Comparing Nucleotomy and Percutaneous Laser Disc Decompression for Lumbar Disc Herniation: A Review Article

Chronic low back pain and sciatica caused by intervertebral disc herniation are among the leading causes of disability and healthcare utilization worldwide. Effective management of lumbar disc herniation is crucial, encompassing medical therapy, physiotherapy, and interventional procedures. Nucleotomy, the gold standard for decades, directly removes herniated disc material but carries risks such as infection and adjacent segment disease. Recently, percutaneous laser disc decompression (PLDD), a minimally invasive technique, has gained prominence due to its favorable safety profile, reduced recovery times, and efficacy in selected cases. PLDD employs laser energy to vaporize the nucleus pulposus, reducing intradiscal pressure and alleviating nerve compression. This review critically compares nucleotomy and PLDD, focusing on their techniques, indications, outcomes, and complications. While nucleotomy is preferred for complex herniations, PLDD is effective for smaller, contained cases, with success heavily reliant on patient selection. The integration of nutraceuticals with PLDD represents a promising innovation, enhancing neuroprotection and pain management. With a growing emphasis on minimally invasive solutions, PLDD offers a cost-effective alternative for patients seeking less invasive options. This discussion aims to guide clinicians and patients in selecting the most appropriate treatment while exploring advancements shaping the future of spinal care.

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Keywords: ، Chronic low back pain ، intervertebral disc herniation ، nucleotomy ، percutaneous laser disc decompression ، Minimally Invasive ، Pain management