Percutaneous Laser Discectomy ~> question

[skidoo]

Whether you call it Percutaneous Laser Disc Decompression, or Discoplasty, or Discectomy, or PLDD, from what I've read so far, it's all the same thing.

I've sent my MRI to Dr Choy in New York (inventor of this technique 25 years ago), he's reviewed it and said i would be a good candidate but would need it on 3 discs... ugh! At least the herniation seems to be 'contained' (no fragments outside the discs) and my stenosis is milder than they thought.

So yeah, I'm a good candidate, but I have no insurance and the cost of PLDD for 3 discs with Dr Choy would be around $23,000. Plus frankly, Dr Choy is almost 80 years old, about to take his retirement and it takes place in NYC, so i'd have to add the cost of 2 R/T tickets (1 for first consultation and 1 for actual PLDD) and one night in hotel since you're supposed to see Dr Choy the day after the procedure. So I guess i'll be close to 25 grands total. I can certainly take a loan or ask my father, but I'd rather not, and being handles by likely shaky hands is a concern to me, sine this operation requires a lot of precision.

So I did my homework and started to look for a Doctor in the area here in south Florida who would perform Percutaneous Laser Disectomy , but I was able to find only 3 so far:

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- LASER SPINE INSTITUTE (in Tampa, FL):
> Laser Spine Orthopedic Surgery | Spinal Back Surgery Experts

Some call them crooks because they charge also around 25K and that's for just 1 disc. What they do is sugar-coat their package with a 5-day visit to their 5-star marble-floored facility (sounds like a cruise to the Caribbeans) with some bullshit seminar, preparation etc... while really, this is an operation that takes 45 minutes as an outpatient and normally you should be able to go back home right after the procedure. But I guess they need to justify the price. My primary doctor had a patient who got treatment from there and it worked, but you need to know that they use a slightly different technique than Dr Choy: they use the Ho:YAG laser and an endoscope so the diameter of the opening is slightly larger (2.5mm vs 1mm) and transfers more heat than Choy's technique (who uses the Nd:YAG laser). Source: 23rd anniversary of percutaneous laser disc decompression | Medicine & Health > Medical Treatments & Procedures from AllBusiness.com

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- MIAMI PAIN CLINIC (in Miami, FL):
> Miami Pain Clinic | Home

The first thing that strikes me with this facility is the website's domain name... "Thunder Man the Movie".... really? What is that all about?... weird, hu? Unlike for the Spine Institute, Miami Pain Clinic's website doesn't look very fancy or even professional, but heck, who cares... what's important is the doctor's skills, right? So I did a bit of research and found out Dr Osmin Morales is not even a Neurologist nor a Neurosurgeon, but a simple anesthesiologist. Plus, it's a PAIN CLINIC... in Florida... if you see what I mean... so I'm a bit doubtful. But still I called and inquired about their price, and it would cost approx. $1,200/disk + $1,900 for the equipment (I assume they rent this Laser device). Wow, that's almost 5 times cheaper than Dr Choy in NYC or the Laser Institute! Does that mean the service would be plain awful? Hard to say. I'd need to visit the place. From the reviews i've read about Morales on Healthgrades.com and Vitals.com, it seems like this facility is the big meeting-point of all Miami's junkies. But maybe those reviews come from competitors or angry patients, you never know. So I might give it a shot and at least visit the place and talk to Morales, even though the initial visit will cost me $400 for a simple MRI report review. I'm curious to see if he says the same thing as Dr Choy.

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- SPACE COAST PAIN INSTITUTE (in Merritt Island, FL)
> Pain Institute. Neck Pain, Back Pain and Cancer Pain. Merritt Island, Florida.

I don't remember how i found this one, but what strikes me is that Dr. Stanley Golovac who runs it, has a very similar background to Osmin Morales from Miami Pain Clinic. He's also an anesthesiologist, with a sub-specialty in sub-specialty in Interventional Pain Medicine, just like Osmin Morales. Despite some bad reviews on Vitals.com, this doctor seems competent to perform PLDD.

