Hi rickval,
I found a number of citations that might interest you on PubMed. I
have outlined a few different types of surgeries.
--------------------------------------
Arthroscopic discectomy:
This type of surgery has a success rate of 70 to 87 percent, depending
on the study.
Here is a summary of some conclusions from an article on discectomy:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9137176&dopt=Abstract
"Prudent patient selection, adherence to inclusion and exclusion
criteria, and avoidance of entry into the spinal canal when possible
will reduce the incidence of perineural and intraneural fibrosis and
will ensure a satisfactory outcome. Although the incidence of
complications has been acceptable, a satisfactory outcome ranging from
75% to 87% has been reported after arthroscopic microdiscectomy."
From "Arthroscopic Microdiscectomy:
An Alternative to Open Disc Surgery" by
PARVIZ KAMBIN, M.D. AND MARTIN H. SAVITZ, M.D
Mount Sinai Journal
http://www.sinaionsitehealth.org/msjournal/67/page283_287.pdf
"Results: In terms of patients self-evaluation, satisfactory outcome
rates of 85?92% were realized.
The patients considered brief intravenous anesthesia and same-day
scheduling preferable to general
anesthesia and hospitalization needed for open laminotomy and
discectomy. Fewer than 2% of the
cases required a second surgery.
Conclusion: The authors are of the opinion that advantages include:
(1) one-hour operative time, (2)
negligible blood loss, (3) avoidance of significant scarring in the
spinal canal, and (4) anterolateral fen-
estration of the annulus for continuing relief of intradiscal pressure
and nerve root decompression."
Here is another study comparing closed discectomy to open discectomy:
http://www.ejbjs.org/cgi/content/abstract/81/7/958
"A Prospective, Randomized Study Comparing the Results of Open
Discectomy with Those of Video-Assisted Arthroscopic Microdiscectomy"
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11021785&dopt=Abstract
This one is a study in which many different forms of endoscopic
discectomy, not just laser, were performed, but laser was measured
separately, had good results, and is recommended as a state-of-the-art
new technology in this type of surgery.
Interestingly, I found this site from this year made by the government
of the state of Washington, saying that these types of laser surgeries
are investigational, not proven to be more effective than conventional
open discectomy and not covered by insurance. From the studies I cite
above it has been proven to be at least more effective than open
procedures, in which the body is actually opened for surgery and the
patient has a longer recovery period.
http://www.lni.wa.gov/ClaimsIns/Providers/Treatment/SpecCovDec/PercutDisc.asp
Blue Cross takes the same policy:
http://medpolicy.bluecrossca.com/policies/SURG/disc_decompress.html
Here are some more studies which seem to outweigh the insurance
companies' thoughts on the matter:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16850062&query_hl=16&itool=pubmed_docsum
"RESULTS: Significant pain relief, functional improvement, and a
decrease in medication use were achieved following nucleoplasty. There
were no complications associated with the procedure. CONCLUSION:
Nucleoplasty should be used in those patients who fail conservative
medical management including medication, physical therapy, behavioral
management, psychotherapy, and who are unwilling to undergo a more
invasive technique such as spinal surgery."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16479630&query_hl=16&itool=pubmed_docsum
"CONCLUSION: Percutaneous endoscopic interlaminar discectomy is a
safe, effective, and minimally invasive procedure for the treatment of
intracanalicular disc herniations at the L5-S1 level in properly
selected cases, especially when the transforaminal approach is not
possible because of anatomic constraints."
------------------------------------------------
This type of surgery is also known as PLDD (Percutaneous Laser Disc Decompression.)
A study in 1995 found that 9 out of 14 patients taking this type of
surgery for leg pain experienced total relief of symptoms, while four
people required further surgery.
