Ablation of Bone, Cartilage, and Facet Joint Capsule Using Ho:YAG Laser

Hafez, M.I.; Coombs, Richard; Zhou, S.; McCarthy, Ian

doi:10.1089/10445470260420759

Cited by 16 publications

(11 citation statements)

References 8 publications

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“…The image analysis software used in the present study has been validated previously in a veterinary report comparing MRI and histomorphologic measurements of articular cartilage thickness revealing strong correlations without signifi cant differences (Pр.001). 12 Scion Image has also been used in prior studies within the orthopedic literature to measure joint space narrowing of the wrist and digits, 13 the effect of impaction bone grafting on prosthetic fi t in the proximal humerus, 14 the impact of Ho:YAG laser bone ablation of the lumbar spine, 15 and the determination of an optimal femoral donor site in autologous osteochondral transplantation. 16 Other versions of computer imaging software have also been used to determine shoulder capsular thickness 17 and patellar articular cartilage thickness.…”

Section: Discussionmentioning

confidence: 99%

Articular Cartilage Thickness of the Humeral Head: An Anatomic Study

Fox¹,

Cole²,

Romeo³

et al. 2008

ORTHOPEDICS

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This study determined the thickness of normal humeral head articular cartilage by anatomic cross section using computer-aided image analysis software. Sixteen adult cadaveric humeral heads were analyzed. Our fi ndings reveal that the thickness of humeral articular cartilage is substantially thinner than articular cartilage found in the knee. The cartilage is thickest in the central portion of the head and becomes progressively thinner towards the periphery. Surgical techniques used to treat pathology in the glenohumeral joint, specifi cally thermal energy or mechanical debridement, may have deleterious effects on the relatively thin humeral articular cartilage.A rticular cartilage thickness has been extensively studied in the knee. 1-7 However, there is a paucity of data regarding the thickness of articular cartilage of the humeral head. Most characterizations of humeral head articular cartilage have been performed using radiographic imaging studies, specifi cally magnetic resonance imaging with and without the use of intraarticular contrast. [8][9][10] The radiographic data obtained in two of these studies were compared to the corresponding data obtained by direct measurement of the articular surface. In both studies, only limited areas of the humeral head were analyzed, and direct measurements of the articular surface were performed by observers using loupe magnifi cation. The diffi culty in accurately imaging the highly spherical humeral head and the substantially thinner articular cartilage found on the hu-meral head as compared to the knee were the reasons given for the inferior results. According to Eckstein 2 , magnetic resonance imaging (MRI) of strongly curved surfaces can overestimate cartilage thickness without appropriate derivations. Soslowsky et al 11 used stereophotogrammetry to defi ne the geometry of the glenohumeral articulation and reported on surface area and cartilage thickness of both the humeral head and the glenoid.The purpose of this study was to determine the thickness of humeral head articular cartilage via anatomic measurements from multiple cross sections of cadaveric humeral heads using computeraided image analysis software. From this data a topographical map of humeral head articular cartilage was developed. This information may serve as a standardization of normal articular cartilage thickness of the humeral head. MATERIALS AND METHODSEighteen adult cadaveric humeri (8 left and 10 right) were obtained through the anatomic gift association at Rush University Medical Center. The age of the specimens ranged from 53 to 91 years. Overlying muscle and soft tissue were sharply dissected away with a scalpel and scissors with care taken to avoid injury to the articular surface. Two right humeral heads were eliminated: one head demonstrated evidence of degenerative changes, and the second head had developed subchondral cysts. Thus, 16 humeral heads were analyzed. Humeral heads were cut at the anatomical neck with a band saw. The heads were then placed in a plastic container and potted in Iso...

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Section: Discussionmentioning

confidence: 99%

Articular Cartilage Thickness of the Humeral Head: An Anatomic Study

Fox¹,

Cole²,

Romeo³

et al. 2008

ORTHOPEDICS

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“…has been proven to be a safe procedure to widen the lumbar foramen by removing part of bone and ligamentous tissue surrounding the foramen (17,(24)(25)(26)(27)(28). However, the disadvantages of endoscopic foraminoplasty are quite obvious, for example, expensive equipment, low working efficiency, inadequate decompression for lateral recess stenosis, and risk of heat-damage to surrounding spinal nerves (11,12,15,16). Hoogland et al (19,29,30) invented the Tessys technique which uses a graded trephine to widen the foramen gradually.…”

Section: Safety Of a Specially Designed Instrument For Modified Plfmentioning

confidence: 99%

“…nel of the rigid endoscope (11,12,15,16). In cases combined with lateral recess stenosis, retrieval of a highly migrated herniation can be technically very challenging even for an experienced surgeon.…”

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confidence: 99%

“…Lewandrowski (12) also reported clinical failures that occurred in patients with bony stenosis in the lateral recess and entry zone of the neuroforamen. Besides, the increase in temperature while using a highspeed burr or side-firing laser may potentially lead to inflammation of the nerve and may also cause deterioration of nerve conduction to some extent (15,16). Knight et al (17) reported that transient post-operative "flares" were noted in 19% of patients when a sidefire laser was used in transforaminal endoscopic lumbar foraminoplasty for foraminal stenosis, while Ahn et al (18) reported 6.1% postoperative dysesthesia after endoscopic foraminotomy with an endoscopic high-speed drill.…”

