• To evaluate and update the clinical effectiveness of percutaneous lumbar laser discectomy in managing radicular pain secondary to contained disc herniation.

This systematic review by Singh et al (2013) provides an up to date review of the effectiveness of percutaneous lumbar laser discectomy.

The acceptance of minimally invasive spine surgery continues to grow from both a demand by patients and amongst surgeons. The goals of having smaller incisions, limiting soft tissue trauma, shorter operating times and hospital stays, improvements in outcomes, and decreased costs of healthcare have led to modifications of the original open discectomy approach including the use of the laser to accomplish these goals.

Despite percutaneous laser disc decompression being approved for use in the U.S. in 1991, there were been no randomized trials comparing this approach to traditional surgical procedures until after this paper was published by Singh et al. As the authors of this review have pointed out, supportive evidence “remains relatively poor” for percutaneous lumbar laser disc decompression.

This review included a literature search from 1996 through September 2012 looking at papers where the primary intervention was lumbar laser disc decompression. Out of 875 published papers that were initially identified, only 84 were considered for inclusion based on the methodology utilized.   Results were drawn from 15 (N=3171 subjects) observational studies.  There were no randomized studies included. Many of the excluded manuscripts had small sample sizes.

The analysis was based on the United States Preventive Services Task Force (USPSTF) criteria which rated the evidence as good, fair, or limited/poor. While there was some data to suggest that percutaneous lumbar laser disc decompression provides relief of symptoms in both the short and term term for a select subset of patients, based on the overall data reviewed, the authors concluded that evidence is limited for percutaneous lumbar laser disc decompression for disc herniations. As with any systematic review, one of the main limitations is having heterogeneous patient selection criteria and non-standardized outcome measures across the studies.

Since this paper was published in 2013, Brouwer et al (Spine 2015) published the results of a randomized control trial for percutaneous laser disc decompression versus conventional microdiscectomy for sciatica. This study included 115 subjects and utilized the Roland-Morris Disability Questionnaire, Visual Analog Scale, and patient’s perceived recovery as the outcome measures. Patients in the conventional microdiscectomy group did recover faster and the number of reoperations was more than double for the percutaneous laser disc group (38% vs 16%). The overall results showed noninferior outcomes for percutaneous laser disc decompression at 1 year. As noted by the editors, the conventional approach included either an open approach or microscope assisted. The results are questioned as the initiation of the study was 10 years prior to publication. A trial utilizing modern minimally invasive discectomy approaches may have produced a different outcome.