MRI changes and clinical results of low-energy semiconductor percutaneous laser disc decompression（LS-PLDD） for lumbar disc herniation in adolescents

MRI changes and clinical results of low-energy semiconductor percutaneous laser disc decompression（LS-PLDD） for lumbar disc herniation in adolescents | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article MRI changes and clinical results of low-energy semiconductor percutaneous laser disc decompression（LS-PLDD） for lumbar disc herniation in adolescents Li Shiwen, Hu Tianyu, Ivanenko Valentinovich, Xu Jiayuan, Wang Wenyu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4827462/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Nov, 2025 Read the published version in Lasers in Medical Science → Version 1 posted 11 You are reading this latest preprint version Abstract Purpose Low-energy semiconductor percutaneous laser disc decompression (LS-PLDD) is a minimally invasive surgical method that uses a laser to treat lumbar disc herniation. However, there is currently no clinical efficacy evaluation of this surgical method for treating lumbar disc herniation in adolescents. This study aimed to evaluate the safety and effectiveness of LS-PLDD compared with percutaneous endoscopic discectomy (PELD) in the treatment of adolescent LDH patients. Methods collected data on 30 adolescent LDH patients who received LS-PLDD in our center, 60 adolescent LDH patients who received PELD in our center were matched based on age and gender. The lumbar ODI and back pain VAS score before surgery and 1 week, 1 month, 3 months and 6 months after surgery were collected to evaluate the clinical outcome of two groups. And we also compared the lumbar MR imaging examinations before surgery and 3 months after surgery to observe the changes of MR of disc. Results The preoperative back VAS scores were (7.0 ± 0.91) and (7 ± 0.8) in the LS-PLDD group and PELD group respectively, with no significant statistical difference (P = 0.779). The VAS scores of both groups had improvement after surgery. At the last follow-up, the VAS scores of both groups were (2.0 ± 1.3) and (1.0 ± 0.8) respectively ( P < 0.01). The VAS scores of patients in PELD group improved most significantly in the first week after surgery and then gradually stabilized, while that in LS-PLDD group improved more gradually during 6 months after surgery. The preoperative ODI scores of the LS-PLDD group and PELD group were (71.1 ± 7.9)% and (68.0 ± 7.3)% (P = 0.061), at the last follow-up, the ODI scores were (28.0 ± 13.1)% and (19.0 ± 8.4)% (P < 0.01). The preoperative canal cross-sectional areas in the LS-PLDD group and PELD group were (1373.0 ± 376.6) and (1457 ± 415.9) respectively, with no significant difference between the two groups (P = 0.157), at the last follow-up, the canal cross-sectional area of the surgical segments were (1373 ± 476.6) and (1457 ± 579.1) (P = 0.227)respectively. Conclusions This study shows that low-energy semiconductor laser LS-PLDD is a safe and effective treatment method for adolescent LDH. It can achieve sustained retraction of the herniated disc and retain the intact structure of the disc. LDH LS-PLDD Semiconductor laser MRI Disc repair Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 1.Background Adolescent patients with LDH account for about 5% of all LDH cases [1] , it has great impact on social and athletic activities to adolescence, it is influenced by multiple factors such as BMI, excessive exercise, bad living habits [2, 3] , adolescents physical growth, asymmetries of lumbar [4] . In adolescent patients with LDH, histological examination shows that the nucleus pulposus is relatively water-rich [5, 6] and less degenerative than it in older LDH patients, disc structure in adolescence is usually intact and elastic [7] . Disc has great contrition to lumbar motion range, so when treating adolescent LDH, we aim to maximize preservation of disc structure with mini-invasive surgery, which is significant for maintaining motion range of lumbar and preventing adjacent vertebrae degenerative. Percutaneous Laser Disc Decompression (PLDD) is a kind of minimally invasive technique used to treat LDH through the photothermal effects of laser energy [8, 9] . This procedure employs a optical fiber to transmit pulsed laser energy to target disc, which will vaporizes part of the protruding nucleus pulposus (Fig. 1 ). The vaporization effectively reduces or eliminates the compression on the nerve roots. PLDD is characterized by its advantages of bloodless, minimally invasive, rapid recovery and safety [10] . It is particularly suitable for adolescent LDH patients. There are some types of lasers for PLDD technique includes Nd:YAG laser, Ho:YAG laser and CO 2 laser currently [11, 12] . Semiconductor lasers [13, 14] , a type of solid-state laser, generate laser light through semiconductor materials such as gallium nitride (GaN) and gallium arsenide (GaAs). Compared to other types of lasers, semiconductor lasers have significant advantages in several aspects. For instance, the wavelength, frequency and intensity of the laser can be precisely controlled, enabling more accurate radiation, and semiconductor lasers can be rapidly activated and maintain stable operating conditions without complex heating processes [15] ; this results in longer operational lifespans and lower maintenance costs. This study aims to evaluate the medium-term clinical efficacy and MRI changes of low-energy semiconductor PLDD(LS-PLDD) in treating adolescent LDH. We retrospectively employed a control group of young LDH patients who had received percutaneous endoscopic lumbar discectomy (PELD), they have similar demographic characteristics to the LS-PLDD group. 2.Method 2.1 Study design: This was a retrospective study. 2.2 Participants and Setting: We collected the date of patients who underwent LS-PLDD surgery for adolescent LDH patients from January 2022 to December 2023, According to the characterize of LS-PLDD group, we matched 60 LDH patients who were aged and gender similar and received PELD treatment in our center between January 2014 and December 2022 as the control group. 2.3 Device: The semiconductor laser therapy instrument used in this study is Aldor laser therapy device(Table 1 ). Table 1 Parameters of low-energy semiconductor laser therapy equipment Item Value Peak wavelength 0.97µm Maximum output power 5W Laser output mode continuous output/pulse output Energy density 1–10 J/cm² Pulse frequency 900-2000Hz Pulse output power range 0.1 ~ 5W Pulse output duration 0.05 ~ 5S, ± 5%。 Pulse output interval time 0.1 ~ 9.9S, ± 5%。 Divergence angle ≤ 30 µm 2.4 Inclusion and exclusion criteria: The inclusion criteria for patients in LS-PLDD group are based on that in previous studies (Table 2 ) [16, 17] . Patients were included in the study who experiencing low back pain or leg pain, without significant osteophyte formation at the posterior edge of vertebra. In this study, we aimed to evaluate the efficacy of LS-PLDD on adolescent LDH patients. We included patients who are adolescents (14–35 years old) without obvious rupture of the fibrous. The inclusion criteria for the PELD group are the same as those for the LS-PLDD group. This study has been approved by the ethics committee and all study patients have signed informed consent for surgery. Table 2 Summary of inclusion and/or exclusion criteria Indications for LS-PLDD surgery Indications for surgery (satisfying three of the following conditions) 1. MRI or CT shows lumbar disc herniation; 2.Symptoms of nerve root injury ( Lasègue's sign(+); hypoesthesia and decreasing muscle strength of low limb; knee and ankle reflexes abnormal); 3. there was no significant improvement after 6 weeks of conservative treatment. exclusion criteria : 1. Coagulation dysfunction; 2. Lumbar spondylolisthesis or other instability of the lumbar spine; 3. Lumbar stenosis; 4. Previous lumbar surgery; 2.5 Surgical method: LS-PLDD group: patients took a prone position, the surgical approach is determined based on surgical segment(Fig. 2 ). The skin at the puncture site is anesthetized with 0.1% lidocaine. Under C-arm guidance, the tip of the puncture needle is positioned at the base of the protruding disc herniation, laser fiber is then introduced into the disc along the guide needle, extending approximately 0.5 cm from disc herniation top. If the location of laser fiber is satisfactory under C-arm guidance, we proceed with the operation. The disc is irradiated from the inside out using laser radiation (peak wavelength: 0.97 µm, maximum power: 3W, pulse interval: 1 seconds, pulse duration: 1 seconds) for 4 minutes. During operation, the needle is gradually retracted from the base to the apex of the herniation, we can observe the bubbles emerging from the puncture needle, which indicates cavitation effects of disc vaporization within the interdisc space. During the procedure, a syringe is repeatedly used to extract the turbid fluid from disc and inject clean saline into it, which acts as heat transfer medium and buffer preventing excessive thermal effects on the intervertebral disc tissue. PELD group: patients in the PELD group underwent surgery in the prone position under local anesthesia. A single-channel spinal endoscope is used to perform PELD via either transforaminal or interlaminar approach depending on the surgical segment. Postoperative Care: both groups of patients were instructed to avoid physical activity during the first month following surgery, engaging only in routine activities, additionally, they were requested to wear lumbar support braces while standing or sitting. 