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PLDD - Percutaneous Laser Disc Decompression

AnonymousUserAAnonymousUser Posts: 49,322
edited 06/11/2012 - 8:39 AM in Back Surgery and Neck Surgery
Have had sciatica for about 4 mos now. I met with a surgeon for a microdiscectomy a couple of times and yesterday I called his secretary and booked a surgery date.

However, the other day I was researching alternative treatments and came upon this procedure done by a doctor in New York City who also seems to have invented it.

Unlike PLDD microdiscectomies, this treatment uses a needle inserted with the help of flouroscopy into the disk. A thin fiber optic laser (i believe) is then inserted into the needle to heat the nucleus of the disk. The disk evaporates causing a pressure gradient pulling the herniation back towards the disk. There is no incision and is therefore much less invasive.

The doc claims to have a success rate of 80%.

Anybody familiary with this?
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1

Comments

  • This procedure has actually been in use since the 80s. It has never become widely available because there have never been any research studies completed that proved it resulted in better outcomes than standard discectomy. The data showed that at five years out, people who had this procedure and people who treated the problem conservatively with NO surgery had the same results.

    That being said, some doctors, and particularly the "laser spine" surgical centers that one sees advertised all the time online, offer the treatment. I imagine some people are happy with the results. You might want to ask what the reherniation rate is compared to that of a discectomy.

    If you are up to reading some medical studies, here's a link to a good study:

    http://www.ajnr.org/cgi/content/full/27/1/232#T1

    I think there are people on the board that have had PLDD. Hopefully they will chime in with their results and experience.

    Once word of caution: be sure to check out the doctor's credentials. Some fellowship-trained spinal specialists are offering the procedure, but some other types of doctors have also gotten into the business. Just be sure you know who would be doing the procedure.

    Good luck making your decision.

    Gwennie
  • good article...

    I dont know however, why authors end it on a down note...
    the success rates in the larger studies are greater than 75%.

    Thats not bad considering how less invasive it is than microdisectomy.
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  • My doc was the 7th in this country to perform this surgery. I don't think that the doc in NY invented it. My doc was trained by a doc in another country I think.

    Anyway. It is absolutely worth trying before doing anything more invasive. The worst that could happen is that it does not work and you have to go for the more major surgery.

    The PLDD will actually tighten up the disc and make it much less likely that the disc will reherniate unlike other surgerys that carry a high risk of reherniation.

    I no longer have nerve pain running down my leg but I do have back pain. I also have other issues in my spine that are causing my back pain.

    My opinion is that you have nothing to lose by trying this first. I have been seeing my doc for 4 years and have seen many folks that have not been able to find help anywhere else after searching for years. This procedure did help them.

    Good luck and keep us posted.

    I had this done 2 years ago
  • I knew that you were misinformed but I wanted to make sure. PLDD has only been available in the US since 1991. Dr Choy is the doc that invented it and he is the one that trained my doc. Here is the information that I looked up

    The first clinical percutaneous laser disc decompression was performed in Europe by Choy and Ascher in 1986 [5]. The U.S. Food and Drug Administration approved PLDD for use in the USA in 1991.

    Hope it helped.
  • Not to be picky, but most advances in spine surgery are developed on an almost global effort. People combine research...different doctors contribute pieces of research that ultimately result in a new procedure, etc.

    Big companies like Medtronics have lots of spinal specialists onboard, working on various research in their offices all over the world. So while many doctors seem to take credit with developing a particular procedure, or piece of equipment for surgery, etc., in reality, I think many doctors are making that claim for the same thing.

    Weinie, you want to be sure that your doctor has performed this procedure many times and that he/she is well qualified. I was just asking my surgeon about the use of lasers last week and he told me a story of a surgeon here in my city that used the laser a tad long and burned a hole right through the intestine. No one knew it and the man almost died of peritonitis. (I don't know how the disc surgery turned out... @) )
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  • IDET?

    I guess the difference is the use of a laser instead of a thermal coil,...hmmmm.

    Looks like a good minimally invasive option to try before surgery.

    GL
  • I know its a sin, understandably, on this forum to mention drs by name, i believe its necessary here since there are so few in the field doing this procedure.

    I am seeing dr. choy tomorrow. I cant find any one on the internet who does the procedure the same way. In fact, from what i have read, the guy literally wrote the text book on the procedure and invented the instruments involved.

  • Interesting to see you are both talking about the same physician. I looked at his website. He has excellent academic credentials and qualifications, and he does indeed claim to have invented the procedure. It also states he has trained over 700 doctors in the procedure and it is being done in a variety of places in the United States and elsewhere.

    The only thing that surprises me is that they will not take any insurance.

    Anyway, it sounds like an appropriate procedure for you. I will be eager to hear what you think after meeting with the surgeon.

    Good luck!
    Gwennie
  • Dr. Choy absolutely invented this procedure. My doc does it exactly the same way that Choy does. I think that he will be an excellent choice. Good luck and let me know how you make out.
  • After the consulation ($400), I decided not to do this.
    Several reasons...
    1) the office, despite being in a posh area of manhattan is dreary looking and poorly lit. I was one of only two patients there.
    2)The doc tries to sell you more on his inventions and accomplishments than on the procedure, although he does give you the percentages of sucess and failure, why, and what happens if there are complications (only 10 in 7000 due to infections which were later treated and cured).
    Success for me based on my age,etc was determined to be 89%.
    Failure would be due to detached particles of disc not visible in the MRI.
    3)He goes over your MRI but proceeds to diagnose you by your flexibilty and strength in your legs and feet.
    I went to him for 1 disc... he concluded based on these rather quick and simple tests that i have 3 disks that need treatment!!!!

    It sounded to me like that was an upsell and you dont really want to be upsold on something this serious if you don't need it, even forgetting about the additional cost per disc.

    Finally, most of the literature I saw on this procedure seems to be written by him!!!

    I am scheduled for surgery in 2 wks but i am calling that off too. Both the surgeon and the PLDD doc said I would have to give up the gym, weights, running, skiing, jumping, picking up my toddler daughter, you name it. I've had this bad disc for 10 yrs while doing all this (okay maybe heavy squating years ago wasnt the best, nor recent running). But I'm not going to let this change my life.

    On the recommendation of a chiro friend, im seeing a chiro w/ a drx9000 machine. This guy had a much more positive attitude. Along w/ the machine, he does some table work to relieve the disk and tens to relax the muscles after they have been stretched on the drx. 3 x a week for 8 wks @3200. He says I should feel improvements in ~12 treatments.

    As far as the PLDD treatment, I still can't say whether it would work or not. Unfortunately, I don't know. If he said I only had to do 1 disc, I might have done it.
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