NCBI Bookshelf. Khangura S, Ryce A. A total of 83 citations were identified in the electronic database search. Following the screening of titles and abstracts, 48 citations were excluded and 35 potentially relevant reports were selected for full-text review. In addition, the grey literature search identified two potentially relevant publications.
Also cutting edge technologies, such as high-vision camera, monitor, Laser and radio-frequency-wave are used. NCBI Bookshelf. Khangura S, Ryce Disk bulge laser. Lasers may also be best for shrinking disc material around a nerve. Read on to learn about these….
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Treatment Options. An endoscopic foraminotomy is Disk bulge laser as an outpatient treatment with the client being motivated Disk bulge laser walk following the procedure. Share on Twitter Tweet. How many days of work did you miss? Other conservative strategies may include the placement of a spinal cord stimulator—or STIM—which is designed not to correct the underlying degeneration, but to lessen the pain the condition causes. Share on Pinterest Pin it. Different people refer to bulging discs in different Nurse credentialing research coalition. Amount on Over-the-counter meds. What are the Common Massage Therapy Techniques? Tap here to get started. How are Bulging Discs treated?
A disc bulges when the outer layer of a vertebral disc swells outward and places pressure on the surrounding nerves and structures.
- To understand what a bulging or herniated disc is, we first need to understand the basic structure of an intervertebral disc.
- When a bulging disc first occurs, it may not be immediately apparent due to the lack of nerves it touches.
- Bulging discs are quite common, especially as people age.
- A disc bulges when the outer layer of a vertebral disc swells outward and places pressure on the surrounding nerves and structures.
PELD is indicated for both mild or severe disc herniation. This scope can provide clear vision by magnifying up to x A herniated disc can be removed through a 6mm-diameter cannula by using a 3mm micro-forceps with the help of a special microendoscope.
Also cutting edge technologies, such as high-vision camera, monitor, Laser and radio-frequency-wave are used. The surgery is performed under local anesthesia and usually takes an hour. You can walk three hours after surgery and requires to stay one night. The surgical incision is just 6 mm and requires no stitch, just a bandade. This technique is the mildest surgery for lumbar disc herniation. Discharge the next day. Micro-forceps Herniated disc is removed by a 3 mm micro-forceps under endoscopic visualization.
Micro-forceps The position of the forceps is secured under fluoroscopy. Radio frequency wave is used to stop bleeding. This tool can be used outside disc. Before surgery.
Right after PELD. One month after PELD. Additional examination for LDH An additional examination may be needed to make a precise diagnosis. But there is a possibility that some pain may remain and numbness may prolong.
I have a scheduled surgery in December. It can occur in your lumbar spine lower back , thoracic spine upper and mid-back or your cervical spine neck. As people age, the spinal discs lose fluid and become less resilient, which can lead to bulging discs; in addition, athletes, pregnant women, and obese people are particularly prone to bulging discs. Muscles, ligaments, and tendons link each vertebrae to the next. By getting rid of the particles, a compressed nerve is launched, and unpleasant symptoms are alleviated.
Disk bulge laser. Treatment Options
Dr. Gott: Laser procedure for bulging discs | The Spokesman-Review
NCBI Bookshelf. Khangura S, Ryce A. A total of 83 citations were identified in the electronic database search.
Following the screening of titles and abstracts, 48 citations were excluded and 35 potentially relevant reports were selected for full-text review. In addition, the grey literature search identified two potentially relevant publications. Full-text review of the resulting 37 potentially relevant sources identified 32 that were ineligible for various reasons and excluded from this review.
Additional references of potential interest are provided in Appendix 5. One eligible health technology assessment HTA in the form of a rapid HTA report ; two randomized controlled trials RCTs and; one evidence-based guideline were eligible for inclusion in this review. No studies of cost-effectiveness were identified. Additional details describing the characteristics of included studies are reported in Appendix 2.
The rapid HTA report identified nine clinical studies and four eligible guidelines. Of the guidelines, one overlapped with the guideline identified in the current review. Two of these nine clinical studies overlapped with those identified as eligible studies within the current review one systematic review 8 and one RCT 7.
Because the overlapping systematic review 8 was described by the authors of the rapid HTA, we excluded it from this review. Conversely, the overlapping guideline 15 and RCT 7 were both retained in this review to allow for full-text retrieval and data abstraction. Abrishamkar and colleagues studied plasma-laser nucleoplasty in patients with herniated lumbar disc in one centre; 12 while Brouwer and colleagues studied PLDD in patients with sciatica due to herniated disc across eight centres.
