Advertisement

The Role of Radiology in Percutaneous Laser Disc Decompression

  • John A. Botsford
Chapter
  • 137 Downloads

Conclusion

Diagnostic radiology plays a major but formerly underemphasized role in the diagnosis and treatment of the PLDD patient. Laser treatment success rates can be improved when patient selection is based on preoperative diagnostic imaging performed by physicians knowledgeable in the specific needs of the PLDD candidate. A clear understanding of fundamental radiologic principles combined with state of the art intraoperative imaging will result in rapid, accurate positioning of the laser of choice within the central nucleus, optimizing the chances for symptomatic improvement by PLDD. When treatment fails, diagnostic imaging modalities can usually identify the reason for failure or uncover a postoperative complication.

Keywords

Disc Herniation Lumbar Disc Herniation Herniate Nucleus Pulposis Magnetic Resonance Appearance Recurrent Disc Herniation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Botsford JA. Radiological considerations: percutaneous laser disc decompression. J Clin Laser Med Surg 1993;11(5):223–231.PubMedGoogle Scholar
  2. 2.
    Botsford JA. The role of radiology in percutaneous laser disc decompression. J Clin Laser Med Surg 1995;13(3):173–186.PubMedGoogle Scholar
  3. 3.
    Adams MA, Hutton WC. Mechanics of the intervertebral disc. In: Ghosh P, ed. The Biology of the Intervertebral Disc. Boca Raton, FL: CRC Press; 1989.Google Scholar
  4. 4.
    Nachemson, A. Disc pressure measurement. Spine 1981;6:93–97.PubMedGoogle Scholar
  5. 5.
    Choy DSJ. Intervertebral disc pressure as a function of fluid volume infused. Spine 1993;7(1) (state-of-the-art review: laser discectomy): 11–15.Google Scholar
  6. 6.
    Onik G, Helms CA, Ginsberg L, Hoaglund FT, Morris J. Percutaneous lumbar discectomy using a new aspiration probe. AJR Am J Roentgenol 1985;144:1137–1140.PubMedGoogle Scholar
  7. 7.
    Brock M, Gorge H, Curio G. Intradiskal pressure volume response: a methodological contribution to chemonucleolysis. J Neurosurg 1984;60:1029–1032.PubMedGoogle Scholar
  8. 8.
    Choy DSJ, Altman P. Fall of intradiscal pressure with laser ablation. Spine 1993;7(1) (state-of-the-art review: laser discectomy):23–29.Google Scholar
  9. 9.
    Botsford JA. Radiological considerations: patient selection for percutaneous laser disc decompression. J Clin Laser Med Surg 1994;12(5): 255–259.PubMedGoogle Scholar
  10. 10.
    Thornbury JR, Fryback DG, Turski PA, et al. Disk-caused nerve compression in patients with acute low back pain. Diagnosis with MR, CT myelography, and plain CT. Radiology 1993;186:731–738.PubMedGoogle Scholar
  11. 11.
    Firooznia H, Benjamin V, Kricheff II, et al. CT of the lumbar spine disc herniation: correlation with surgical findings. AJR Am J Roentgenol 1984;142:587–592.PubMedGoogle Scholar
  12. 12.
    Modic MT, Masaryk TJ, Boumphrey F, et al. Lumbar herniated disc disease and canal stenosis: prospective evaluation by surface coil MR, CT, and myelography. AJR Am J Roentgenol 1986;147:757–765.PubMedGoogle Scholar
  13. 13.
    Thornbury JR, Fryback DG, Lawrence WF, et al. Reply: diagnostic accuracy, patient outcome, and economic factors in lumbar radiculopathy. Radiology 1994;190:21–30.Google Scholar
  14. 14.
