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Failed Percutaneous Laser Disc Decompression : Multi-center Questionnaire Survey of University Hospitals Basis in the Kinki District of Japan Riya Kosaka 1 , Muneaki Abe 1 , Takumi Yonezawa 1 1Department of Orthopedic Surgery, Osaka Medical College Keyword: questionnaire , アンケート調査 , PLDD , 経皮的レーザー椎間板減圧法 , complication , 合併症 pp.603-610
Published Date 2004/4/1
DOI https://doi.org/10.11477/mf.1408100437
  • Abstract
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 In accordance with an increasing number of patients receiving percutaneous laser disc decompression (PLDD) in Japan, several reports of unsatisfactory outcomes have been emerging for the past 5-6 years. To detect the clinical background of unsatisfactory cases, we conducted a questionnaire survey for doctors who managed patients after failed PLDD performed at the other private hospitals. Clinical data of 74 patients was collected and was retrospectively analyzed. The most common cause of failure in PLDD was inappropriate preoperative diagnosis and/or indication which included non-contained disc, lateral recess stenosis and segmental instability in 44 of 74 patients (59.5%). Second major cause of failure was perioperative complication. A particular complication specific to PLDD procedure was end-plate injury adjacent to the disc with or without bone necrosis on MRI, which was presumably caused by thermal damage (35 of 74 patients). Some patients was primarily treated with PLDD by anesthesiologist or general surgeon ; unspecialized doctors to spine surgery. To achieve a satisfactory outcome of PLDD, special attentions should be paid to precise technique of needle placement, an appropriate regulation of laser energy, adequate preoperative diagnosis, adherence to strict therapeutic indication, precaution for possible complications and prompt decision making for salvage surgery, if required.


Copyright © 2004, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1286 印刷版ISSN 0557-0433 医学書院

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