RESUMEN
OBJECTIVE: In recent years, percutaneous laser disc decompression (PLDD) has become a routine surgical procedure because it can be performed under local anesthesia and is minimally invasive. However, there is a risk of nerve root and endplate injury owing to heat generated by laser irradiation during PLDD. We recently performed salvage surgery on a patient with heat injury to the L5 nerve root that developed after PLDD. CLINICAL PRESENTATION: One month before presenting to our hospital, the patient underwent two sessions of PLDD for lumbar vertebral disk herniation at another institution. The patient developed worsening sciatica, as well as bowel and urinary problems after the PLDD. INTERVENTION: We performed salvage surgery after PLDD. The intraoperative findings in the present case included carbon spots in the dura mater of the nerve root and a disc herniation strongly adherent to the nerve roots. These findings indicate that the area adjacent to the nerve roots was damaged by excessive heat during laser irradiation. CONCLUSION: When salvage surgery is performed after a PLDD procedure, disc and nerve root injuries owing to laser heat energy must be considered.
Asunto(s)
Desplazamiento del Disco Intervertebral/cirugía , Terapia por Láser/efectos adversos , Vértebras Lumbares/patología , Ciática/etiología , Raíces Nerviosas Espinales/patología , Descompresión Quirúrgica/efectos adversos , Descompresión Quirúrgica/métodos , Duramadre/patología , Disuria/etiología , Disuria/cirugía , Calor/efectos adversos , Humanos , Desplazamiento del Disco Intervertebral/patología , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Ciática/cirugía , Adherencias Tisulares/etiologíaRESUMEN
OBJECTIVE: We identified several problems associated with percutaneous lumbar disc decompression (PLDD) based on a study of patients who required salvage operations for complications after undergoing PLDD at an outside institution. BACKGROUND DATA: PLDD has been performed as a new treatment for intervertebral disc herniation in recent years, and its safety and effectiveness are in the process of being established. Because the procedure is simple to perform under local anesthesia, inappropriate irradiation and application to patients for whom it is not indicated have sometimes resulted in a poor outcome and serious complications. METHODS: The patients comprised 10 with lumbar disc herniation and three with lumbar spondylolisthesis. We analyzed the magnetic resonance (MR) imaging and operative findings as well as the pathological features of surgically obtained disc specimens and studied their relationships with the clinical outcomes of the operations. RESULTS: Initial examination of all patients at our hospital showed that PLDD had no effect on low back pain or sciatica. In patients who showed MR signal changes in the end-plate, the pathological examination revealed extensive necrosis of cartilage and bone. During salvage operations, severe adhesion of herniated masses to nerve roots was often observed, with carbonized disc tissue surrounding the nerve roots and might have their nerve root injured thermally. CONCLUSION: PLDD is associated with significant risk of disc, end-plate, and nerve root injuries, contrary to the general belief that the procedure is minimally invasive. Our findings highlight the need for careful diagnosis and sufficient technical skill when selecting PLDD as a treatment option.