Laser technologies are among the innovative methods offered by modern medicine for the treatment of lumbar and cervical disc herniation. Low‑Level Laser Therapy (LLLT) and Percutaneous Laser Disc Decompression (PLDD) are minimally invasive approaches that aim to improve patients’ quality of life. LLLT is noted for its pain‑reducing effects, while PLDD alleviates pressure caused by the herniation and provides functional improvement.
| Definition | – A minimally invasive treatment method that uses laser energy to reduce intradiscal pressure and relieve nerve root compression. A portion of the disc tissue is vaporized, thereby reducing the disc’s volume. |
| Indications | – Radicular pain due to lumbar or cervical disc herniation (pain radiating to the leg or arm) – Mild to moderate disc herniations that do not respond to conservative treatments (medication, physical therapy) – Pain associated with nerve root compression |
| Procedure | – Performed under local anesthesia. – Under fluoroscopic or CT guidance, a needle is inserted into the disc. – A laser fiber is advanced through the needle into the disc. – Laser energy is applied to heat and vaporize the disc tissue. – The disc shrinks, reducing pressure on the nerve root. |
| Advantages | – Minimally invasive – Does not require general anesthesia – Provides a rapid recovery time – Carries a low risk of complications – No need for a surgical incision |
| Risks and Complications | – Mild pain or discomfort – Infection (rare) – Nerve injury (very rare) – Continued pain due to insufficient disc shrinkage |
| Success Rate | – With proper patient selection, pain reduction can be achieved in 70–85% of cases. |
| Preparation | – Patients should inform their doctor about any blood-thinning medications. – Fasting is generally required prior to the procedure. – The herniated disc is evaluated using MRI or CT imaging. |
| Procedure Duration | – Typically around 30 minutes. |
| Recovery | – Patients are usually discharged about 2 hours after the procedure. – Light daily activities can be resumed within 1–2 days. – Avoid heavy lifting and strenuous physical activities for several weeks. |
| Alternative Methods | – Nucleoplasty – Microdiscectomy – Epidural steroid injections – Conservative treatments (physical therapy, medications) |
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
What Is Laser Therapy for Disc Herniation and How Does It Work?
Disc herniation (lumbar and cervical) is a condition in which the structural integrity of the intervertebral discs is compromised, causing pressure on the nerve roots that results in pain, numbness, and loss of function. Laser therapy is a modern, minimally invasive approach that targets this problem using two primary techniques: Percutaneous Laser Disc Decompression (PLDD) and Low‑Level Laser Therapy (LLLT). Additionally, High‑Intensity Laser Therapy (HILT), which uses higher-powered lasers, is emerging as an effective option.
PLDD aims to reduce the pressure within a herniated disc. Under imaging guidance, a needle is advanced into the disc, and laser energy is delivered to the disc nucleus. This energy vaporizes part of the nucleus, reducing the disc’s volume and thereby decreasing pressure on the nerve roots, which in turn alleviates pain. PLDD is characterized by a low complication rate and high success percentages (75–87%).
LLLT, on the other hand, utilizes the biochemical effects of laser light to reduce pain and inflammation. It accelerates cellular metabolism, promotes tissue repair, and helps control inflammation.
HILT penetrates deeper tissues and combines thermal and photochemical effects. By increasing oxygenation, it accelerates the healing process and is particularly effective in managing chronic pain and motor function disorders.
How Effective Is Laser Therapy in the Treatment of Lumbar Disc Herniation?
In recent years, laser therapy has emerged as an innovative approach in the treatment of lumbar disc herniation. Methods such as Low‑Level Laser Therapy (LLLT), Percutaneous Laser Disc Decompression (PLDD), and High‑Intensity Laser Therapy (HILT) are used as minimally invasive options to alleviate pain and improve quality of life.
Studies on LLLT have shown that it is effective in reducing back and leg pain. For instance, a meta-analysis conducted in 2023 demonstrated that LLLT provides significant improvements in pain and disability compared to inactive controls; however, it was noted that the evidence is based on low to moderate quality studies and further high-quality research is needed. LLLT has been observed to be more effective in pain control when combined with traditional treatments.
PLDD has been performed approximately 35,000 times worldwide since 2006 and stands out as an alternative to surgery for lumbar disc herniation. Although it offers a shorter recovery time, there is ongoing debate about its efficacy due to a lack of randomized controlled trials. A review from 2009 indicated that PLDD is moderately effective in both short‑ and long‑term pain control.
