Percutaneous endoscopic laser annuloplasty for discogenic low back pain☆

Abstract 

Background

Laser-assisted spinal endoscopy (LASE) kit has been used for percutaneous intradiscal decompression to evaporate and shrink the posterior and central nucleus for improvement of leg and radicular pain due to contained disc herniation. Percutaneous endoscopic laser annuloplasty (PELA), a new minimally invasive technique, uses LASE to directly coagulate the inflamed disc granulation tissue associated with annular tears. The small diameter of the endoscope including Ho:YAG laser, irrigation, and light, plus the extreme posterolateral approach into the posterior annulus, enables one to minimize damage to normal nuclear tissue. The authors sought to demonstrate the safety and efficacy of PELA for controlling discogenic low back pain (DLBP) due to abnormal disc tissues, new vessels, and nerves in the central torn posterior annulus.

Methods

Clinical outcomes of PELA were investigated in patients having DLBP with an annulus-torn degenerative disc or contained disc herniation. Thirty patients treated at a single level and achieving a mean follow-up of 9.7 months were analyzed. Outcomes were assessed using the visual analog scale (VAS) for back pain, the Korean Oswestry Disability Index (KODI), and the modified Macnab's criteria.

Results

The mean back pain VAS score improved from 8.0 to 2.4, and the mean KODI score improved from 79.0 to 22.4 (P < .001). Results by the modified Macnab's criteria also showed a good outcome, with a success rate of 90.0%. There were no serious complications observed during follow-up.

Conclusions

Percutaneous endoscopic laser annuloplasty using the Ho:YAG laser provides favorable outcomes for carefully selected groups of patients with DLBP.

Abbreviations: AP, anteroposterior, CI, confidence interval, CT, computed tomography, DDD, degenerative disc disease, DRAM, Distress and Risk Assessment Method, HIZ, high-intensity zone, HNP, herniated nucleus pulposus, Ho:YAG laser, Holmium:Yttrium-Aluminum-Garnet laser, IDD, internal disc disruption, KODI, Korean Oswestry Disability Index, LASE, laser-assisted spinal endoscopy, MRI, magnetic resonance imaging, PELA, percutaneous endoscopic laser annuloplasty, PELD, percutaneous endoscopic lumbar diskectomy, TDR, total disc replacement, VAS, visual analog scale

Keywords: Percutaneous endoscopic laser annuloplasty, Discogenic low back pain, Ho: YAG laser, Annular tear