# Laser Reconstruction of Spinal Discs Experiments and Clinic
## 4 Clinical Aspects of LRD of IVD in DDD of the Spine
### LRD Puncture
After piercing the AF, the needle is inserted another 2 cm and placed in the center of the disc. After the discography, subject to the necessary indications, an optical fiber is inserted into the disc for conducting laser radiation. In total, three or four zones of the IVD are irradiated in the direction of the needle placement, one or two zones are in the center of the NP and two zones along the inner surface of the AF. Figure 5: Scheme of LRD technology. Figure 6: LRD of the cervical spine according to the Cloward approach. Figure 7: LRD of the lumbar spine. Clinical effect of puncture LRD. Immediately at the time of laser irradiation of the IVD, in some cases, patients note light sensations of \"tingling, warmth, bursting\" in the spine. In the days following puncture LRD, the majority of patients experienced relief of existing pain. This is most likely due to local heating and microcavitation effect on the pain receptors of the disc. The exacerbation of pain syndrome observed in some cases was associated with a needle puncture of the inflamed AF. Usually, within a few weeks, the aggravation of pain in these patients diminished, and the level of pain becomes significantly less than preoperative. Complications in the postoperative period were not observed if all the rules were followed. Persistent positive effects of LRD are associated with the regeneration of the intervertebral disc cartilage and begin to appear approximately 3-6 months after the intervention. They consist of a decrease in pain, an increase in the voluntary range of motion in the spine [32; 34]. Long-term results of LRD have been analyzed in several long-term studies [33; 34; 35; 36; 37]. According to the results of one of the studies (475 patients), the total score before the operation was 33.0 (Q25% = 23.0; Q75% = 42.5), after the operation it significantly increased (\(Z\), \(p\) < 0.001), reaching 64.0 (Q25% = 50.0; Q75% = 78.5). The median index of pain severity according to the visual analogue scale (VAS) before surgery was 7 points (Q25% = 5.0; Q75% = 8.0), and after LAD it decreased to 3.0 points (Q25% = 2, 0; Q75% = 4.0). For the purpose of the general assessment of the efficiency of LRD, the following gradations of results were used: \"Positive result\"--the total score SF-36 after the LRD is higher than before the operation, the VAS indicator after the LRD is lower than before the operation; \"Negative result\"--the total score SF-36 after the operation is lower than before the operation, the VAS after the operation is higher than before the operation; \"Neutral result\"--the total score SF-36 after the LRD did not change compared to the preoperative level; VAS after surgery did not change compared to the preoperative level. When performing LRD on the discs of the cervical spine, the results were distributed as follows: positive in 91.6% of cases; negative and neutral--4.2% of cases. When performing LRD on the discs of the lumbar spine, the following results were obtained: positive 89.1% of cases; negative 4.1% of cases; neutral 6.8% of cases. Example 1. Male patient, 53 years old, suffering from chronic low back pain for many years (VAS 7/10). MRI revealed degenerated L4L5 disc, Pfirrmann 5 grade. The patient underwent provocative L4L5 discography which detected highly concordant low back pain and succeeded with function transformal LRD of L4L5 disc. Pain intensity decreased considerably in 24 months (VAS 3/10), and he could continue working activity. Control MRI revealed drastic improvement in MRI disc morphology as change of the disc degeneration to Pfirrmann 4, apparent formation of the new cartilage tissue in the center of the disc, increase in signal intensity from the disc cartilage on the T2 WI and STIR images (Figure 8). Additionally, the change of the signal is noticeable, from the adjacent to the disc vertebral bone as the mark of disc metabolism shift in the T1 WI image.