients undergoing posterior spine surgery for various thoracic spinal disorders, local pain was investigated before and after surgery. In all 19 patients with preoperative back pain presumably due to thoracic lesions, pain was well alleviated after surgery. In contrast, 6 patients (21%) newly developed persistent shoulder angle pain after surgery, which resembled axial pain after cervical laminoplasty. In 5 of these 6 patients surgical exposure was extended to the cervicothoracic junction, whereas persistent shoulder angle pain was independent of disease etiologies and surgical procedure, and all of the 5 patients had no other etiologies of local pain such as surgical site infections, hardware failures, pseudoarthrosis, other metastasis, and vertebral fractures. These results suggest that dissection of muscle attachments to the cervicothoracic junction would play some part in the development of persistent local pain after posterior spine surgery for thoracic lesions, although surgical exposure of the zygapophysial joints at the cervicothoracic junction might be a possible source of postoperative shoulder pain. Therefore, to minimize such surgical complications, muscle insertions into the cervicothoracic junction should be preserved as far as possible.