    Schellinger D, Manz HJ, Vidic B, et al. Disc fragment migration. Radiology 1990;175:831–836.PubMedGoogle Scholar
  15. 15.
    Haughton VM. MR imaging of the spine. Radiology 1988;166:297–301.PubMedGoogle Scholar
  16. 16.
    Modic MT, Masaryk TJ, Ross JS, Carter JS. Imaging of degenerative disc disease. Radiology 1988;168:177–186.PubMedGoogle Scholar
  17. 17.
    Ross JS, Tkach J, VanDyke C, Modic MT. Clinical MR imaging of degenerative spinal disease: pulse sequences, gradient-echo techniques, and contrast agents. J Magn Reson Imaging 1991;1:29.PubMedGoogle Scholar
  18. 18.
    Ross JS, Modic MT. Current assessment of spinal degenerative disease with magnetic resonance imaging. Clin Orthop Rel Res 1992;279: 68–81.Google Scholar
  19. 19.
    Greenspan, A. CT discography vs MRI in intervertebral disk herniation. Appl Radiol March 1993:34–40.Google Scholar
  20. 20.
    Joubert JM, Laredo JD, Ziza JM, et al. Gadolinium-enhanced MR imaging in the preoperative evaluation of lumbar disc herniations. Presented at the 78th Scientific Assembly and Meeting of the Radiological Society of North America; November 29-December 4, 1992; Chicago. Abstract 304.Google Scholar
  21. 21.
    Boden SD, David DO, Dina TS, et al. Postoperative diskitis: distinguishing early MR imaging findings from normal postoperative disc space changes. Radiology 1992;184:767–771.Google Scholar
  22. 22.
    Georgy BA, Hesselink JR. Gadolinium-enhanced fat suppression MR imaging of the postoperative back. Presented at the 78th Scientific Assembly and Meeting of the Radiological Society of North America; November 29-December 4, 1992; Chicago. Abstract 303.Google Scholar
  23. 23.
    Ross JS, Delamarter R, Hueftle MG, et al. Gadolinium-DTPA enhanced MR imaging of the post-operative lumbar spine: time course and mechanism of enhancement. Am J Neuroradiol 1989;10:37–46.Google Scholar
  24. 24.
    Schellinger D, Manz HJ, Vidic B, et al. Disc fragment migration. Radiology 1990;175:831–836.PubMedGoogle Scholar
  25. 25.
    Modic MT, Ross JS. Morphology, symptoms, and causality. Radiology 1990;175:619–620.PubMedGoogle Scholar
  26. 26.
    Bozzao A, Gallucci M, Masciocchi C, et al. Lumbar disk herniation: MR imaging assessment of the natural history in patients treated without surgery. Radiology 1992;185:135–141.PubMedGoogle Scholar
  27. 27.
    Edwards WC, Orme TJ, Orr-Edwards G. CT discography: prognostic value in the selection of patients for chemonucleolysis. Spine 1987;12:792–795.PubMedGoogle Scholar
  28. 28.
    Botsford JA. CT discography: prognostic value in patient selection for percutaneous laser disc decompression (PLDD). Presented at the 94th Annual Meeting of the American Roentgen Ray Society; April 24–29, 1994; New Orleans. Abstract 265.Google Scholar
  29. 29.
    Bernard TN. Lumbar discography followed by computed tomography. Spine 1990;15:690–707.PubMedGoogle Scholar
  30. 30.
    Milette PC, Melanson D. Lumbar discography. Radiology 1987;163: 828–829.PubMedGoogle Scholar
  31. 31.
    Vanharanta H, Ska BE, Spivey MA, et al. The relationship of pain provocation to lumbar disc deterioration seen by CT discography. Spine 1987;12:295–298.PubMedGoogle Scholar
  32. 32.
    Walsh TR, Weinstein JN, Spratt KF, et al. Lumbar discography in normal subjects. J Bone Joint Surg Am 1990;72(7):1081–1088.PubMedGoogle Scholar
  33. 33.