"CONCLUSIONS: Percutaneous laser disc decompression can relieve
sciatica caused by a herniated intervertebral disc. The technique
requires limited use of health resources. Preliminary results suggest
that an early return to work can be expected in patients successfully
relieved of their leg pain."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7553467&dopt=Abstract
Further resources:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10150634&dopt=Abstract
http://www.openradiology.org/zosirws/survey/laser%20disk%20decompression/
http://www.dornier.com/europe/english_gb/physician/orthopedics/pldd/procedure.htm
This book is extremely expensive, but it was written by the man who
performed the first procedure of PLDD and includes many diagrams, so
it might be worth trying to find it from a library.
http://www.amazon.com/gp/product/038700260X/103-8174026-6508661?v=glance&n=283155
This website explains the technique of PLDD very well and also evaluates it:
http://www.ajnr.org/cgi/content/full/27/1/232
"Because of the minimally invasive nature and the fact that return to
work is usually possible within a few days after treatment, PLDD
appears to be an interesting alternative to conventional surgery;
however, considerable skepticism still greets PLDD. Opponents usually
dismiss PLDD as being an experimental treatment with unproven
efficacy, whereas those advocating the use of PLDD tend to present it
as some kind of miracle treatment."
"Success rates in the larger studies varied from 75% to 87%... Because
of insufficient improvement of symptoms or recurrent herniation, 4.4%
to 25% of patients received additional surgical treatment. In most
cases, surgery revealed the presence of free fragments in the spinal
canal.
The most frequently described complication of PLDD is (spondylo-)
diskitis, both aseptic and septic. The reported frequency of diskitis
varies from 0% to 1.2%. Aseptic diskitis is the result of heat damage
to either the disk or the adjacent vertebral endplates. To avoid this
complication, careful monitoring of patient complaints during the
procedure is necessary, with adjustment of laser power, pulse rate, or
pulse interval when heat sensations occur. The goal of laser disk
decompression is to selectively decrease the amount of nucleus
pulposus tissue, while leaving the annulus fibrosus and surrounding
tissues unaffected. Therefore, the extent of heat penetration is to be
kept as low as possible."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16804261&query_hl=23&itool=pubmed_docsum
"RESULTS: There was immediate pain relief in 32/40 (80%). According to
MacNab criteria good to fair response was seen in 37/40 (92%) and 3
patients (7.5%) responded poorly to this treatment. On follow up which
ranged from 1 to 7 years, 34/40 (85%) had pain relief with no need for
further treatment. COMPLICATIONS: Significant pain at local puncture
site was experienced by 8 (20%), pain during lasing was experienced by
one. One patient developed muscular spasm. CONCLUSION: Percutaneous
laser disc decompression is a safe, relatively noninvasive and
effective treatment modality for contained, nonsequestered, herniated
lumbar disc disease in carefully selected patients."
-------------------------------------------
Stryker DEKOMPRESSOR--
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15752964&dopt=Abstract
"Percutaneous nucleotomy: preliminary communication on a decompression
probe (Dekompressor) in percutaneous discectomy. Ten case reports."
Amoretti N, Huchot F, Flory P, Brunner P, Chevallier P, Bruneton JN.
"We have conducted, from September 2003 to March 2004, a retrospective
review on 10 patients (mean age of 49.8), chosen at random, presenting
a nonextruded herniated disc resisting all medical treatments. The
procedure is CT guided or performed under fluorosocopy, a discography
is performed by introducing the probe at the level of the protruded
disc. After local anesthesia, an incision of a few millimeters is
performed, allowing the introduction of a coxial trocar to the level
of the disc. The decompression probe is then introduced. No technical
failure occurred. The results in our series show, in eight patients, a
satisfactory result with a decrease of the initial VAS of more than
70% and a complete elimination of the medical therapy. Our preliminary
results are encouraging but should also be confirmed by a multicentric
based on a large series, and the criteria of inclusion or exclusion
must be strictly respected to obtain satisfactory clinical results."
This study focuses on a problem that surgeons had with the probe
during surgery, but the patient nonetheless had an uneventful
recovery.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=16543105
--------------------------------------------
Additional sources:
http://www.remedyfind.com/treatments/41/1983/
Search terms:
kambin arthroscopic discectomy
arthroscopic discectomy pubmed
laser spinal endoscopy
laser discectomy pubmed
nucleoplasty laser
Percutaneous laser disc decompression
dekompressor pubmed
If you need any more help or clarifications, please let me know and
I'll be happy to help!
Cheers,
--keystroke-ga |
