Document Detail


Laser disc decompression. The importance of proper patient selection.
MedLine Citation:
PMID:  7825045     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: The value of adherence to selection criteria for laser disc decompression (LDD) was evaluated. A total of 204 patients who underwent LDDs were identified. Follow-up information could be obtained for 164 (80.8%) patients. Results were compared based on the selection criteria. SUMMARY OF BACKGROUND DATA: Laser disc decompression is a relatively new procedure. Few reports concerning outcome of LDD exist; and none deal specifically with patient selection. OBJECTIVE: This study compared the results of LDD performed among patients who met appropriate selection criteria with those who did not. Also, the value of discography in patient selection for LDD was investigated. METHODS: Two independent reviewers extracted data from patient charts. From this information, each patient was assigned to one of three groups: 1) those who met all selection criteria for LDD (leg pain, positive physical examination finding such motor, sensory, or reflex deficits, and/or straight leg raise, contained disc herniation confirmed by discography); 2) those who did not meet the selection criteria (had a normal physical examination, the presence of stenosis, spondylolisthesis, extruded disc fragment, leakage of discographic dye from the outer annulus, multiple prior lumbar surgeries); or 3) those who could not be assigned to either of the first two groups for reasons such as discography not being performed or inadequate physical examination data recorded in the chart. At 1 year follow-up, each patient was sent a questionnaire assessing outcome. Successful outcome was defined to be no subsequent lumbar surgery, the patient felt that LDD had helped, and if the patient was working before symptom onset, he was able to work at the time of follow-up. RESULTS: Among the 41 patients who met all selection criteria, the success rate was 70.7% (29/41); among patients who did not meet all the criteria, the success rate was only 28.6% (12/42); significantly less than in the first group (P < 0.005). Among patients who could not be assigned definitively to either of the first two groups, the success rate was 55.6% (45/81). Also, the success rate among patients with discographic confirmation of a contained disc herniation was significantly greater than among those who either did not have discography performed or extravasation of contrast was noted (70.7% vs. 44.4%, P < 0.035). CONCLUSIONS: These results emphasize the importance of strict adherence to appropriate selection criteria to obtain satisfactory results from LDD.
Authors:
D D Ohnmeiss; R D Guyer; S H Hochschuler
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Spine     Volume:  19     ISSN:  0362-2436     ISO Abbreviation:  Spine     Publication Date:  1994 Sep 
Date Detail:
Created Date:  1995-02-14     Completed Date:  1995-02-14     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  2054-8; discussion 2059     Citation Subset:  IM    
Affiliation:
Texas Back Institute Research Foundation, Plano.
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MeSH Terms
Descriptor/Qualifier:
Adult
Diskectomy, Percutaneous / methods*
Female
Follow-Up Studies
Humans
Intervertebral Disk / radiography,  surgery
Intervertebral Disk Displacement / epidemiology,  radiography,  surgery*
Laser Therapy*
Lumbar Vertebrae / radiography,  surgery*
Male
Patient Selection*
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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