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So there, it seems like Percutaneous Laser Discectomy has become a procedure handled neither by neuro-surgeons, nor by Orthopedic-surgeons, but in fact rather by simple anethesiologists, pretty much the same way they're the ones handling Cortisone Injections (Lumbar Epidural Steroid Injections). And it actually makes sense, as neuro-surgeons have this attitude towards this type of non-invasive outpatient surgeries (is it still called surgery?), that it's not 'good enough' for them. That's why they have a bit of a condescending attitude when you ask about it, even though it's proved to be efficient for good candidates (over 80% success rate) and minimizes both cost and recovery period. My chiropractor says that actually, there would be no one better than an anesthesiologist to perform such a procedure, since it involves dexterity and a big syringe. Makes sense, I don't know... you tell me: would you prefer to have a 60-years-old neuro-surgeon with experience - but shaky hands - inserting this syringe in your tiny disc's nucleus, or a 35 years-old skilled anesthesiologist?

Therefore I think that this procedure suffers from bad marketing and inappropriate training when it comes to Neurologists' referrals, who likely never mention this innovative alternative, unless you've done your homeworks and mention it yourself.

So all i wanted to share here was my experience when it comes to finding someone able to perform PLD/PLDD locally. So far, it's been really a pain. You'll find countless articles on this, but Google is of very poor help when it comes to finding doctors doing this procedure. And neither Healthgrades.com nor Vitals.com (otherwise really great sites!) mention this sub-specialty, so it's a dead-end.

That's why I would like to ask through this forum if anyone has had a PLD in Florida and could share with me his/her experience and some details. Right now, I'm quite confused and while in excrutiating pain (i take hydromorphone 2x4mg.. ugh! that's 10 times more potent than morphine!), I'm trying one day at a time to make sense of all of this and find a place where I could get this procedure at a reasonable cost (5 to 10K max is my budget) and in confidence I will not end-up in a wheel chair. While this procedure doesn't seem to be rocket -science, from what I read, results vary drastically depending on how deep in the serynge and laser probe is inserted in the nucleus, and in which of its 4 quadrants you're doing it (they're a study in Japan studying this).

Finally, I have to say that while Dr Choy might well be a genius for inventing this technique, and his website is very informative ( Laser Spine Center - Treatment for herniated discs & back pain - Percutaneous Laser Disc Decompression ), his marketing is awful. He's claimed to have trained over 300 (or is it 1,000?) doctors to do his procedure. Yet, when you call his office, all he wants is to do it on you and will not reveal a list of this students. I don't want to do that away from home. After all, all these 'students' of his, shall have the privilege - pretty much the same that happens when you purchase a franchise or license - to be listed on his website. If I was Choy though, I would ask for 10% or something like that, some sort of royalty or at least some affiliation program. That way it would be easy for patients to find local doctors doing this procedure and also be informed on details such as which technique they use exactly (endoscope or not), which laser type, testimonials etc...

Really I think this procedure needs some clarity. Right now it looks really 'underground' because of poor marketing, and therefore looks a bit scary for patients like me. I'm up to a point where I might well start a blog about that, collecting all addresses of doctors performing PLDD across the country. At least someone needs to do it... so right now your contribution would be more than welcome, starting with my state of Florida, and take it from there.

All comments welcome on the subject, and of course if you know someone who does it in the area, please let me know ASAP. I want to do this before xmas!

Many thanks for reading :-)

[klh]

Chris,

First I am sorry you are having so many back issues. I empathize as I have had them for many long years too.
Just a few thoughts. If you are definitely set in getting a PLDD and can't find someone you like in Florida so far, call Dr Choy and ask his office, or if you can, Dr Choy personally, for a referral in Florida. Since he has trained so many docs, he should know.

If you can find who makes the instrument (wand needle) in the procedure itself, you can call the company and they can refer you to docs who use it in PLDD.

Did you get a copy of the written report of your MRI? If not, get a copy and read it. See exactly what the radiologist said. Remember, just because your MRI may show several bulging or herniated discs, it does not mean they are all the cause or generator of your pain. Many people have bad discs with no pain at all (BTW - Shaquille O'Neal is one).
I know money is an issue, but if it were me and it was three discs, I would want to have a discogram to see which discs are the ones causing pain.

