Pulsed holmium:yttrium-aluminum-garnet (Ho:YAG) laser ablation of fibrocartilage and articular cartilage

Trauner, Kenneth B.; Nishioka, Norman S.; Patel, Dinesh Kumar

doi:10.1177/036354659001800316

Cited by 104 publications

(26 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…HNP is still one of the most challenging health problems, and posterior surgical decompression is the commonly used conventional treatment modality [12,16,33,38,43,44,47]. Recently, several percutaneous discectomy methods have been proposed as an alternative to the conventional surgical approach in the treatment of HNP [4, 11, 13-15, 21, 22, 34, 35, 40-42, 53].…”

Section: Discussionmentioning

confidence: 99%

“…The use of laser energy to ablate disc tissue was first performed by Ascher and Choy [4]. At present, several types of lasers are available for disc decompression, and the holmium:YAG laser has a theoretical advantage over the other laser systems [12,14,35,[40][41][42]47]. The Nd:YAG is the most commonly used laser for this application in spite of its unpredictable risk of thermic damage to surrounding tissue.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, an optimum irradiation condition for healthy disc tissue, similar to our preliminary studies and previous animal trials by others [14,53], was set for nucleus pulposus vaporization without surrounding tissue destruction. As a rule, however, the amount of laser energy for the vaporization of water in degenerated disc with a lesser water content is more than the amount of energy for the vaporization of water in normal disc [47]. So, excessive heat rise occurs in the adjacent tissues to the disc and there is a risk of ther-real damage to cartilaginous end-plate and vertebral bone.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Extensive damage to the end-plates as a complication of laser discectomy an experimental study using an animal model

et al. 1997

View full text Add to dashboard Cite

To date, there have been no reports of experiments demonstrating the effects of neodymium:YAG laser (Nd:YAG laser) on the vertebral end-plates. In this study the effect of Nd:YAG laser on end-plates was examined in 32 guinea pigs which were randomly divided into two groups. The first group was the control group, the second one the Nd:YAG laser group. All animals had experimental disc degeneration at three levels. Re-exploration was performed two months after the surgical ventral disc herniation. In the second group the same procedure was performed but at the end of the re-exploration, Nd:YAG laser irradiation of the degenerated discs was done. The wounds in both groups were closed again. Two months later all animals were sacrificed for histological and biochemical analysis. The cervical spine was excised en bloc and the overlying muscles were removed. Determination of hydroxyproline was done colorimetrically in the specimens harvested from each of these groups. Light microscopy was undertaken to evaluate the extent of morphological changes. The differences observed between the two groups were statistically significant (p < 0.05). From the results of this study, there is the question whether the Nd:YAG laser is a useful instrument in neurosurgery. Therefore, it remains to be proven whether or not this is of real benefit in the treatment of patients with degenerated disc disease.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Extensive damage to the end-plates as a complication of laser discectomy an experimental study using an animal model

et al. 1997

View full text Add to dashboard Cite

show abstract

“…Nd:YAG (λ = 1:06 mm, τ L = 100 μs-cw) and Ho:YAG (λ = 2.12 nm, τ L = 150-800 µs) have been used in majority during these studies [39][40][41][42][43] because of the main advantage that these lasers can be conveniently transmitted via a glass fiber. From practical point of view, this characteristic becomes very important because in a actual surgery setup, maneuverability of the surgical tools plays a key role in order to carry out the operations optimally.…”

Section: Thermal Interactionsmentioning

confidence: 99%

Non-conventional and Hybrid Methods of Bone Machining

Dahotre

Joshi

2016

Machining of Bone and Hard Tissues

View full text Add to dashboard Cite

Having explored the basics of important fundamental contact (mechanical) and noncontact (thermal) operations involved in machining of the bones, the discussion will proceed towards some of the non-conventional techniques. These techniques have evolved as a result of research works on interaction of bones with various energy sources such as photon/electron beam and mechanical vibrations. Hybrids of fundamentals operations of machining have also been taken into account. Laser, microwave, and ion-beam based methods have been discussed under beam based techniques. Ultrasonic machining which has been extensively explored for bone application has been dealt in a separate section. Pneumatic and hydraulic machining have been taken into account under the section on hybrid machining. These nonconventional/hybrid techniques are not as popular as conventional ones but hold a huge potential for the future. High Energy Beam Based TechniquesThe high energy beam based methods employ some sort of radiation as the means of energy source for removal of the bone material. These techniques have mostly been employed previously in case of the structural materials. Unlike conventional mechanical contact methods employing physical tools which result in generation of heat as the secondary effect, beam based techniques employ heat as the primary means of tooling. The heat is generated by means of various electromagnetic waves within the electromagnetic spectrum such as ultraviolet, microwave, and infrared with various combinations for ranges of energy and wavelength ( Fig. 3.1). As the combinations dictate the extent and mode of interaction of the energy source with the workpiece, any machining operation can be carried out with careful process control. Most common methods explored in this category include laser, ion-beam, and microwave machining which are discussed in detail in the following subsections. Laser MachiningLasers (Light Amplification by Stimulated Emission of Radiation) have been used as a means of machining for quite some time now. Theoretically any wavelength within the electromagnetic spectrum can be made into a laser source. Principally, a lasing medium is excited using a energy source such as inert gas flash lamp. The input of energy (Fig. 3.2a) transfers the electrons within the atoms of the medium to higher energy state, technically termed as population inversion. On the other hand, the random absorption of energy gives rise to spontaneous emission (Fig. 3.2b). In case of population inversion, these electrons jump to lower energy state at the same time emitting photons of the same energy corresponding to difference between ground and excited state (Fig. 3.2c). A set of two mirrors, some times called resonators, one totally and the other partially reflecting, generates the chain reaction giving rise to highly concentrated beam coming out of the partially reflecting mirror (Fig. 3.3). This beam is monochromatic, coherent, and highly collimated in nature and can be employed for various applications depending on the wavele...

show abstract

“…Excimer lasers can be used via an arthroscope, but ablation rates are too low [10]. At present, the best laser system for arthroscopic application seems to be the Ho:YAG, which combines a high ablation rate with acceptable thermal side effects and the possibility of using it in a fluid medium [11][12][13]. But even with the Ho:YAG laser, synovectomy is more time-consuming than with a mechanical device.…”

Section: Introductionmentioning

confidence: 99%