Like other procedures that rely on central disc decompression for their mechanism of action, APLD is applicable in selected patients. At present, the patient with an extruded lumbar disc is still best treated by an open posterior approach, such as microdiscectomy or laminectomy. The brass ring of lumbar spine surgery will belong to those who are able to develop a procedure with the safety of APLD that can still deal with extruded and free fragments of disc. I have no doubt that, with the advent of sophisticated real-time guidance in the form of helical multislice CT and interventional MRI, this goal is attainable.
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