PLDD technique and procedure

The laser application was introduced at the end of 70’s such in several surgical specialities with great advantages both for the surgeon both for the patient.

At the end of the past millennium a new application area took place: Percutaneous laser disc decompression (PLDD)
Today, after 10 years of international experiences, the PLDD procedure can be considered as the mini invasive and standardized solution for the herniated disc treatment.
PLDD procedure has become a technique daily used by an even bigger number of specialists all across the world.
Italy had a primary rule in the development of materials, standardization and correct diffusion of the procedure by the contribute of his scientists and specialists.
Since 2003 the Italian laser utilizers have been developing more than thirty meeting days of learning projects and tutoring courses with the help of qualified professional people.

PPLD procedure

The percutaneous laser decompression is a surgical procedure used for the treatment of disc herniation since ten yrs ago; The procedure, following the ISLASS protocol, consists of a 21G atraumatic tip chiba needle guided by C-arm fluoroscopy, or CT-scan percoutaneousely inserted into the herniated disc under local anesthesia and ev seduction (Figg.1-3). Diode Laser 980nm (Biolitec-AG, Diode laser 980nm), 1500J of total energy, was delivered through a disposable 360µm Silica Fiber Optic; The power parameters were 12 W with exposure time 0.60 sec in a pulsed wave, with 2-3 seconds pauses for heat dissipation.
A smoke evacuation system specifically designed and worldwide patented (Menchetti’s handpiece) connected to the needle permits to eliminate the gas formation during the treatment, by reducing the postoperative muscle contracture. It’s possible to concentrate the energy delivered in a few mm2, with an adsorbition peak more than 90%, without dissipation on surrounding tissues.The one single level treatment has a duration of 20 minutes and the patient stays in hospital 1 (day surgery) or 2 days. An antibiotical therapy is applied for the following 4 days, and the return to the daily activities is reached into 7-10 days.
The procedure appear to be now days a safe and valid alternative to the microsurgery, with a rate of success of 80%, particularly under CT-Scan guidance, in order to visualize the nerve root and also apply energy on several points of disc herniation. This permits to have a shrinking concentrated in a bigger area, realizing a minimal invasiveness on the spine to be treated, and avoiding the potential complications related to the microdiscectomy (recurrence rate of more than 8-15%, peridural scar in more than 6-10%, dural sac tear, bleeding, iatrogenic microinstability), and does not preclude traditional surgery, if needed.