1. 2013;16;SE229-SE260Percutaneous Lumbar Laser Disc Decompression: An Update of Current Evidence
   Systematic Review
   Steven P. Cohen, MD, Joshua A. Hirsch, MD, David L. Caraway, MD, Frank J.E. Falco, MD, Laxmaiah Manchikanti, MD, Aaron K. Calodney, MD, Peter S. Staats, MD, and Vijay Singh, MD.

BACKGROUND: Since the descriptions by Mixter and Barr of surgical treatment for rupture of the intervertebral disc in 1934, open surgical procedures have become a common practice. Disc herniations are often classified as being contained or non-contained. The results of open surgical discectomy for contained disc herniation have been poor. Consequently, several  less invasive techniques have been developed including percutaneous lumbar laser disc decompression.

STUDY DESIGN:  A systematic review of the literature of percutaneous lumbar laser disc decompression.

OBJECTIVE:  The objective of this systematic review is to evaluate and update the clinical effectiveness of percutaneous lumbar laser discectomy in managing radicular pain secondary to contained disc herniation.

METHODS: The available literature on lumbar laser disc decompression in managing chronic low back and lower extremity pain was reviewed. Quality assessment and clinical relevance of randomized trials were graded according to the Cochrane Musculoskeletal Review Group criteria for interventional techniques, and observational studies according to the Newcastle-Ottawa Scale criteria.
The level of evidence was classified as good, fair, and limited or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF).
Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to September 2012, and manual searches of the bibliographies of known primary and review articles.

OUTCOME MEASURES:  Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return-to-work.
Short-term effectiveness was defined as effectiveness lasting one year or less, whereas, long-term effectiveness was defined as benefit persisting for greater than one year.

RESULTS: Based on USPSTF criteria, the indicated level of evidence for percutaneous lumbar laser disc decompression is limited for short- and long-term relief.

LIMITATIONS:  Although laser discectomy has been utilized for many years, there is a paucity of randomized clinical trials.

CONCLUSION:  This systematic review shows limited evidence for percutaneous lumbar laser disc decompression.