Immediate pain improvement is a useful predictor of long-term favorable outcome after percutaneous laser disc decompression for cervical disc herniation

Objective: The purpose of this study was to evaluate the long-term clinical outcome of percutaneous laser disc decompression (PLDD) for cervical disc herniation and to identify factors affecting long-term favorable outcome. Background Data: PLDD using the Ho:YAG laser has been regarded as an effective alternative for soft disc herniation. However, little is known about long-term favorable outcome parameters. Methods: We retrospectively reviewed the clinical and radiological data of 60 patients who underwent PLDD with laser-assisted spinal endoscopy (LASE) for contained cervical soft disc herniation from January 1998 to January 2000. The clinical outcome was measured using the Macnab criteria. Statistical analysis was performed using Fisher's exact test. Sex, age, operated level and location of disc hemiation, amount of laser energy, and time for symptom improvement were selected as parameters. Results: The mean follow-up period was 71.0 months (range, 59-83 months). The mean age was 45.7 years (range, 26-68 years), and the mean symptom duration was 13.0 months (range, 2-60 months). The Visual Analogue Scale (VAS) score was significantly improved from 7.9 preoperatively to 2.6 at the final follow-up (p < 0.001). At the final follow-up, 51 (85.0) patients achieved a favorable outcome. Immediate (within 24 h) pain relief was achieved in 19 patients, and it was strongly related to long-term success (p = 0.006). Conclusion: The long-term clinical outcome of PLDD with LASE was fairly good, with a success rate of 85%. Immediate pain relief is a useful prognostic factor predicting favorable outcome following the procedure.