Authors' objectives: To assess the safety and effectiveness of PLDD in the treatment of lumbar, cervical and thoracic herniated discs.

Authors' recommendations: 1. In general, the level of scientific evidence used to assess PLDD interventions for treatment of herniated discs is limited, and is essentially based on observational studies having a medium-low methodological quality. Our search located only one recent RCT with a good methodological design, which compared PLDD to conventional surgery in the lumbar area and indicated that PLDD (with additional surgery where necessary) was not inferior to conventional surgery. 2. Based on these studies, and bearing in mind their limitations, good results were observed in terms of pain reduction (60%-89% of patients) and improvement of symptoms (54-83%) following PLDD interventions on the herniated discs. 3. Special mention should be made of the laser technique's high failure rate after its initial success, which may necessitate reoperation with conventional surgery in up to 38% of cases treated with PLDD in the lumbar area. 4. PLDD is a minimally invasive technique, which normally poses a slight risk and a low risk of complications. In lumbar treatment, discitis due to heat damage during the use of the laser is frequent in this technique; and in the cervical and thoracic regions there is a risk of appearance of retro-pharyngeal abscesses and pneumothorax, owing to the anatomy of vital structures in these areas. 5. The PLDD approach is not incompatible with subsequent reoperations, whether by PLDD again or by conventional surgery. 6. To ensure effective and safe outcomes with PLDD, patients must be correctly selected, by exclusively including only those who meet the inclusion criteria. The principal indication is contained lumbar disc herniation which does not respond to conservative treatment, but PLDD would be contraindicated in the case of sequestered herniated discs and degenerative disease.

Project Status: Completed

URL for project: http://avalia-t.sergas.es/Paxinas/web.aspx?tipo=paxtxt&idLista=4&idContido=656&migtab=38%3b39%3b656&idTax=12028

Year Published: 2016

URL for published report: http://avalia-t.sergas.es/DXerais/652/avalia-t_201601_NucleolisisDiscal_DEF.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Scientific Advice Unit, avalia-t; The Galician Health Knowledge Agency (ACIS)

Contact Address: Conselleria de Sanidade, Xunta de Galicia, San Lazaro s/n 15781 Santiago de Compostela, Spain. Tel: 34 981 541831; Fax: 34 981 542854;

Contact Name: avalia-t@sergas.es

Contact Email: avalia-t@sergas.es

Copyright: Scientific and Technical Advice Unit, avalia-t