Percutaneous Lumbar Laser Disc Decompression: An Update of Current Evidence

Background: Since the descriptions by Mixter and Barr of surgical treatment for rupture ofthe intervertebral disc in 1934, open surgical procedures have become a common practice. Discherniations are often classified as being contained or non-contained. The results of open surgicaldiscectomy for contained disc herniation have been poor. Consequently, several less invasivetechniques have been developed including percutaneous lumbar laser disc decompression.Study Design: A systematic review of the literature of percutaneous lumbar laser discdecompression.Objective: The objective of this systematic review is to evaluate and update the clinicaleffectiveness of percutaneous lumbar laser discectomy in managing radicular pain secondary tocontained disc herniation.Methods: The available literature on lumbar laser disc decompression in managing chroniclow back and lower extremity pain was reviewed. Quality assessment and clinical relevance ofrandomized trials were graded according to the Cochrane Musculoskeletal Review Group criteriafor interventional techniques, and observational studies according to the Newcastle-Ottawa Scalecriteria.The level of evidence was classified as good, fair, and limited or poor based on the quality ofevidence developed by the U.S. Preventive Services Task Force (USPSTF).Data sources included relevant literature identified through searches of PubMed and EMBASEfrom 1966 to September 2012, and manual searches of the bibliographies of known primary andreview articles.Outcome Measures: Pain relief was the primary outcome measure. Other outcome measureswere functional improvement, improvement of psychological status, opioid intake, andreturn-to-work.Short-term effectiveness was defined as effectiveness lasting one year or less, whereas, long-termeffectiveness was defined as benefit persisting for greater than one year.Results: Based on USPSTF criteria, the indicated level of evidence for percutaneous lumbar laserdisc decompression is limited for short- and long-term relief.Limitations: Although laser discectomy has been utilized for many years, there is a paucity ofrandomized clinical trials.Conclusion: This systematic review shows limited evidence for percutaneous lumbar laser discdecompression.Key words: Intervertebral disc disease, chronic low back pain, disc herniation, disc protrusion,radiculitis, contained disc herniation, mechanical disc decompression, percutaneous lumbar laserdiscectomy, laser assisted spinal endoscopy