2.6 Clinical evacuation The primary clinical evaluation indicators include preoperative and postoperative 1-week, 1-month, 3-month, and 6-month VAS scores and ODI scores for the low back pain The second clinical evaluation indicators include recurrence of symptoms and other postoperative adverse events. 2.7 MRI measurement and observation indicators Observing indicators in MRI imaging include cross-sectional area (CSA [18] ) and signal change of disc before and 3 months after surgery(Fig. 3 ). All distances and area were measured by ImageJ. The same MRI film was independently measured twice by two orthopedic physicians and the average was accepted. 2.8 Statistical analysis Data statistics analysis was using SPSS 20.0, classification data were analyzed using Chi-square test and continuous variables data was analyzed using T-test and Mann-Whitney U test. P < 0.05 was considered statistically significant. 3.Results 3.1 General information The general clinical data of the two groups are shown in Table 3 . The average age of the LS-PLDD group is (26 ± 7) years old. The surgical segments are mostly located at L4/5 (53.3%), followed by L5/S1 (30.0%). 28 patients among all patients complained of low back pain with lower limb pain, while 2 patients complained of low back pain only. We matched 60 patients with LDH who underwent PELD treatment in our center basing on age and gender from January 2014 to December 2022. The age (29 ± 6) and gender distribution (32 males and 28 females) in this group, as well as the clinical symptoms and inclusion criteria, are similar to those in the LS-PLDD group. Table 3 Basic patients characteristics LS-PLDD (N = 30) PELD (N = 60) P value Sex .825* Female 13 (37.0%) 28 (63.4%) Male 17 (63.0%) 32 (36.6%) Age (year) .936✝ Median(Q1, Q3) 26(23,32) 29(24,34) BMI .799✝ Median(Q1, Q3) 21(19.75, 24.00) 22(20.00, 23.75) Surgery level .421* L1/2 1 0 L2/3 0 1 L3/4 4 4 L4/5 16 32 L5/S1 9 23 Follow time(month) .076# Median(Q1, Q3) 9(7, 11) 9 (7, 10) Pre-op VAS .779# Median(Q1, Q3) 7(6, 8) 7(6, 8) Pre-op ODI .061# Median(Q1, Q3) 71.1% (68.0%, 80.5%) 68.0% (62.5%, 76%) VAS Score at last follow-up .000# Median(Q1, Q3) 2(2, 3) 1(1, 2) ODI score at last follow-up .000# Median(Q1, Q3) 28.0% (22.5%, 35.5%) 19.0% (14.5%, 25.0%) VAS improvement .000# Median(Q1, Q3) 67.0% (55.3%, 72.0%) 33.3% (71.0%, 86.0%) ODI improvement .000# Median(Q1, Q3) 58.5% (51.5%, 69.3%) 73.0% (62.5%,78.5%) Pre-op CSA .157# Median(Q1, Q3) 822 (636, 1163) 1035 (763, 1268) Post-op CSA .227# Median(Q1, Q3) 1373(1005, 1593) 1457(1257, 1978) * Chi-Square Test, ✝Independent Samples t-Test, # Mann-Whitney U Test 3.2 Clinical outcomes In the LS-PLDD group, all patients received surgical treatment. two patients experienced recurrence and subsequently received PELD treatment again. One patient was a 16-year-old female high school student(Fig. 4 ), within one week post-surgery, her lumbar pain symptoms improved from a VAS score of 7 to 4, but she did not adhere to postoperative rest instructions she returned to school and experienced prolonged sitting, three weeks post-surgery, her lumbar pain symptoms recurred with a VAS score returning to 7, MRI revealed recurrence of LDH. Conservative treatment (bed rest, physical therapy, etc.) did not significantly alleviate symptoms, and she received PELD surgery six months postoperatively. The second patient, a 28-year-old male with a BMI of 24.0, experienced symptom recurrence one month after PLDD surgery and he received PELD treatment last. No recurrence or repeat surgeries were reported among the remaining patients in the LS-PLDD group. The preoperative VAS scores of LS-PLDD group and the PELD group were (7.0 ± 0.91) and (7 ± 0.80) respectively, with no significant statistical difference in the VAS scores for low back pain between the two groups (P = 0.779). The VAS scores of the two groups decreased continuously at 1 week, 1 month, 3 months, and 6 months postoperatively (Fig. 5 ). The last follow-up VAS scores were (2.0 ± 1.3) and (1.0 ± 0.8) (P < 0.01). The PELD group experienced faster postoperatively pain relief compared to the LS-PLDD group. In the PELD group, the most significant pain relief was observed in one week after surgery, then it plateaued. The VAS improvement rates of LS-PLDD group and PELD group were 67.0% (P = 0.176) and 33.3% (P = 0.113) at 6 months postoperatively, and the difference was statistically significance (P < 0.01). The preoperative ODI scores of LS-PLDD group and PELD group were (71.1 ± 7.9)% and (68.0 ± 7.3)% respectively(Fig. 5 ), with no significant statistical difference between two groups (P = 0.061). Both groups showed a continuous decrease in ODI scores at 1 week, 1 month, 3 months and 6 months postoperatively. At the last follow-up, the ODI scores were (28.0 ± 13.1)% for the LS-PLDD group and (19.0 ± 8.4)% for PELD group (P < 0.01). The average lumbar function of the PELD group at the last follow-up was superior to that of the LS-PLDD group. 3.3 MRI follow-up and outcomes Both groups of patients had complete MRI films collected before surgery and at last follow-up. The preoperative CSA of the surgical segments in the LS-PLDD and PELD groups were (1373.0 ± 376.6) and (1457 ± 415.9) respectively, with no significant difference between two groups (P = 0.157) (Fig. 6 ). At the last follow-up, the surgical segment CSA between LS-PLDD group and PELD group were (1373 ± 476.6) and (1457 ± 579.2) respectively. We observed an improvement in disc abnormal signal in LS-PLDD groups, including retraction of the herniated disc and restoration of spinal canal volume(Fig. 7 ). In the PELD group, there was also obvious nerve decompression, but the abnormal disc signal still persisted. 4.Discussion In this study, we evaluated safety and efficacy of LS-PLDD in treating LDH of adolescent patients. Clinical outcomes analyses revealed that the one-year post-op improvement in the LS-PLDD group is slightly inferior to that in the PELD group, but improvement is still over 50% relative to the preoperative state. The post-op ODI score improvement indicates different patterns of improvement between the LS-PLDD and PELD groups, the PELD group showd the most significant improvement between before and one month after surgery and it plateaued gradually over the year postoperatively. In contrast, the LS-PLDD group showed slower improvement in the first month compared to the PELD group, but there was continuous symptom improvement from one month to one year postoperatively, with improvement nearing that of the PELD group by the end of one year. In order to further validate this trend, we systematically reviewed clinical research of PLDD from 2006 to 2021, totally obtained 14 clinical studies (Table 5), these studies report that the success rate of PLDD generally fluctuates around 75% (based on the MacNab criteria), with approximately 50% rated as excellent and 25% as good, additionally, 0.4-1% of patients experienced complications (primarily postoperative fever and discitis), and the recurrence rate was about 5%. Compared to previous studies, the improvement rate in our study is relatively higher(78%). we think this may be attributed to the enrolled patients were all adolescents, who typically has better postoperative outcomes compared to the elderly. Among the 14 reviewed studies, we found that the studies by Arun (2006) and Stefan (2021) reported better outcomes and higher success rates. These studies had relatively lower baseline age distributions, with average ages of 41 and 50.5 years respectively. However, this hypothesis may be influenced by selection bias, which needs further validation through larger clinical trials. This study also find the postoperative MRI change characteristics of LS-PLDD, we wonder relevance between MRI change and clinical improvement trend and if these changes align with symptom improvement patterns. Interestingly, we found the dynamic process of disc herniation retraction after LS-PLDD treatment (Fig. 7 ), we compare the T2WI MRI taken at 3 month, 6 months and 1 year after LS-PLDD surgery, the part of disc herniation showd a gradual smooth retraction trend, while the annulus fibrosus continues to maintain good shape without obvious rupture, which suggested that the puncture needle and fine optical fiber didn’t significantly influence the integrity of annulus fibrosus. Over the course of one year postoperatively, we also observed the internal signal of the nucleus pulposus becoming