Treatment PLDD

Treatment Principle of PLDD

The treatment principle of PLDD is based on the concept of the intervertebral disk being a closed hydraulic system. This system consists of the nucleus pulposus, containing a large amount of water, surrounded by the inelastic annulus fibrosus. An increase in water content of the nucleus pulposus leads to a disproportional increase of intradiskal pressure. In vitro experiments have shown that an increase of intradiskal volume of only 1.0 mL causes the intradiskal pressure to rise by as much as 312 kPa (2340 mmHg). On the other hand a decrease of intradiskal volume causes a disproportionally large decrease in intradiskal pressure. The radicular pain that characteristically accompanies lumbar disk herniation is the result of nerve root compression by the herniated portion of nucleus pulposus. A reduction of intradiskal pressure causes the herniated disk material to recede toward the center of the disk, thus leading to reduction of nerve root compression and relief of radicular pain.
In PLDD, this mechanism is exploited by application of laser energy to evaporate water in the nucleus pulposus. Laser energy is delivered by a laser fiber through a hollow needle placed into the nucleus pulposus. The needle is placed into the intervertebral disk under local anesthesia. Apart from evaporation of water, the increase in temperature also causes protein denaturation and subsequent renaturation. This causes a structural change of the nucleus pulposus, limiting its capability to attract water and therefore leading to a permanent reduction of intradiskal pressure by ≤57%.

Technique of PLDD

Sixteen clinical trials were included in this review, representing a total of 1579 patients  Trials were only included if they provided enough information on techniques used in the procedure (laser type, parameters used, etc) and no additional techniques such as endoscopy were used. Clinical trials were only included when they addressed the outcome of PLDD.

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