E.N. Sobol1, A.V. Baskov2, A.B. Shekhter4, I.A. Borshchenko3, O.L. Zakharkina1, V.A. Baskov4, I.Yu. Kolyshev4
(1 Institute of Laser and Information Technologies of the Russian Academy of Sciences, Troitsk;
2 The Faculty of Neurosurgery of the Russian Medical Academy of Postgraduate Education, Moscow;
3 Medical Center of Vertebrology and Orthopedics, Moscow;
4 Sechenov Moscow Medical Academy, Moscow)
Laser reconstruction of intervertebral disks (LRID) is a new minimum-invasive method for treatment of their diseases. The essence of a new approach lies in local modification of a structure and stress fields in a cartilage with the help of a non-destructive laser impact, providing controllable regeneration of a cartilaginous tissue and a long-term anesthetic effect. A pulsed fiber erbium-doped glass laser with a wavelength of 1.56 µm was used in experiments on animals and clinical studies. The experiments were carried our on disks of 48 rabbits. Dynamics of a temperature field was estimated with a fiber radiometer and a thermocouple, introduced into a pulpous nucleus. Structural changes within rabbits’ tissue were studied before and immediately after a laser impact, as well as in 3, 7, 14, 40 days and 2, 3 months. It was done with use of histological and histochemical methods, optical coherent tomography and an atomic microscope. Clinical studies were carried out on 160 cases, aged 22-64 (a mean age of 45 years). A follow-up period was 12 months. The experiments on rabbits demonstrated a non-destructive character of a laser impact. Signs of regenerative processes were watched in 3-7 days after irradiation. A new tissue grew in a zone of irradiation in 1-2 months. It was represented either by a hyaline cartilage (in mild modes of irradiation) or by a fibrous tissue (in tough modes of irradiation, leading to tissue denaturation). Studies with an atomic microscope and optical coherent tomography revealed acceleration of fluid motion in a zone of a laser impact. It was connected with heterogeneous heating up to 50o C and formation of micropores, promoting increase of water metabolism and nutrition of tissue cells. Later the method under discussion was probated in a clinic for treatment of patients with degenerative diseases of intervertebral disks. Clinical trials were indicative of positive results, watched in the overwhelming majority of cases. A good effect of LRID manifested itself 2 months after intervention. It became stable in 6 months. Considerable reduction of pain syndrome was achieved in 96% of cases; 92% of patients returned to their work and active life.