Block randomization was used in both trials; however, blinding to treatment allocation was not possible in either study due to the nature of the intervention e. The primary outcome in the Abrishamkar trial was pain measured using a numeric pain scale rating i. The non-inferiority margin in the Abrishamkar et al. In the Brouwer et al. Both trials also reported on secondary outcomes, including measures of function, surgical complications and the proportion of patients requiring re-operation.
Brouwer and colleagues specified that secondary outcomes were analyzed for superiority, rather than non-inferiority as with the primary outcomes. Finally, both studies used a repeated-measure ANOVA to analyze data on the primary outcome at various time points, ending at one-year of follow-up. Several methodological limitations were noted of the rapid HTA. For instance, neither a protocol, nor a priori methods were referenced and no description of source selection or explicit rationale for the exclusion of studies was reported.
The RCTs by Abrishamkar et al. Both described study power calculations — including an explanation of the expected variability in the primary outcome. Treatment assignment was randomized in both studies; though, the Brouwer et al.
Length of follow-up was consistent for all patients in each arm of the trial, and some findings were described clearly in both reports — including observed surgical complications.
Additional strengths specific to the Brouwer study included: a detailed description of the surgical interventions under study, and a report of loss to follow-up. As well, neither study addressed the possibility of potentially confounding variables. Abrishamkar and colleagues neither described the surgical interventions, nor the primary outcome measure in detail, and; a lack of clarity was noted with regard to the description of the design as a non-inferiority trial as opposed to the report of findings which describes comparative effectiveness and, the number of patients included in the study.
In addition, Abrishamkar et al. Importantly, neither RCT clearly reported or addressed some of the important considerations that non-inferiority trial designs impose on the interpretation of study findings.
Abrishamkar et al. Further, the authors of the Abrishamkar et al. Similarly, while Brouwer and colleagues were transparent about a protocol revision from an efficacy to a non-inferiority trial design based on lower-than-expected recruitment , important features of the limitations of non-inferiority trials were likewise not described in sufficient detail.
The ASIPP clinical guideline stated a clear objective, research questions, target population and intended users.
Specifically, they employed a series of systematic reviews of the literature and included sufficient detail when describing the methods used to search and identify relevant evidence. An expert working group was assembled, and levels of evidence were assigned to sources included in the development of recommendations.
Finally, conflicts of interest for the guideline authors were reported. Relevant and common measures of clinical effectiveness included pain, function and proportions of patients requiring re-operation.
Pain was a primary outcome in both of the RCTs included in this review, 7 , 12 however, both trials sought to establish non-inferiority of the experimental laser surgical approach compared with conventional, open surgery.
In the Abrishamkar et al. However, at 3-months and one-year follow up, radicular pain scores were statistically significantly higher in patients who had undergone plasma-laser nucleoplasty as compared to those who underwent conventional, open surgery.
The Brouwer et al. Finally, the authors emphasized a significantly higher proportion of patients who required re-operation in the PLDD group compared to the conventional surgery group. As it concerns self-reported functional disability, the Brouwer et al. The investigators also measured function as a secondary outcome using the Prolo and SF Scales, reporting no significant difference in patient function between groups at all time points throughout study follow-up.
With regard to surgical complications, Abrishamkar and colleagues reported no cases of infection or discitis in either the plasma-laser nucleoplasty or conventional, open surgery groups. The guideline included in this review did not make any recommendation with regard to the use of PLDD, other than to state that the evidence informing its use is limited. Importantly however, this guideline was published in , prior to the publication of the two RCTs described within this report.
While the relatively recent publication of two RCTs contributes toward narrowing the clinical evidence gap in this area, neither trial was designed to establish the comparative clinical effectiveness of laser spine surgical approaches against conventional surgical approaches; rather, both studies concluded that the laser spine surgical approaches under study were non-inferior to open, conventional surgery.
Finally, the guideline that was included in this review was unable to establish any recommendation regarding PLDD based on a lack of high-quality evidence. The copyright and other intellectual property rights in this document are owned by CADTH and its licensors.
These rights are protected by the Canadian Copyright Act and other national and international laws and agreements. Users are permitted to make copies of this document for non-commercial purposes only, provided it is not modified when reproduced and appropriate credit is given to CADTH and its licensors.
Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial-NoDerivatives 4. Turn recording back on. National Center for Biotechnology Information , U. Show details Khangura S, Ryce A. Search term. Summary of Evidence. Quantity of Research Available A total of 83 citations were identified in the electronic database search.
Summary of Study Characteristics One eligible health technology assessment HTA in the form of a rapid HTA report ; two randomized controlled trials RCTs and; one evidence-based guideline were eligible for inclusion in this review. Summary of Findings 1.