Application of the Flexible CO2 Laser in Minimally Invasive Laminectomies: Technical Note.

By Kamruz Zaman
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Application of the Flexible CO2 Laser in Minimally Invasive Laminectomies: Technical Note.

Cureus. 2016;8(6):e628

Authors: Hussain NS, Perez-Cruet M

Abstract
Background Minimally invasive laminectomy is a very effective surgical method for treating lumbar stenosis. However, this technique can be technically difficult, especially in patients suffering from severe stenosis. The contralateral decompression from a unilateral approach can result in durotomy during removal of the hypertrophied ligamentum flavum. This complication can be difficult to treat through a small working channel. Objective To detail our group’s operative experience with the CO2 laser and discuss our results and previous studies in the literature reporting results.  Methods The CO2 laser (Omniguide, Boston, MA) was investigated in the surgical ablation of the contralateral ligamentum flavum during minimally invasive laminectomies. Forty levels have been investigated thus far. The amount of voltage needed to adequately desiccate and remove the ligamentum flavum safely as well as the effectiveness of this technique were investigated. Results The contralateral ligamentum flavum could be removed effectively using the 9 to 11 watt continuous wavelength (10,600 nanometer) power setting on the CO2 laser. Shrinkage of the contralateral ligamentum flavum facilitated its removal using a number 2 Kerrison Punch. No durotomies occurred, and the use of the laser did not significantly lengthen operative times.  Conclusions The CO2 laser appears to be a useful tool in the armamentarium of instruments available to the minimally invasive spine surgeon and may help to reduce the incidence of durotomies when performing minimally invasive laminectomies.

PMID: 27433407 [PubMed]

Laser assisted disc decompression: an alternative treatment modality in the Medicare population.

By London Spine

Related Articles Laser assisted disc decompression: an alternative treatment modality in the Medicare population. J Okla State Med Assoc. 1996 Jan;89(1):11-5 Authors: Casper GD, Hartman VL, Mullins LL Abstract The current study evaluated the efficacy of LADD within the Medicare population, and examined the influence of coexisting medical conditions and previous surgical intervention on surgical…

Laser Spine Surgery for Herniated Discs and/or Nerve Root Entrapment: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines

By London Spine

Related Articles Laser Spine Surgery for Herniated Discs and/or Nerve Root Entrapment: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines Book. 2017 04 27 Authors: Khangura S, Ryce A Abstract The purpose of this report is to search, synthesize and summarize evidence describing the clinical effectiveness, cost-effectiveness, and evidence-based guidelines addressing laser spine surgery in…

Laser-guided lumbar medial branch kryorhizotomy.

By London Spine
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Laser-guided lumbar medial branch kryorhizotomy.

J Neurosurg Spine. 2010 Sep;13(3):341-5

Authors: Andres RH, Graupner T, Bärlocher CB, Augsburger A, Fandino J

Abstract
The authors describe a modification of the medial branch kryorhizotomy technique for the treatment of lumbar facet joint syndrome using a fluoroscopy-based laser-guided method. A total of 32 patients suffering from lumbar facet joint syndrome confirmed by positive medial nerve block underwent conventional or laser-guided kryorhizotomy. The procedural time (20.6 +/- 1.0 vs 16.3 +/- 0.9 minutes, p < 0.01), fluoroscopy time (54.1 +/- 3.5 vs 28.2 +/- 2.4 seconds, p < 0.01), radiation dose (407.5 +/- 32.0 vs 224.1 +/- 20.3 cGy/cm(2), p < 0.01), and patient discomfort during the procedure (7.1 +/- 0.4 vs 5.2 +/- 0.4 on the visual analog scale, p < 0.01) were significantly reduced in the laser-guided group. There was a tendency for a better positioning accuracy when the laser guidance method was used (3.0 +/- 0.3 vs 2.2 +/- 0.3 mm of deviation from the target points, p > 0.05). No difference in the outcome was observed between the 2 groups of patients (visual analog scale score 3.5 +/- 0.2 vs 3.3 +/- 0.3, p > 0.05). This improved minimally invasive surgical technique offers advantages to conventional fluoroscopy-based kryorhizotomy.

PMID: 20809727 [PubMed – indexed for MEDLINE]

Results of a clinical trial of the holmium:YAG laser in disc decompression utilizing a side-firing fiber: a two-year follow-up.

By London Spine

Related Articles Results of a clinical trial of the holmium:YAG laser in disc decompression utilizing a side-firing fiber: a two-year follow-up. Lasers Surg Med. 1996;19(1):90-6 Authors: Casper GD, Hartman VL, Mullins LL Abstract BACKGROUND AND OBJECTIVE: Laser-assisted disc decompression (LADD) is an operative technique for the treatment of symptomatic, nonsequestered herniated nucleus pulposus that has…