HILT may offer significant benefits on muscle strength and motor functions. A study in 2024 showed that HILT increased muscle strength and reduced the risk of falls compared to standard rehabilitation. This method holds promise, especially for patients with functional impairments.
Can Laser Therapy Alleviate Symptoms of Cervical Disc Herniation?
Cervical disc herniation is a condition characterized by severe pain, limited movement, and functional impairment that can significantly affect daily life. Among the modern treatment options available, High‑Intensity Laser Therapy (HILT) is notable as a minimally invasive method. It aims to increase blood circulation, reduce inflammation, and relieve pain. Research has demonstrated that HILT is an effective option for pain management, and when combined with exercise, it provides significant benefits.
Studies comparing HILT with traditional modalities such as ultrasound (US) and transcutaneous electrical nerve stimulation (TENS) have shown comparable outcomes in pain relief. Randomized controlled trials have also demonstrated that laser therapy not only reduces pain but also improves neck range of motion (ROM). Patients treated with laser therapy have reported significant improvements in quality of life and functional activity measures.
Additionally, laser therapy is noted for its safety profile. The infrequent occurrence of side effects makes it a safe alternative for individuals with cervical disc herniation. Multicenter clinical trials have confirmed that laser therapy offers similar efficacy to physical therapy in alleviating cervical disc herniation symptoms.
What Are the Advantages of Laser Therapy Over Traditional Treatments for Disc Herniation?
Laser therapy offers several innovative approaches in the treatment of disc herniation. Unlike traditional surgical methods, laser treatments are minimally invasive, using fine needles instead of large incisions. Percutaneous Laser Disc Decompression (PLDD), in particular, directs laser energy directly to the damaged disc, relieving pressure and reducing pain. This minimally invasive nature significantly lowers the risk of surgical complications, thereby enhancing patient safety.
Laser therapy is also advantageous due to the lower incidence of complications such as infections and excessive bleeding. Furthermore, the preservation of surrounding tissues during and after the procedure accelerates the recovery process, allowing patients to return to their daily activities more quickly.
In terms of pain control, laser therapy significantly improves both back and leg pain, thereby enhancing quality of life. Its positive effects on motor function disorders further attest to its effectiveness. The economic advantages are also noteworthy; reduced hospital stays and quicker return to work help lower overall treatment costs.
The high precision offered by laser technology allows for targeted treatment of damaged tissue while minimizing the risk of harming adjacent structures, making it an attractive option for disc herniation treatment.
Are There Any Risks or Side Effects Associated With Laser Therapy for Disc Herniation?
Laser treatment for disc herniation (PLDD) is a minimally invasive procedure that provides an alternative to surgery. However, like any medical procedure, there are certain risks and side effects to consider. The infection risk is minimal—typically limited to the needle insertion site—and the incidence is below 1%, which can be prevented with proper sterilization techniques.
The risk of bleeding is a rare side effect of laser therapy. Minor bleeding may occur during needle placement, but serious bleeding is extremely unlikely (less than 0.5%). The risk of nerve injury is also very low and is usually associated with needle contact with the nerve root; such effects are generally temporary.
Discitis (infection of the disc space) is very rare (with a risk below 0.3%). Additionally, recurrence of symptoms after treatment has been reported in 5–10% of cases, a rate similar to that seen with traditional surgical methods. Complications such as spinal instability are also rare, given the minimally invasive nature of the procedure.
Who Is the Ideal Candidate for Laser Therapy in Disc Herniation?
Laser therapy, particularly Percutaneous Laser Disc Decompression (PLDD), is a minimally invasive option for treating lumbar and cervical disc herniation. It is most effective in patients with contained disc herniation (where the nucleus pulposus has not breached the annulus fibrosus), also known as “closed disc herniation.” In this group, success rates range from 70% to 89%.
When assessing candidates for PLDD, the duration of symptoms is an important criterion; patients with chronic sciatica lasting more than eight weeks are considered eligible. Age is also considered, with the method typically being suitable for individuals between 18 and 70 years old. The size of the herniation is a critical evaluation point; ideal candidates have a herniation that occupies less than one-third of the spinal canal.
Furthermore, candidates for PLDD should not have disc sequestration (free fragments of disc material) and should not have coexisting spinal disorders such as severe deformities or lateral recess stenosis, as these may negatively affect treatment outcomes. Patients who have not responded to conservative treatments (physical therapy, medications) and those who have had limited surgical intervention in the past tend to benefit most from this treatment.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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