uniform and consistent in MRI. Based on above findings, we hypothesized that low-energy laser may have a positive effect on tissue repairing, but it need further histological experiments to verify it. The safety and efficacy of LS-PLDD have always been the concerns of physicians, how will the disc height change as time goes by and how long will the efficacy maintain still are uncertain. Ren [19] studied the mid-term postoperative MRI changes of PLDD, the results showed that at the one-year postoperative, the height of disc at surgical segment (including the anterior, middle, posterior edges) did not changes significantly compared to pre-op measurements (p > 0.05), however, there was a significant difference in the disc protrusion index (the ratio of the disc herniation portion to the maximum anteroposterior diameter of the spinal canal) before and after surgery, this finding suggests that the PLDD procedure can increase the spinal canal volume while maintaining integrity of annulus fibrosus. Nevertheless, the study did not provide a detailed description of the annulus fibrosus morphology, the decreased disc height aligns with most imaging results in our study, which may be attributed to the absorption of the nucleus pulposus following vaporization ablation. In the short term, the thermal effect of lasers on discs is certain, which well resulting in disc herniation retraction, however, the long-term effects of lasers on tissue repair and inflammation reduction remain subjects for further investigation. A clinical study conducted by Florian [20] involved 24 cases of MRI guided LS-PLDD, during a follow-up period of at least 3 months postoperatively, pre and post-operative MR images were collected, notably T1 images at 6 months postoperatively showed improvement in Modic changes in the adjacent endplates of surgical segment. Modic change [21] is a typical manifestation of endplate degeneration, and their reduction suggests that the laser may have an anti-inflammatory effect. Additionally, Kun-Tsung [15] further confirmed the anti-inflammatory effect of lasers through animal experiments, experiments used low-level laser irradiation (LLLI) in wound healing and anti-inflammatory applications and the results revealed a decrease in expression of various anti-inflammatory factors, including TNF-α, IL-1β, IL-6, and IL-8. Although the lasers used in these studies were not produced by the same medium, we hypothesize that they may have similar mechanisms, this requires further validation through additional animal experiments. operating process During the LS-PLDD surgical procedure, we observed that laser irradiation results in the liquefaction and vaporization of the nucleus pulposus tissue. We review the previous studies and the varying levels of laser energy induce distinct changes in soft tissue [22] , the medium through which the laser conducts energy to the interstitial disc is very important. we paid particular attention to a critical step during the irradiation process for all patients in this study, we used a syringe to extract the contents produced by the ablation from the disc and injected clean saline. This step aimed to remove vaporized and liquefied tissues to prevent them from interfering with the effective laser irradiation of the disc tissue. The transmittance of laser in saline and tissue fluid is different [23] , penetration depth of different wavelengths laser in the same tissue fluid can range from micrometers to centimeters. During the procedure, turbid fluid could be extracted, primarily due to the carbonization of some tissue caused by high temperatures. Currently, the two main types of lasers used are YAG:Nd (neodymium) laser (wavelength = 1.064 µm) and CO2 laser (wavelength = 10.6 µm) [24, 25] . the penetration depths of the two lasers are approximately 2–5 mm and 10 µm in blood-rich soft tissues respectively. Turbid tissue fluid can hinder laser penetration, clean saline has superior thermal conductivity, enabling it to radiate over a broader area. Additionally, saline can effectively control the temperature at the tip of the optical fiber, preventing the adverse effects of excessive carbonization on the laser's radiation efficacy, maintaining an appropriate temperature is crucial for normal tissue, therefore, we strictly regulate the relevant parameters during the procedure to ensure the safety and effectiveness of the surgery. 5.Conclusion This preliminary clinical study indicates that low-energy semiconductor PLDD is a safe and effective therapeutic option for treating adolescent LDH patients without obvious annulus fibrosus rupture. On the premise of retaining the intergrity of disc structure, this method can achieve sustained retraction of the disc herniation and decompressing the spinal canal during 1 year after surgery. Declarations Ethics approval and consent to participate: This study was approved by the Ethics Committee of the First Affiliated Hospital of Harbin Medical University(Grant No. [ IRB-AF/SC-04/02.0 ]). All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent to Participate declaration: This study was conducted as a retrospective analysis of existing clinical data. The research protocol was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Harbin Medical University. As the study involved the analysis of de-identified and anonymized patient data. The use of retrospective data without direct patient involvement aligns with ethical guidelines and ensures the protection of patient privacy and confidentiality. Funding: This article is sponsored by the Bethune · Special Research Fund Project (BK-JP2021001). Author Contribution Li Shiwen: Study conception, manuscript drafting.Hu Tianyu: Data acquisition, analysis, and interpretation.Ivanenko Andrei Valentinovich: Supervision, final manuscript review.Xu Jiayuan: Data acquisition, analysis, and interpretation.Wang Wenyu: Study design, literature review.Qi Quan: Supervision, final manuscript review. Acknowledgement Thank Harbin Science and Technology Bureau for supporting this research. Data Availability Data is provided within the manuscript or supplementary information files References Dang L, Liu Z (2010) A review of current treatment for lumbar disc herniation in children and adolescents. Eur Spine J 19:205-214 Qu L, Wang Y, Wang F, Zhang S (2023) Surgical outcomes of percutaneous endoscopic lumbar discectomy in obese adolescents with lumbar disc herniation. 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Exp Ther Med 18:3552-3562 Hashemi M, Dadkhah P, Taheri M, Katibeh P, Asadi S (2020) Effectiveness of intradiscal injection of radiopaque gelified ethanol (DiscoGel(®)) versus percutaneous laser disc decompression in patients with chronic radicular low back pain. Korean J Pain 33:66-72 Terai H, Tamai K, Iwamae M, Kaneda K, Katsuda H, Shimada N, Nakamura H (2021) Characteristics and Short-Term Surgical Outcomes of Patients with Recurrent Lumbar Disc Herniation after Percutaneous Laser Disc Decompression. Medicina (Kaunas) 57:1225 Tables Table 5 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table5.docx DateinSPSS.sav Cite Share Download PDF Status: Published Journal Publication published 15 Nov, 2025 Read the published version in Lasers in Medical Science → Version 1 posted Editorial decision: Revision requested 31 Jul, 2025 Reviews received at journal 31 Jul, 2025 Reviewers agreed at journal 30 Jul, 2025 Reviewers agreed at journal 30 Jul, 2025 Reviewers agreed at journal 21 Jul, 2025 Reviews received at journal 18 Dec, 2024 Reviewers agreed at journal 12 Dec, 2024 Reviewers invited by journal 12 Aug, 2024 Editor assigned by journal 12 Aug, 2024 Submission checks completed at journal 07 Aug, 2024 First submitted to journal 30 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4827462","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":347771726,"identity":"56dd4436-620d-4866-84ad-d062a6dbbd47","order_by":0,"name":"Li Shiwen","email":"","orcid":"","institution":"First Affiliated Hospital of Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Shiwen","suffix":""},{"id":347771727,"identity":"bd6f1065-1f15-4ca5-90a4-dd43f0fc9661","order_by":1,"name":"Hu Tianyu","email":"","orcid":"","institution":"First Affiliated Hospital of Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hu","middleName":"","lastName":"Tianyu","suffix":""},{"id":347771728,"identity":"bdadd096-755d-49c7-845e-ceb4ed0b6111","order_by":2,"name":"Ivanenko Valentinovich","email":"","orcid":"","institution":"National Research Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Ivanenko","middleName":"","lastName":"Valentinovich","suffix":""},{"id":347771729,"identity":"78fc6c38-2a83-4d8a-88ea-743b9a586439","order_by":3,"name":"Xu Jiayuan","email":"","orcid":"","institution":"First Affiliated Hospital of Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xu","middleName":"","lastName":"Jiayuan","suffix":""},{"id":347771730,"identity":"7d57617e-7485-484f-9382-792e7d1b9abc","order_by":4,"name":"Wang Wenyu","email":"","orcid":"","institution":"First