Abstract. Laser radiation provides a means to control the fields of temperature and thermo mechanical stress, mass transfer, and modification of fine structure of the cartilage matrix. The aim of this outlook paper is to review physical and biological aspects of laser-induced regeneration of cartilage and to discuss the possibilities and prospects of its clinical applications. The problems and the pathways of tissue regeneration, the types and features of cartilage will be introduced first. Then we will review various actual and prospective approaches for cartilage repair; consider possible mechanisms of laser-induced regeneration. Finally, we present the results in laser regeneration of joints and spine disks cartilages and discuss some future applications of lasers in regenerative medicine. C 2011 Society of Photo-Optical Instrumentation Engineers (SPIE).

Study design: Intercostal nerve to spinal nerve root anastomosis in chronic spine-injured patients. Objectives: To analyze the effectiveness of neurogenic bladder reinnervation in spinal cordinjured patients through artificial creation of sprouting (intercostal nerve to spinal nerve root anastomosis). Setting: Center of Neurosurgery, Moscow, Russia. Operations were performed by Professor A Livshits. (At present, Professor A Livshits is working at the Spinal Care Unit, Meir General Hospital, Kfar Saba, Israel.) Methods: A total of 11 patients with spinal cord injury of the L1 level were operated on in the late (chronic) stage. The neurological status and urodynamics were investigated before and 12 months after operation. A laminectomy from T11 to L3 was performed. Next, a neurolysis of the 11th and 12th intercostal nerves was carried out, at a distance of 20-21 cm, and transferred to the vertebral canal. The S2-S3 roots were then cut in their proximal portion and anastomosed end-to-end to the intercostal nerves. The results of urodynamic studies were calculated by the Wilcoxon signed rank test for comparison before and 12 months after operation. Results of urodynamic studies: Bladder capacity (ml) before operation -489779, after operation -350739, urine volume (ml) before -18.2717, after -306.4739.8, residual urine (ml) before -459799.4, after -50711.8. Detrusor tone (rel. units) before -0.671.5, after 1.270.2; voiding pressure (cmH 2 O) before -4.475.2, after -30.574.9. Force of detrusor contraction before -575.8, after -32.875.5. Sphincter resistance (cmH 2 O) before -6.573.8, after -21.174.2. Significant improvements in bladder function were observed during the 10th to 12th postoperative months. Restoration of reflex voiding occurred in all patients; in eight of the 11 paresthesic in the groin and scrotum and reappearance of the bulbocavernous, anal and cremasteric reflexes were noted. Conclusion: These results suggest that a restitutive process occurs in the bladder under novel conditions of its nerve supply provided by the intercostal nerve and by new connections established between it and the bladder nerves. Spinal cord lesions that might benefit from nerve crossover surgery would be located at the conus, so functional intercostal nerves could be connected to sacral roots to bypass the injury in an attempt to restore central connections to the bladder.

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Objective: Compare rehabilitation after spinal cord lesions (SCL) in different countries. Design: Multicenter comparative study. Setting: Four spinal rehabilitation units, in Denmark, Russia, Lithuania and Israel. Subjects: 199 SCL patients. Interventions: Information was collected about unit properties, rehabilitation objectives, American Spinal Injury Association (ASIA) scale and spinal cord independence measure (SCIM) assessments, and patient data. w 2 -test, t-test, ANOVA and ANCOVA were used for statistical analysis. Main outcome measures: Time from lesion onset to admission for rehabilitation (TAR), length of stay in rehabilitation (LOS), SCIM and spinal cord ability realization measurement index (SCI-ARMI) scores, SCIM gain, SCI-ARMI gain and rehabilitation efficiency (RE). Results: Differences were found between the units in rehabilitation objectives, facilities and special equipment for rehabilitation. Staff/bed ratio was 1.7 in Lithuania and Denmark, 1.1 in Israel and 0.9 in Russia. Russian patients were the youngest and had the most severe lesions among participating units. Admission SCIM and SCI-ARMI were the lowest in Israel: 25.1 ± 17.2 and 34.3 ± 17.3. TAR was highest in Russia (12.4 month) and lowest in Israel (2 weeks; Po0.01). LOS was longest in Denmark (176.9 days; Po0.001). SCIM score at the end of rehabilitation was highest in Denmark (67.3 ± 23). SCIM gain and SCI ARMI gain were highest in Israel (36.9±18.3 and 38.5±19.4, respectively) and lowest in Russia (Po0.001). RE was highest in Lithuania and lowest in Denmark (Po0.001). Conclusions: In the participating units, SCL rehabilitation outcomes depend on SCL severity and unitspecific properties. A moderately delayed rehabilitation with long LOS achieved high functioning, and early or slightly delayed rehabilitation combined with shorter LOS achieved high functional gain or efficiency.

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