    Collins CD, Stack JP, O’Connell DJ, et al. The role of discography in lumbar disc disease: a comparative study of magnetic resonance imaging and discography. Clin Radiol 1990;42:252–257.PubMedCrossRefGoogle Scholar
  34. 34.
    Kornberg, M. Discography and magnetic resonance in the diagnosis of lumbar disc disruption. Spine 1989;14:1368–1372.PubMedGoogle Scholar
  35. 35.
    Collis JS Jr, Gardner WJ. Lumbar discography: analysis of 600 degenerated discs and diagnosis of degenerative disc disease. JAMA 1961;178:167–170.Google Scholar
  36. 36.
    Collis JS Jr, Gardner WJ. Lumbar discography: an analysis of one thousand cases. J Neurosurg 1962;19:452–461.PubMedCrossRefGoogle Scholar
  37. 37.
    Goldie I. Changes observed in the intervertebral disc after discography. Acta Pathol 1958;42:193–197.Google Scholar
  38. 38.
    Seidenwurm D, Russel EJ, Hambly M. Diagnostic accuracy, patient outcome, and economic factors in lumbar radiculopathy. Radiology 1994;190:21–30.PubMedGoogle Scholar
  39. 39.
    Choy DSJ, Ascher PW, Saddekni S, et al. Percutaneous laser disc decompression. Spine 1992;17:949–956.PubMedGoogle Scholar
  40. 40.
    Hijikata S, Yamagishi M, Nakayama T, Oomori K. Percutaneous diskectomy: a new treatment for lumbar disc herniation. J Toden Hosp 1975;5:5–13.Google Scholar
  41. 41.
    Choy DSJ. The problem of the L5-S1 disc solved by needle entry with an extrathecal approach. J Clin Laser Med Surg 1994;12(6): 321–324.PubMedGoogle Scholar
  42. 42.
    Hueftle MG, Modic MT, Ross JS, et al. Lumbar spine: postoperative MR imaging with Gd-DTPA. Radiology 1988;167:817–824.PubMedGoogle Scholar
  43. 43.
    Soitropoulos S, Chafetz NI, Lang P, et al. Differentiation between postoperative scar and recurrent disc herniation: prospective comparison of MR, CT, and contrast enhanced CT. Am J Neuroradiol 1989;10:639–643.Google Scholar
  44. 44.
    Bundschuh CV, Modic MT, Ross JS, Masaryk TJ, Bohlman H. Epidural fibrosis and recurrent disc herniation in the lumbar spine: MR imaging assessment. Am J Neuroradiol 1988;9:169–178.Google Scholar
  45. 45.
    Boden SD, Davis DO, Dina TS, et al. Contrast enhanced MR imaging performed after successful lumbar disk surgery: prospective study. Radiology 1992;182:59–64.PubMedGoogle Scholar
  46. 46.
    Dina TS, Boden SD, David DO. Lumbar spine after surgery for herniated disk: imaging findings in the early postoperative period. AJR Am J Roentgenol 1995;164:665–671.PubMedGoogle Scholar
  47. 47.
    Kosaka R, Abe M, Yonezawa T, Ichimura Y, Onomura T. Bone necrosis adjacent to the disc after percutaneous laser disc decompression—an analysis of magnetic resonance imaging. In: Gerber BE, Knight M, Siebert WE, eds. Lasers in the Musculoskeletal System. Berlin: Springer-Verlag; 2001:345–350.Google Scholar
  48. 48.
    Botsford JA. Potential operative complications of percutaneous laser discectomy. In: Gerber BE, Knight M, Siebert WE, eds. Lasers in the Musculoskeletal System Berlin: Springer-Verlag; 2001:351–356.Google Scholar
  49. 49.
    Gundry CR, Heithoff KB. Epidural hematoma of the lumbar spine: 18 surgically confirmed cases. Radiology 1993;187:427–431.PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 2003

Authors and Affiliations

  • John A. Botsford

There are no affiliations available

Personalised recommendations

Cite chapter

Buy options