Affiliated Hospital of Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wang","middleName":"","lastName":"Wenyu","suffix":""},{"id":347771731,"identity":"8a0812d9-7b06-4a3b-bc6b-dc8ac3eadf49","order_by":5,"name":"Qi Quan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYDACZgiVwMDAw3CAoUJCTp5ELWcsjA0biLQMrIWBsa0iEagRP+A7zrxN4ucOhjz+2WcPHi6cJ5HA2MD88NENPFokD7OVSfaeYSiWOJeXcHjmNok8dgY2Y+McPFoMDvOYSfC2MSQ2nOExOMy7TaKYsYGHTZqQFsm/QC3zwVrmSCQ2HCBCizTIlg1gLQ1EaAH6pdhaFqhl4xm+hMM8xySMDZsJ+IXv/OGNN98Ctcw7w3v4M09NnZw8e/PDx/i0AGPBAEj+RxJhxqccoWUUjIJRMApGAR4AAB6BSYyv1f0tAAAAAElFTkSuQmCC","orcid":"","institution":"First Affiliated Hospital of Harbin Medical University","correspondingAuthor":true,"prefix":"","firstName":"Qi","middleName":"","lastName":"Quan","suffix":""}],"badges":[],"createdAt":"2024-07-30 09:23:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4827462/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4827462/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10103-025-04730-2","type":"published","date":"2025-11-15T15:57:22+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":64569060,"identity":"1d545b92-5916-47cc-a6d1-bc41eb8b4a15","added_by":"auto","created_at":"2024-09-16 00:44:50","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":178530,"visible":true,"origin":"","legend":"\u003cp\u003ePattern diagram of LS-PLDD\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-4827462/v1/34f235c08d480d8c465f37c2.png"},{"id":64569053,"identity":"2d63dc86-ec63-4421-be0c-321f4ef54e32","added_by":"auto","created_at":"2024-09-16 00:44:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":482605,"visible":true,"origin":"","legend":"\u003cp\u003eA-C：transforaminal approach for L4/5 LDH；D-F：interlaminar approach for L5/S1 LDH\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-4827462/v1/127e329be8bcaf942716e808.png"},{"id":64569061,"identity":"fcdb9f51-d267-4221-9550-f452cbf05f66","added_by":"auto","created_at":"2024-09-16 00:44:50","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":303015,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative and postoperative T2WI MR images of LDH patients accepting LS-PLDD treatment. A\u0026amp;C Preoperative and postoperative sagittal images are selected to determine the selected cross-sectional segment to measure. B\u0026amp;D: Axial views showing the measurement of CSA at the site of greatest compression.\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-4827462/v1/7340083e55d38a16040c594e.png"},{"id":64569690,"identity":"a6839fb9-b0ec-4f81-9b87-817da4c736e3","added_by":"auto","created_at":"2024-09-16 00:52:50","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":305660,"visible":true,"origin":"","legend":"\u003cp\u003eA 16-year-old female patient. The preoperative MRI of A\u0026amp;B showed that the L4/5 disc herniation was deviated to the right side. The L4/5 disc herniation recurred one month after C\u0026amp;D surgery.\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-4827462/v1/b23eade4575021ad556ee909.png"},{"id":64569689,"identity":"edbdc1fe-630d-4baa-bd58-7d6c6f92cffc","added_by":"auto","created_at":"2024-09-16 00:52:50","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":60589,"visible":true,"origin":"","legend":"\u003cp\u003eChanges in VAS and ODI scores in the LS-PLDD and PELD groups preoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively (ns: no significant statistical difference, **: p＜0.01, ***: p＜0.001）\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-4827462/v1/94861d1c163bc4b53347c58e.png"},{"id":64570222,"identity":"3bddc0e6-ebb3-40f2-93a1-09da2bea588a","added_by":"auto","created_at":"2024-09-16 01:00:50","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":14585,"visible":true,"origin":"","legend":"\u003cp\u003eCSA in LS-PLDD group and PELD group before and after surgery （**：p＜0.01，***：p＜0.001）\u003c/p\u003e","description":"","filename":"image6.png","url":"https://assets-eu.researchsquare.com/files/rs-4827462/v1/dadd89070f8e097fe7321dde.png"},{"id":64569692,"identity":"3df5530e-25b5-45b4-9b38-077bd39774a7","added_by":"auto","created_at":"2024-09-16 00:52:50","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":416522,"visible":true,"origin":"","legend":"\u003cp\u003ePre-op (A\u0026amp;D) and Post-op MRI at 3 months (B\u0026amp;E)、6 months (C\u0026amp;F); continuous retraction of the disc protrusion over time (white arrows); Gradual reduction in disc height over time (red arrows).\u003c/p\u003e","description":"","filename":"image7.png","url":"https://assets-eu.researchsquare.com/files/rs-4827462/v1/29cf549b6c0f9ab52caa5e3a.png"},{"id":96104990,"identity":"0e38259f-9dc9-4c3f-b067-0766214878c6","added_by":"auto","created_at":"2025-11-17 16:06:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3097740,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4827462/v1/d6a3f2ed-48fe-4c9d-9263-ba53c799bff6.pdf"},{"id":64569057,"identity":"59f7b050-2147-4d75-90bf-bf5bf10d16d6","added_by":"auto","created_at":"2024-09-16 00:44:50","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18256,"visible":true,"origin":"","legend":"","description":"","filename":"Table5.docx","url":"https://assets-eu.researchsquare.com/files/rs-4827462/v1/a3e7bad2cbee514bfda57c37.docx"},{"id":64569055,"identity":"e1d7166d-816b-455f-a218-1add095c59b4","added_by":"auto","created_at":"2024-09-16 00:44:50","extension":"sav","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":7103,"visible":true,"origin":"","legend":"","description":"","filename":"DateinSPSS.sav","url":"https://assets-eu.researchsquare.com/files/rs-4827462/v1/fa0c1b2238241b2499e4e1b1.sav"}],"financialInterests":"No competing interests reported.","formattedTitle":"MRI changes and clinical results of low-energy semiconductor percutaneous laser disc decompression（LS-PLDD） for lumbar disc herniation in adolescents","fulltext":[{"header":"1.Background","content":"\u003cp\u003eAdolescent patients with LDH account for about 5% of all LDH cases\u003csup\u003e[1]\u003c/sup\u003e, it has great impact on social and athletic activities to adolescence, it is influenced by multiple factors such as BMI, excessive exercise, bad living habits\u003csup\u003e[2, 3]\u003c/sup\u003e, adolescents physical growth, asymmetries of lumbar\u003csup\u003e[4]\u003c/sup\u003e. In adolescent patients with LDH, histological examination shows that the nucleus pulposus is relatively water-rich\u003csup\u003e[5, 6]\u003c/sup\u003eand less degenerative than it in older LDH patients, disc structure in adolescence is usually intact and elastic\u003csup\u003e[7]\u003c/sup\u003e. Disc has great contrition to lumbar motion range, so when treating adolescent LDH, we aim to maximize preservation of disc structure with mini-invasive surgery, which is significant for maintaining motion range of lumbar and preventing adjacent vertebrae degenerative.\u003c/p\u003e \u003cp\u003ePercutaneous Laser Disc Decompression (PLDD) is a kind of minimally invasive technique used to treat LDH through the photothermal effects of laser energy \u003csup\u003e[8, 9]\u003c/sup\u003e. This procedure employs a optical fiber to transmit pulsed laser energy to target disc, which will vaporizes part of the protruding nucleus pulposus (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The vaporization effectively reduces or eliminates the compression on the nerve roots. PLDD is characterized by its advantages of bloodless, minimally invasive, rapid recovery and safety\u003csup\u003e[10]\u003c/sup\u003e. It is particularly suitable for adolescent LDH patients. There are some types of lasers for PLDD technique includes Nd:YAG laser, Ho:YAG laser and CO\u003csub\u003e2\u003c/sub\u003e laser currently \u003csup\u003e[11, 12]\u003c/sup\u003e. Semiconductor lasers\u003csup\u003e[13, 14]\u003c/sup\u003e, a type of solid-state laser, generate laser light through semiconductor materials such as gallium nitride (GaN) and gallium arsenide (GaAs). Compared to other types of lasers, semiconductor lasers have significant advantages in several aspects. For instance, the wavelength, frequency and intensity of the laser can be precisely controlled, enabling more accurate radiation, and semiconductor lasers can be rapidly activated and maintain stable operating conditions without complex heating processes\u003csup\u003e[15]\u003c/sup\u003e; this results in longer operational lifespans and lower maintenance costs.\u003c/p\u003e \u003cp\u003eThis study aims to evaluate the medium-term clinical efficacy and MRI changes of low-energy semiconductor PLDD(LS-PLDD) in treating adolescent LDH. We retrospectively employed a control group of young LDH patients who had received percutaneous endoscopic lumbar discectomy (PELD), they have similar demographic characteristics to the LS-PLDD group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"2.Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study design:\u003c/h2\u003e \u003cp\u003eThis was a retrospective study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Participants and Setting:\u003c/h2\u003e \u003cp\u003e We collected the date of patients who underwent LS-PLDD surgery for adolescent LDH patients from January 2022 to December 2023, According to the characterize of LS-PLDD group, we matched 60 LDH patients who were aged and gender similar and received PELD treatment in our center between January 2014 and December 2022 as the control group.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Device:\u003c/h2\u003e \u003cp\u003eThe semiconductor laser therapy instrument used in this study is Aldor laser therapy device(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParameters of low-energy semiconductor laser therapy equipment\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eValue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeak wavelength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.97\u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum output power\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5W\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaser output mode\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtinuous output/pulse output\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnergy density\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;10 J/cm\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulse frequency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e900-2000Hz\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulse output power range\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1\u0026thinsp;~\u0026thinsp;5W\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulse output duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.05\u0026thinsp;~\u0026thinsp;5S, \u0026plusmn;\u0026thinsp;5%。\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulse output interval time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.1\u0026thinsp;~\u0026thinsp;9.9S, \u0026plusmn;\u0026thinsp;5%。\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivergence angle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;30 \u0026micro;m\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Inclusion and exclusion criteria:\u003c/h2\u003e \u003cp\u003eThe inclusion criteria for patients in LS-PLDD group are based on that in previous studies (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003csup\u003e[16, 17]\u003c/sup\u003e. Patients were included in the study who experiencing low back pain or leg pain, without significant osteophyte formation at the posterior edge of vertebra. In this study, we aimed to evaluate the efficacy of LS-PLDD on adolescent LDH patients. We included patients who are adolescents (14\u0026ndash;35 years old) without obvious rupture of the fibrous. The inclusion criteria for the PELD group are the same as those for the LS-PLDD group.\u003c/p\u003e \u003cp\u003eThis study has been approved by the ethics committee and all study patients have signed informed consent for surgery.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of inclusion and/or exclusion criteria\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndications for LS-PLDD surgery\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndications for surgery (satisfying three of the following conditions)\u003c/p\u003e \u003cp\u003e1. MRI or CT shows lumbar disc herniation;\u003c/p\u003e \u003cp\u003e2.Symptoms of nerve root injury ( Las\u0026egrave;gue's sign(+); hypoesthesia and decreasing muscle strength of low limb; knee and ankle reflexes abnormal);\u003c/p\u003e \u003cp\u003e3. there was no significant improvement after 6 weeks of conservative treatment.\u003c/p\u003e \u003cp\u003e\u003cb\u003eexclusion criteria\u003c/b\u003e:\u003c/p\u003e \u003cp\u003e1. Coagulation dysfunction;\u003c/p\u003e \u003cp\u003e2. Lumbar spondylolisthesis or other instability of the lumbar spine;\u003c/p\u003e \u003cp\u003e3. Lumbar stenosis;\u003c/p\u003e \u003cp\u003e4. Previous lumbar surgery;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Surgical method:\u003c/h2\u003e \u003cp\u003eLS-PLDD group: patients took a prone position, the surgical approach is determined based on surgical segment(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The skin at the puncture site is anesthetized with 0.1% lidocaine. Under C-arm guidance, the tip of the puncture needle is positioned at the base of the protruding disc herniation, laser fiber is then introduced into the disc along the guide needle, extending approximately 0.5 cm from disc herniation top. If the location of laser fiber is satisfactory under C-arm guidance, we proceed with the operation. The disc is irradiated from the inside out using laser radiation (peak wavelength: 0.97 \u0026micro;m, maximum power: 3W, pulse interval: 1 seconds, pulse duration: 1 seconds) for 4 minutes. During operation, the needle is gradually retracted from the base to the apex of the herniation, we can observe the bubbles emerging from the puncture needle, which indicates cavitation effects of disc vaporization within the interdisc space. During the procedure, a syringe is repeatedly used to extract the turbid fluid from disc and inject clean saline into it, which acts as heat transfer medium and buffer preventing excessive thermal effects on the intervertebral disc tissue.\u003c/p\u003e \u003cp\u003ePELD group: patients in the PELD group underwent surgery in the prone position under local anesthesia. A single-channel spinal endoscope is used to perform PELD via either transforaminal or interlaminar approach depending on the surgical segment.\u003c/p\u003e \u003cp\u003ePostoperative Care: both groups of patients were instructed to avoid physical activity during the first month following surgery, engaging only in routine activities, additionally, they were requested to wear lumbar support braces while standing or sitting.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003e2.6 Clinical evacuation\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe primary clinical evaluation indicators include preoperative and postoperative 1-week, 1-month, 3-month, and 6-month VAS scores and ODI scores for the low back pain The second clinical evaluation indicators include recurrence of symptoms and other postoperative adverse events.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.7 MRI measurement and observation indicators\u003c/h2\u003e \u003cp\u003eObserving indicators in MRI imaging include cross-sectional area (CSA\u003csup\u003e[18]\u003c/sup\u003e) and signal change of disc before and 3 months after surgery(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). All distances and area were measured by ImageJ. The same MRI film was independently measured twice by two orthopedic physicians and the average was accepted.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.8 Statistical analysis\u003c/h2\u003e \u003cp\u003eData statistics analysis was using SPSS 20.0, classification data were analyzed using Chi-square test and continuous variables data was analyzed using T-test and Mann-Whitney U test. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3.Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.1 General information\u003c/h2\u003e \u003cp\u003eThe general clinical data of the two groups are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The average age of the LS-PLDD group is (26\u0026thinsp;\u0026plusmn;\u0026thinsp;7) years old. The surgical segments are mostly located at L4/5 (53.3%), followed by L5/S1 (30.0%). 28 patients among all patients complained of low back pain with lower limb pain, while 2 patients complained of low back pain only. We matched 60 patients with LDH who underwent PELD treatment in our center basing on age and gender from January 2014 to December 2022. The age (29\u0026thinsp;\u0026plusmn;\u0026thinsp;6) and gender distribution (32 males and 28 females) in this group, as well as the clinical symptoms and inclusion criteria, are similar to those in the LS-PLDD group.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBasic patients characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLS-PLDD (N\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePELD (N\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.825*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (37.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (63.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (63.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (36.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.936✝\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian(Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26(23,32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(24,34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.799✝\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian(Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(19.75, 24.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22(20.00, 23.