Technical aspects of the percutaneous cervical and lumbar laser-disc-decompression and -nucleotomy

By London Spine

To achieve optimal results during percutaneous cervical and lumbar laser-disc-decompression, technical aspects have to be taken into consideration for this minimally invasive operation. The selection of the laser system is thus most significant. A Neodym-YAG-Laser is applied with a wavelength of 1064 nm which, compared to vaporization, has the prerequisites for shrinking from the experimental viewpoint. Selection of parameters for the application of energy depends on size and position of the cervical and lumbar discs. A needle with a mandrin having an outer cross section of up to 2 mm is used to puncture the disc. An ultrasharp needle tip is important. The approach depends on the section of the vertebral column involved. The insertion of the needle in the cervical discs is from the right side ventral and dorsolateral in thoracic and lumbar regions. In difficult cases of spondylophytes the insertion is helped by the so-called punctual laserosteotomy through the spondylophytes, which does not require any additional equipment at the operating table. The C-bow is sufficient for X-ray equipment and has to be adjusted according to the disc position. This minimal invasive procedure shows a technical failure rate of only 1.5/1000 in 2535 percutaneous laser disc decompressions and nucleotomies. There are two malfunctions of the laser machine and one of the X-ray technique. The PLDN using Nd-YAG 1064 nm is a technically perfect method with a very high standard of safety

The effect of laser irradiation for nucleus pulposus: an experimental study

By London Spine

BACKGROUND: The radicular pain caused by disc herniation can be explained by two mechanisms: the compression of the nerve root by the herniated disc or the irritation of the nerve root due to chemical factors. Percutaneous laser disc decompression (PLDD) was introduced for the treatment of lumbar disc hernias in the 1980s. Decompression of the nerve root is assumed to be an effective therapeutic mechanism for PLDD. However, laser irradiation might reduce the chemical factors that cause nerve root irritation by altering intra-disc proteins. We used nerve conduction velocities (NCV) and levels of two chemical factors to evaluate the differences between the two groups in this in vivo study. METHODS: All rabbits had the nerve root in contact with the leakage from the nucleus pulposus. One group underwent laser irradiation for the leaking nucleus pulposus including the incision site of the disc and nucleus pulposus itself. The levels of two chemical factors, prostaglandin E2 and phospholipase E2, in the intervertebral disc were measured before and after laser irradiation. RESULTS: NCV in the laser-irradiated group was significantly faster than in the non-laser-irradiated group. The levels of chemical factors were significantly reduced after laser irradiation. CONCLUSIONS: One of the mechanisms thought to be responsible for PLDD’s effectiveness is a decrease in the chemical factors through protein alteration in the intervertebral disc by laser irradiation

Ozone oxidative post-conditioning reduces oxidative protein damage in patients with disc hernia.

By London Spine
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Ozone oxidative post-conditioning reduces oxidative protein damage in patients with disc hernia.

Neurol Res. 2012 Jan;34(1):59-67

Authors: León Fernández OS, Pantoja M, Díaz Soto MT, Dranguet J, García Insua M, Viebhan-Hánsler R, Menéndez Cepero S, Calunga Fernández JL

Abstract
INTRODUCTION/OBJECTIVES: Although inflammation in disc hernia (DH) has been recognized and it is a well-known process mediated by loss of the cellular redox balance, only a few studies about the impact of chronic oxidative stress on this neurological disorder have been made. Ozone therapy has been widely used with clinical efficacy in DH. This work aimed at characterizing the systemic redox status of patients with low back pain and neck pain as well as studying if ozone oxidative post-conditioning modified the pathological oxidative stress and protected against oxidative protein damage and if there is any relationship between oxidative changes and pain in both DH.
METHODS: Redox status of 33 patients with diagnosis of DH by computerized axial tomography, nuclear magnetic resonance, and clinical evaluations was studied. Ozone was administered by paravertebral way. After ozone treatment, plasmatic levels of antioxidant/pro-oxidant markers, pain, and life quality disability parameters were evaluated.
RESULTS: One hundred percent of patients showed a severe oxidative stress. Major changes in superoxide dismutase activity, total hydroperoxides, advanced oxidation protein products, fructolysine content, and malondialdehyde were observed. After ozone oxidative post-conditioning, there was a re-establishment of patients’ cellular redox balance as well as a decrease in pain in both DH. A relationship between indicators of oxidative protein damage and pain was demonstrated.
CONCLUSIONS: Ozone therapy protected against oxidation of proteins and reduced the pain. Relationship between markers of oxidative protein damage, disability parameters, and pain suggests the role of oxidative stress in the pathological processes involved in DH.

PMID: 22196863 [PubMed – indexed for MEDLINE]

Efficacy and safety of vertebral stenting for painful vertebral compression fractures in patients with metastatic disease

By London Spine

BACKGROUND AND PURPOSE: Painful vertebral compression fractures in cancer patients reduce quality of life and may limit survival. We assessed pain relief, vertebral height restoration, and kyphosis correction following vertebral augmentation using a novel expandable titanium stent implant in cancer patients with painful vertebral compression fractures. MATERIALS AND METHODS: Patients >18 years of age with metastatic disease who presented symptomatic compression fractures of vertebral bodies T5-L5, with or without a history of osteoporosis, were included in the study. Back pain at presentation, immediately after vertebral stenting, and at 1-, 3-, 6-, and 12-month follow-up was estimated using the visual analog scale (VAS). Vertebral height and local kyphotic angle (alpha angle) were measured on lateral standing X-ray before and 1-3 months after stenting. RESULTS: Forty-one cancer patients with painful vertebral compression fractures underwent vertebral stenting procedures at 55 levels. There was no perioperative mortality and no significant complication. Median preoperative VAS was 8.0 (range 8-10), falling to 2.0 immediately postop (range 1-6, P = 0.000) and 0 at all subsequent follow-up (P