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confidence: 99%

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Modified Percutaneous Lumbar Foraminoplasty and Percutaneous Endoscopic Lumbar Discectomy: Instrument Design, Technique Notes, and 5 Years Follow-up

2017

Pain Phys

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Background: Conventional percutaneous endoscopic lumbar discectomy (PELD) with an “insideoutside” technique has 4.3% – 10.3% surgical failure rate, especially in central herniated discs (HDs), migrated HDs, and axillary type HDs. PELD with foraminoplasty has been used for complex HDs. Percutaneous lumbar foraminoplasty (PLF), which is performed with a trephine or bone reamer introduced over a guidewire without a protective working cannula in the original Tessys technique, can quickly cut the hypertrophied bony structure under fluoroscopic guidance, and risk injury to the exiting and traversing nerve roots. Study Design: A prospective cohort study. Setting: Hospital and outpatient surgical center. Objective: To evaluate the outcome and safety of modified PLF-PELD with a specially designed instrument for complex uncontained lumbar HDs. Method: From April of 2007 to April of 2009, 148 patients with uncontained lumbar HDs were treated with modified PLF-PELD. Magnetic resonance imaging (MRI) checkup was performed the next morning after the operation. Outcomes of symptoms were evaluated by follow-up interviews at 3 months, 6 months, one year, and 5 years after surgery. Low back pain and leg pain were measured by visual analog scale (VAS) score (1 – 100). Functional outcomes were assessed by using the Oswestry Disability Index (ODI) and modified MacNab criteria. Result: Follow-up data were obtained from 134 cases, including 14 cases on L3-4, 78 cases on L4-5, and 42 cases on L5-S1. One hundred-eight cases were prolapse type, while 26 cases were sequestration type. Pre-operative symptoms and deficits included nerve root dermatome hypoesthesia in 98 patients (73%), nerve root myotome muscle weakness in 32 patients (23%), and weakening or disappearance of tendon reflex in 43 patients (32%). No case required conversion to an open procedure during the surgery. Low back pain and leg pain were significantly relieved immediately after surgery in all patients. MRI examination showed adequate removal of HD in all patients. VAS scores and ODI values were significantly lower at all time points after surgery than before surgery. The percentage of pain relief in leg pain was significantly higher than that in low back pain (P < 0.01). But there was no significant correlation between duration of the preoperative symptoms and the percentage of pain relief. MacNab scores at 5 years after surgery were obtained from 134 patients. Seventy-five cases were rated “excellent”; 49 were rated “good,” Five patients experienced heavier low back pain, thus being classified as “fair.” Five cases with recurrence were rated “poor.” Preoperative and postoperative (5 years follow-up) related nerve root function status was compared. Sensation and muscle strength recovered significantly (P < 0.01), while tendon reflex was not changed (P = 0.782). No patients had infections. Five patients were complicated with dysesthesia in distribution of the exiting nerve that was all operated at L5-S1. Complaints were reduced one week after treatment with medium frequency pulse electrotherapy. Five cases required a revision surgery after recurrence. Limitations: This is an observational clinical case series study without comparison. Cohort Study Modified Percutaneous Lumbar Foraminoplasty and Percutaneous Endoscopic Lumbar Discectomy: Instrument Design, Technique Notes, and 5 Years Follow-up From: The First Affiliated Hospital of Chinese PLA’s General Hospital Beijing, China Address Correspondence: Zhen-zhou Li, M.D. Associate Chief Surgeon The First Affiliated Hospital of Chinese PLA’s General Hospital, Department of Orthopedic Surgery No. 51, Fucheng Road Haidian district Beijing, Beijing 100048 China 86 1068989322 E-mail: dr_lizhenzhou@163.com Disclaimer: There was no external funding in the preparation of this manuscript. Conflict of interest: Each author certifies that he or she, or a member of his or her immediate family, has no commercial association (i.e., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted manuscript. Manuscript received: 08-10-2015 Revised manuscript received: 12-28-2015 Accepted for publication: 03-28-2015 Free full manuscript: www.painphysicianjournal. com Zhen-zhou Li, MD, Shu-xun Hou, MD, Wei-lin Shang, MD, Ke-ran Song, MD, and Hong-liang Zhao, MD www.painphysicianjournal.com Pain Physician 2017; 20:E85-E98 • ISSN 2150-1149 Conclusion: Modified PLF-PELD with a specially designed instrument is a less invasive, effective and safe surgery for complex uncontained lumbar DH. Key words: Lumbar disc herniation, minimally invasive treatment, foraminoplasty, percutaneous endoscopic lumbar discectomy

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“…Infra-red laser sources such as Erbium and Holmium (Er:YAG, 2.94 mm and Ho:YAG, 2.1 mm) have proven to be highly effective in cutting and drilling of biological tissue [12,13].…”

Section: Discussionmentioning

confidence: 99%