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.421*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL1/2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL2/3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL3/4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL4/5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL5/S1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow time(month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.076#\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian(Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(7, 11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (7, 10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-op VAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.779#\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian(Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(6, 8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(6, 8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-op ODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.061#\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian(Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.1% (68.0%, 80.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.0% (62.5%, 76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS Score at last follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.000#\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian(Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(2, 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(1, 2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODI score at last follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.000#\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian(Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.0% (22.5%, 35.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.0% (14.5%, 25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.000#\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian(Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67.0% (55.3%, 72.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3% (71.0%, 86.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eODI improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.000#\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian(Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.5% (51.5%, 69.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.0% (62.5%,78.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-op CSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.157#\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian(Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e822 (636, 1163)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1035 (763, 1268)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-op CSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.227#\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian(Q1, Q3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1373(1005, 1593)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1457(1257, 1978)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e* Chi-Square Test, ✝Independent Samples t-Test, # Mann-Whitney U Test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Clinical outcomes\u003c/h2\u003e \u003cp\u003eIn the LS-PLDD group, all patients received surgical treatment. two patients experienced recurrence and subsequently received PELD treatment again. One patient was a 16-year-old female high school student(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e), within one week post-surgery, her lumbar pain symptoms improved from a VAS score of 7 to 4, but she did not adhere to postoperative rest instructions she returned to school and experienced prolonged sitting, three weeks post-surgery, her lumbar pain symptoms recurred with a VAS score returning to 7, MRI revealed recurrence of LDH. Conservative treatment (bed rest, physical therapy, etc.) did not significantly alleviate symptoms, and she received PELD surgery six months postoperatively. The second patient, a 28-year-old male with a BMI of 24.0, experienced symptom recurrence one month after PLDD surgery and he received PELD treatment last. No recurrence or repeat surgeries were reported among the remaining patients in the LS-PLDD group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe preoperative VAS scores of LS-PLDD group and the PELD group were (7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91) and (7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80) respectively, with no significant statistical difference in the VAS scores for low back pain between the two groups (P\u0026thinsp;=\u0026thinsp;0.779). The VAS scores of the two groups decreased continuously at 1 week, 1 month, 3 months, and 6 months postoperatively (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The last follow-up VAS scores were (2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3) and (1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The PELD group experienced faster postoperatively pain relief compared to the LS-PLDD group. In the PELD group, the most significant pain relief was observed in one week after surgery, then it plateaued. The VAS improvement rates of LS-PLDD group and PELD group were 67.0% (P\u0026thinsp;=\u0026thinsp;0.176) and 33.3% (P\u0026thinsp;=\u0026thinsp;0.113) at 6 months postoperatively, and the difference was statistically significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eThe preoperative ODI scores of LS-PLDD group and PELD group were (71.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9)% and (68.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3)% respectively(Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), with no significant statistical difference between two groups (P\u0026thinsp;=\u0026thinsp;0.061). Both groups showed a continuous decrease in ODI scores at 1 week, 1 month, 3 months and 6 months postoperatively. At the last follow-up, the ODI scores were (28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1)% for the LS-PLDD group and (19.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4)% for PELD group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The average lumbar function of the PELD group at the last follow-up was superior to that of the LS-PLDD group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.3 MRI follow-up and outcomes\u003c/h2\u003e \u003cp\u003eBoth groups of patients had complete MRI films collected before surgery and at last follow-up. The preoperative CSA of the surgical segments in the LS-PLDD and PELD groups were (1373.0\u0026thinsp;\u0026plusmn;\u0026thinsp;376.6) and (1457\u0026thinsp;\u0026plusmn;\u0026thinsp;415.9) respectively, with no significant difference between two groups (P\u0026thinsp;=\u0026thinsp;0.157) (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). At the last follow-up, the surgical segment CSA between LS-PLDD group and PELD group were (1373\u0026thinsp;\u0026plusmn;\u0026thinsp;476.6) and (1457\u0026thinsp;\u0026plusmn;\u0026thinsp;579.2) respectively. We observed an improvement in disc abnormal signal in LS-PLDD groups, including retraction of the herniated disc and restoration of spinal canal volume(Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). In the PELD group, there was also obvious nerve decompression, but the abnormal disc signal still persisted.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4.Discussion","content":"\u003cp\u003eIn this study, we evaluated safety and efficacy of LS-PLDD in treating LDH of adolescent patients. Clinical outcomes analyses revealed that the one-year post-op improvement in the LS-PLDD group is slightly inferior to that in the PELD group, but improvement is still over 50% relative to the preoperative state. The post-op ODI score improvement indicates different patterns of improvement between the LS-PLDD and PELD groups, the PELD group showd the most significant improvement between before and one month after surgery and it plateaued gradually over the year postoperatively. In contrast, the LS-PLDD group showed slower improvement in the first month compared to the PELD group, but there was continuous symptom improvement from one month to one year postoperatively, with improvement nearing that of the PELD group by the end of one year.\u003c/p\u003e \u003cp\u003e In order to further validate this trend, we systematically reviewed clinical research of PLDD from 2006 to 2021, totally obtained 14 clinical studies (Table\u0026nbsp;5), these studies report that the success rate of PLDD generally fluctuates around 75% (based on the MacNab criteria), with approximately 50% rated as excellent and 25% as good, additionally, 0.4-1% of patients experienced complications (primarily postoperative fever and discitis), and the recurrence rate was about 5%. Compared to previous studies, the improvement rate in our study is relatively higher(78%). we think this may be attributed to the enrolled patients were all adolescents, who typically has better postoperative outcomes compared to the elderly. Among the 14 reviewed studies, we found that the studies by Arun (2006) and Stefan (2021) reported better outcomes and higher success rates. These studies had relatively lower baseline age distributions, with average ages of 41 and 50.5 years respectively. However, this hypothesis may be influenced by selection bias, which needs further validation through larger clinical trials.