69 Laser and Ozone Spinal Decompression
Introduction
Low back pain is one of the most frequent chief complaints in medical practices. Approximately 80% of the populations of Western countries will suffer from at least one episode of low back pain in their life. Pain is often characterized as either radicular or postural. While radicular pain is often due to an offending disc herniation, the etiology of low back pain is poorly understood. Proposed pathogenesis includes both mechanical and inflammatory mechanisms, including deformation of the annulus, stimulation of the nociceptive components of the spinal root, ischemia, venous stasis, prostaglandins, and cell-mediated immune response.1 Various surgical procedures have been utilized to address the treatment of low back pain. These include both motion-sparing and fusion interventions. While these procedures have excellent short-term effects, they have been linked to longer-term complications including recurrent disc herniation, postoperative scarring, and adjacent motion segment disease. As a result, less invasive procedures have been developed. Two such procedures, laser spinal decompression and ozone chemodiscolysis, have shown significant promise.
Laser Decompression
Peter Choy and David Asher were the first to use laser energy to evaporate disc material in 1986. Their initial results were poor, but subsequent studies have had good to excellent outcomes in upto 80% of patients.2 While various different lasers have been described, most of them use approximately 1200 joules per disc in a pulsatile manner. The principles of treatment are based on the hypothesis that the intervertebral disc functions as a closed hydraulic system. Thus, an increase in water content within the disc increases the pressure, as a result of the inelastic annulus fibrosus. The energy from the laser seeks to evaporate intradiscal material to decrease intradiscal pressure. Furthermore, the energy is hypothesized to denature and renature proteins, causing irreversible changes to the structure of the disc and its ability to rehydrate.3