If you do have the procedure, ask many questions about the recovery process. They will tell you 4-6 weeks, but that is bull. My procedure many years ago was a nucleoplasty (like PLDD but no laser), it took months to recover and you have to be careful as there are many guidelines. Unfortunately for me, the nucleoplasty failed, and I continued with pain for many more years until now when I am scheduled for an ADR.

Your doing great research. Starting conservatively is almost always the best start. If a PLDD works, great. If not, you still have options. But try calling Dr Choy or the device maker and they should help you find a doc more local.

Good luck!
Ken

[KBear]

Chris,

First I am sorry you are having so many back issues. I empathize as I have had them for many long years too.
Just a few thoughts. If you are definitely set in getting a PLDD and can't find someone you like in Florida so far, call Dr Choy and ask his office, or if you can, Dr Choy personally, for a referral in Florida. Since he has trained so many docs, he should know.

If you can find who makes the instrument (wand needle) in the procedure itself, you can call the company and they can refer you to docs who use it in PLDD.

Did you get a copy of the written report of your MRI? If not, get a copy and read it. See exactly what the radiologist said. Remember, just because your MRI may show several bulging or herniated discs, it does not mean they are all the cause or generator of your pain. Many people have bad discs with no pain at all (BTW - Shaquille O'Neal is one).
I know money is an issue, but if it were me and it was three discs, I would want to have a discogram to see which discs are the ones causing pain.

If you do have the procedure, ask many questions about the recovery process. They will tell you 4-6 weeks, but that is bull. My procedure many years ago was a nucleoplasty (like PLDD but no laser), it took months to recover and you have to be careful as there are many guidelines. Unfortunately for me, the nucleoplasty failed, and I continued with pain for many more years until now when I am scheduled for an ADR.

Your doing great research. Starting conservatively is almost always the best start. If a PLDD works, great. If not, you still have options. But try calling Dr Choy or the device maker and they should help you find a doc more local.

Good luck!
Ken

I couldn't agree more with the above.

[Justin]

Makes sense, I don't know... you tell me: would you prefer to have a 60-years-old neuro-surgeon with experience - but shaky hands - inserting this syringe in your tiny disc's nucleus, or a 35 years-old skilled anesthesiologist?

Skidoo, I have to ask with the "shaky hands" comments, do you know that Dr. Choy has shaky hands or are you just assuming this based on his age alone?

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Here's an interesting review article from 2006 (my emphasis is below [bold and underlining]):

American Journal of Neuroradiology 27:232-235, January 2006

Percutaneous Laser Disk Decompression: A Review of the Literature
Link to the full-text publication: full-text.

B. Schenka, P.A. Brouwera, W.C. Peulb and M.A. van Buchema
a Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
b Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands and the Department of Neurosurgery, Haaglanden Medical Center, the Hague, the Netherlands
© 2006 American Society of Neuroradiology

Discussion

No randomized, controlled trials were available. Almost all trials were case series, with a relatively low strength of evidence. Furthermore, the sample size in most trials was relatively small, resulting in broad 95% CIs that made interpretation of success rates difficult. Generalization of the results into general practice remains difficult, because of the different inclusion and exclusion criteria, laser types, and outcome measures used and the large variation in duration of follow-up. These individual differences impair the mutual comparability of the studies and, more important, limit the possibilities for a valid comparison to studies evaluating the outcome of conventional surgical treatment for lumbar disk herniation.

Despite the fact that PLDD has been around for almost 20 years, scientific proof of its efficacy still remains relatively poor, though the potential medical and economic benefits of PLDD are too high to justify discarding it as experimental or ineffective on the sole basis of insufficient scientific proof. Well-designed research of sufficient scientific strength, comparing PLDD to both conventional surgery and conservative management of lumbar disk herniation, is needed to determine whether PLDD deserves a prominent place in the treatment arsenal for lumbar disk herniation.