\u003c/p\u003e \u003cp\u003eThis study also find the postoperative MRI change characteristics of LS-PLDD, we wonder relevance between MRI change and clinical improvement trend and if these changes align with symptom improvement patterns. Interestingly, we found the dynamic process of disc herniation retraction after LS-PLDD treatment (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e), we compare the T2WI MRI taken at 3 month, 6 months and 1 year after LS-PLDD surgery, the part of disc herniation showd a gradual smooth retraction trend, while the annulus fibrosus continues to maintain good shape without obvious rupture, which suggested that the puncture needle and fine optical fiber didn\u0026rsquo;t significantly influence the integrity of annulus fibrosus. Over the course of one year postoperatively, we also observed the internal signal of the nucleus pulposus becoming uniform and consistent in MRI. Based on above findings, we hypothesized that low-energy laser may have a positive effect on tissue repairing, but it need further histological experiments to verify it.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe safety and efficacy of LS-PLDD have always been the concerns of physicians, how will the disc height change as time goes by and how long will the efficacy maintain still are uncertain. Ren\u003csup\u003e[19]\u003c/sup\u003e studied the mid-term postoperative MRI changes of PLDD, the results showed that at the one-year postoperative, the height of disc at surgical segment (including the anterior, middle, posterior edges) did not changes significantly compared to pre-op measurements (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05), however, there was a significant difference in the disc protrusion index (the ratio of the disc herniation portion to the maximum anteroposterior diameter of the spinal canal) before and after surgery, this finding suggests that the PLDD procedure can increase the spinal canal volume while maintaining integrity of annulus fibrosus. Nevertheless, the study did not provide a detailed description of the annulus fibrosus morphology, the decreased disc height aligns with most imaging results in our study, which may be attributed to the absorption of the nucleus pulposus following vaporization ablation.\u003c/p\u003e \u003cp\u003eIn the short term, the thermal effect of lasers on discs is certain, which well resulting in disc herniation retraction, however, the long-term effects of lasers on tissue repair and inflammation reduction remain subjects for further investigation. A clinical study conducted by Florian\u003csup\u003e[20]\u003c/sup\u003e involved 24 cases of MRI guided LS-PLDD, during a follow-up period of at least 3 months postoperatively, pre and post-operative MR images were collected, notably T1 images at 6 months postoperatively showed improvement in Modic changes in the adjacent endplates of surgical segment. Modic change\u003csup\u003e[21]\u003c/sup\u003e is a typical manifestation of endplate degeneration, and their reduction suggests that the laser may have an anti-inflammatory effect. Additionally, Kun-Tsung\u003csup\u003e[15]\u003c/sup\u003e further confirmed the anti-inflammatory effect of lasers through animal experiments, experiments used low-level laser irradiation (LLLI) in wound healing and anti-inflammatory applications and the results revealed a decrease in expression of various anti-inflammatory factors, including TNF-α, IL-1β, IL-6, and IL-8. Although the lasers used in these studies were not produced by the same medium, we hypothesize that they may have similar mechanisms, this requires further validation through additional animal experiments.\u003c/p\u003e \u003cp\u003e \u003cb\u003eoperating process\u003c/b\u003e \u003c/p\u003e \u003cp\u003eDuring the LS-PLDD surgical procedure, we observed that laser irradiation results in the liquefaction and vaporization of the nucleus pulposus tissue. We review the previous studies and the varying levels of laser energy induce distinct changes in soft tissue\u003csup\u003e[22]\u003c/sup\u003e, the medium through which the laser conducts energy to the interstitial disc is very important. we paid particular attention to a critical step during the irradiation process for all patients in this study, we used a syringe to extract the contents produced by the ablation from the disc and injected clean saline. This step aimed to remove vaporized and liquefied tissues to prevent them from interfering with the effective laser irradiation of the disc tissue.\u003c/p\u003e \u003cp\u003eThe transmittance of laser in saline and tissue fluid is different\u003csup\u003e[23]\u003c/sup\u003e, penetration depth of different wavelengths laser in the same tissue fluid can range from micrometers to centimeters. During the procedure, turbid fluid could be extracted, primarily due to the carbonization of some tissue caused by high temperatures. Currently, the two main types of lasers used are YAG:Nd (neodymium) laser (wavelength\u0026thinsp;=\u0026thinsp;1.064 \u0026micro;m) and CO2 laser (wavelength\u0026thinsp;=\u0026thinsp;10.6 \u0026micro;m)\u003csup\u003e[24, 25]\u003c/sup\u003e. the penetration depths of the two lasers are approximately 2\u0026ndash;5 mm and 10 \u0026micro;m in blood-rich soft tissues respectively. Turbid tissue fluid can hinder laser penetration, clean saline has superior thermal conductivity, enabling it to radiate over a broader area. Additionally, saline can effectively control the temperature at the tip of the optical fiber, preventing the adverse effects of excessive carbonization on the laser's radiation efficacy, maintaining an appropriate temperature is crucial for normal tissue, therefore, we strictly regulate the relevant parameters during the procedure to ensure the safety and effectiveness of the surgery.\u003c/p\u003e "},{"header":"5.Conclusion","content":"\u003cp\u003eThis preliminary clinical study indicates that low-energy semiconductor PLDD is a safe and effective therapeutic option for treating adolescent LDH patients without obvious annulus fibrosus rupture. On the premise of retaining the intergrity of disc structure, this method can achieve sustained retraction of the disc herniation and decompressing the spinal canal during 1 year after surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of the First Affiliated Hospital of Harbin Medical University(Grant No. [\u003cem\u003eIRB-AF/SC-04/02.0\u003c/em\u003e]). All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted as a retrospective analysis of existing clinical data. The research protocol was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Harbin Medical University. As the study involved the analysis of de-identified and anonymized patient data. The use of retrospective data without direct patient involvement aligns with ethical guidelines and ensures the protection of patient privacy and confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis article is sponsored by the \u003cem\u003eBethune\u003c/em\u003e\u003cem\u003e\u0026middot;\u003c/em\u003e\u003cem\u003eSpecial Research Fund Project (BK-JP2021001).\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLi Shiwen: Study conception, manuscript drafting.Hu Tianyu: Data acquisition, analysis, and interpretation.Ivanenko Andrei Valentinovich: Supervision, final manuscript review.Xu Jiayuan: Data acquisition, analysis, and interpretation.Wang Wenyu: Study design, literature review.Qi Quan: Supervision, final manuscript review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThank Harbin Science and Technology Bureau for supporting this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript or supplementary information files\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDang L, Liu Z (2010) A review of current treatment for lumbar disc herniation in children and adolescents. 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Lasers Surg Med 54:530-539\u003c/li\u003e\n\u003cli\u003eKobayashi S, Uchida K, Takeno K, Yayama T, Nakajima H, Nomura E, Hayakawa K, Meir A, Yonezawa T, Baba H (2007) A case of nerve root heat injury induced by percutaneous laser disc decompression performed at an outside institution: technical case report. Neurosurgery 60:ONSE171-172; discussion ONSE172\u003c/li\u003e\n\u003cli\u003eSchenk B, Brouwer PA, van Buchem MA (2006) Experimental basis of percutaneous laser disc decompression (PLDD): a review of literature. Lasers Med Sci 21:245-249\u003c/li\u003e\n\u003cli\u003eHosseini B, Allameh F (2020) Laser Therapy in Lumbar Disc Surgery - A Narrative Review. J Lasers Med Sci 11:390-394\u003c/li\u003e\n\u003cli\u003eSchwaighofer A, Brandstetter M, Lendl B (2017) Quantum cascade lasers (QCLs) in biomedical spectroscopy. Chem Soc Rev 46:5903-5924\u003c/li\u003e\n\u003cli\u003eBoiko DL, Vasil\u0026apos;ev PP (2012) Superradiance dynamics in semiconductor laser diode structures. 