Dr Rezaiamiri was trained by Dr. Daniel Choy at the Laser Spine Center in Manhattan, NY. Dr. Rezaiamiri was his last student.
Dr. Daniel S. J. Choy from Columbia University (New York – USA) pioneered PLDD in 1986. Over one hundred thousand PLDD procedures have been performed successfully world-wide and scientific articles about PLDD have appeared in The New England Journal of Medicine, Spine, Neurosurgery, Clinical Orthopedics and Related Research, Neurology India and The Journal of Clinical Lasers in Medicine and Surgery (now named Photomedicine and Laser Surgery).
This minimally invasive surgery technique can be performed in patients who need surgical intervention for disc herniation or foraminal stenosis with mild stenosis plus slipped disc in the same patient. Patient selection, and disc morphology, are the two most important factors determining the choice of technique.
The treatment principle of PLDD is based on the concept of the intervertebral disc being a closed hydraulic system. This system consists of the nucleus pulposus, containing a large amount of water, surrounded by the inelastic annulus fibrosus. An increase in water content of the nucleus pulposus leads to a disproportional increase of intradiscal pressure. A reduction of intradiscal pressure causes the herniated disc material to recede toward the center of the disc, thus leading to reduction of nerve root compression and relief of radicular pain (leg pain and/or back pain). In the PLDD, this mechanism is due to the application of laser energy evaporating a small amount of water in the nucleus pulposus. Laser energy is delivered by a laser fiber through a tiny needle placed into the nucleus pulposus. The needle is placed into the intervertebral disc under anesthesia. Apart from evaporation of water, the increase in temperature also causes protein denaturation and subsequent renaturation (biochemical effect of laser energy into the nucleus pulposus). This causes a structural change of the nucleus pulposus, limiting its capability to attract water and therefore leading to a permanent reduction of intradiskal pressure.