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Neurol India 54:164-167\u003c/li\u003e\n\u003cli\u003eLee SH, Ahn Y, Choi WC, Bhanot A, Shin SW (2006) Immediate pain improvement is a useful predictor of long-term favorable outcome after percutaneous laser disc decompression for cervical disc herniation. Photomed Laser Surg 24:508-513\u003c/li\u003e\n\u003cli\u003eIwatsuki K, Yoshimine T, Awazu K (2007) Percutaneous laser disc decompression for lumbar disc hernia: indications based on Lasegue\u0026apos;s Sign. Photomed Laser Surg 25:40-44\u003c/li\u003e\n\u003cli\u003eIshiwata Y, Takada H, Gondo G, Osano S, Hashimoto T, Yamamoto I (2007) Magnetic resonance-guided percutaneous laser disk decompression for lumbar disk herniation--relationship between clinical results and location of needle tip. Surg Neurol 68:159-163\u003c/li\u003e\n\u003cli\u003eHaufe SM, Mork AR, Pyne M, Baker RA (2010) Percutaneous laser disc decompression for thoracic disc disease: report of 10 cases. Int J Med Sci 7:155-159\u003c/li\u003e\n\u003cli\u003eRen L, Han Z, Zhang J, Zhang T, Yin J, Liang X, Guo H, Zeng Y (2014) Efficacy of percutaneous laser disc decompression on lumbar spinal stenosis. Lasers Med Sci 29:921-923\u003c/li\u003e\n\u003cli\u003eLuo DX, Jin XJ, Li GT, Sun HT, Li YY, Qi Y (2014) The use of targeted percutaneous laser disc decompression under the guidance of puncture-radiating pain leads to better short-term responses in lumbar disc herniation. Eur Rev Med Pharmacol Sci 18:3048-3055\u003c/li\u003e\n\u003cli\u003eBrouwer PA, Brand R, van den Akker-van Marle ME, Jacobs WC, Schenk B, van den Berg-Huijsmans AA, Koes BW, van Buchem MA, Arts MP, Peul WC (2015) Percutaneous laser disc decompression versus conventional microdiscectomy in sciatica: a randomized controlled trial. Spine J 15:857-865\u003c/li\u003e\n\u003cli\u003eMeng C, Li Y, Wang S, Yu J, Kou D, Liu C (2019) Application of a modified optical fiber in targeted percutaneous laser disc decompression of lumbar disc herniation: A retrospective study. Exp Ther Med 18:3552-3562\u003c/li\u003e\n\u003cli\u003eHashemi M, Dadkhah P, Taheri M, Katibeh P, Asadi S (2020) Effectiveness of intradiscal injection of radiopaque gelified ethanol (DiscoGel(\u0026reg;)) versus percutaneous laser disc decompression in patients with chronic radicular low back pain. Korean J Pain 33:66-72\u003c/li\u003e\n\u003cli\u003eTerai H, Tamai K, Iwamae M, Kaneda K, Katsuda H, Shimada N, Nakamura H (2021) Characteristics and Short-Term Surgical Outcomes of Patients with Recurrent Lumbar Disc Herniation after Percutaneous Laser Disc Decompression. Medicina (Kaunas) 57:1225\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 5 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"lasers-in-medical-science","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"lims","sideBox":"Learn more about [Lasers in Medical Science](https://link.springer.com/journal/10103)","snPcode":"10103","submissionUrl":"https://submission.springernature.com/new-submission/10103/3","title":"Lasers in Medical Science","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"LDH, LS-PLDD, Semiconductor laser, MRI, Disc repair","lastPublishedDoi":"10.21203/rs.3.rs-4827462/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4827462/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eLow-energy semiconductor percutaneous laser disc decompression (LS-PLDD) is a minimally invasive surgical method that uses a laser to treat lumbar disc herniation. However, there is currently no clinical efficacy evaluation of this surgical method for treating lumbar disc herniation in adolescents. This study aimed to evaluate the safety and effectiveness of LS-PLDD compared with percutaneous endoscopic discectomy (PELD) in the treatment of adolescent LDH patients.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003ecollected data on 30 adolescent LDH patients who received LS-PLDD in our center, 60 adolescent LDH patients who received PELD in our center were matched based on age and gender. The lumbar ODI and back pain VAS score before surgery and 1 week, 1 month, 3 months and 6 months after surgery were collected to evaluate the clinical outcome of two groups. And we also compared the lumbar MR imaging examinations before surgery and 3 months after surgery to observe the changes of MR of disc.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe preoperative back VAS scores were (7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91) and (7\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8) in the LS-PLDD group and PELD group respectively, with no significant statistical difference (P\u0026thinsp;=\u0026thinsp;0.779). The VAS scores of both groups had improvement after surgery. At the last follow-up, the VAS scores of both groups were (2.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3) and (1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8) respectively ( P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The VAS scores of patients in PELD group improved most significantly in the first week after surgery and then gradually stabilized, while that in LS-PLDD group improved more gradually during 6 months after surgery. The preoperative ODI scores of the LS-PLDD group and PELD group were (71.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9)% and (68.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3)% (P\u0026thinsp;=\u0026thinsp;0.061), at the last follow-up, the ODI scores were (28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1)% and (19.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4)% (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The preoperative canal cross-sectional areas in the LS-PLDD group and PELD group were (1373.0\u0026thinsp;\u0026plusmn;\u0026thinsp;376.6) and (1457\u0026thinsp;\u0026plusmn;\u0026thinsp;415.9) respectively, with no significant difference between the two groups (P\u0026thinsp;=\u0026thinsp;0.157), at the last follow-up, the canal cross-sectional area of the surgical segments were (1373\u0026thinsp;\u0026plusmn;\u0026thinsp;476.6) and (1457\u0026thinsp;\u0026plusmn;\u0026thinsp;579.1) (P\u0026thinsp;=\u0026thinsp;0.227)respectively.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThis study shows that low-energy semiconductor laser LS-PLDD is a safe and effective treatment method for adolescent LDH. It can achieve sustained retraction of the herniated disc and retain the intact structure of the disc.\u003c/p\u003e","manuscriptTitle":"MRI changes and clinical results of low-energy semiconductor percutaneous laser disc decompression（LS-PLDD） for lumbar disc herniation in adolescents","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-16 00:44:45","doi":"10.21203/rs.3.rs-4827462/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-31T18:18:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-31T09:31:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"314510370321185321451050841237035113084","date":"2025-07-31T02:42:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173264199337484759569144062349943906264","date":"2025-07-31T02:16:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"200821461134790353187027159649820210331","date":"2025-07-21T16:39:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-18T13:59:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"157024481700326735866963247724946074407","date":"2024-12-12T08:20:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-12T16:51:47+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-12T16:51:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-07T23:50:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"Lasers in Medical Science","date":"2024-07-30T09:22:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"lasers-in-medical-science","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"lims","sideBox":"Learn more about [Lasers in Medical Science](https://link.springer.com/journal/10103)","snPcode":"10103","submissionUrl":"https://submission.springernature.com/new-submission/10103/3","title":"Lasers in Medical Science","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a7724c34-64d9-47ab-92eb-8268fd72d1c9","owner":[],"postedDate":"September 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-17T16:00:26+00:00","versionOfRecord":{"articleIdentity":"rs-4827462","link":"https://doi.org/10.1007/s10103-025-04730-2","journal":{"identity":"lasers-in-medical-science","isVorOnly":false,"title":"Lasers in Medical Science"},"publishedOn":"2025-11-15 15:57:22","publishedOnDateReadable":"November 15th, 2025"},"versionCreatedAt":"2024-09-16 00:44:45","video":"","vorDoi":"10.1007/s10103-025-04730-2","vorDoiUrl":"https://doi.org/10.1007/s10103-025-04730-2","workflowStages":[]},"version":"v1","identity":"rs-4827462","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4827462","identity":"rs-4827462","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}