Plapler Hélio, Mancini Marília W, Sella Valéria R G, Bomfim Fernando R C
Department of Surgery, Federal University of São Paulo, São Paulo, Brazil, 04023-900.
, Rua Tomas Carvalhal, 884 apt. 51, 04006-003, São Paulo, SP, Brazil.
Lasers Med Sci. 2016 Apr;31(3):421-8. doi: 10.1007/s10103-016-1865-3. Epub 2016 Jan 21.
Laser discectomy or nucleotomy is an increasingly important method for less invasive procedures of column, but the ideal kind of laser is still not established. As the wavelength is an important parameter for water absorption, this study was performed to investigate the action of the laser emission in the near infrared (808 to 1908 nm) region in the context of surgical procedures for percutaneous intervertebral disc decompression (nucleotomy). Forty intervertebral discs from pigs lumbar spines were irradiated with laser (λ = 808, 980, 1470 and 1908 nm), 1-s on/off time cycles, for 120 cycles and 10 W of power (808, 980, and 1470 nm) or 240 cycles and 5 W of power (1908 nm), with total power of 1200 J, and subjected to microscopic evaluation through hematoxylin-eosin (HE) staining in order to measure the ablation lesions and the residual thermal injury. Ten other discs were not irradiated and worked as controls. The ablation lesions were measured (in mm) at 1.08 ± 1.25, 1.70 ± 0.63, 2.23 ± 1.02, 1.37 ± 0.39, and 0.94 ± 0.41 (median ± SD) for the control, 808, 980, 1470, and 1908 nm groups, respectively. The difference between 1908 nm and all the other groups was statistically significant (p < 0.05). The residual thermal injury was less evident in 1908 nm laser and sharper in 980 nm laser wavelengths. The laser at a wavelength of 1908 nm was considered the most efficient for the vaporization of the nucleus pulposus, followed by the laser wavelengths of 1470, 808, and 980 nm, and proved to be useful for laser nucleotomy procedure.
激光椎间盘切除术或髓核切除术是脊柱微创治疗中一种日益重要的方法，但理想的激光类型仍未确定。由于波长是水吸收的一个重要参数，本研究旨在探讨近红外（808至1908nm）区域激光发射在经皮椎间盘减压术（髓核切除术）手术中的作用。对40个猪腰椎椎间盘进行激光照射（波长分别为808、980、1470和1908nm），开/关时间为1秒，照射120个周期，功率为10W（808、980和1470nm）或240个周期，功率为5W（1908nm），总能量为1200J，并通过苏木精-伊红（HE）染色进行显微镜评估，以测量消融损伤和残余热损伤。另外10个椎间盘未接受照射，作为对照。对照组、808nm、980nm、1470nm和1908nm组的消融损伤分别为1.08±1.25、1.70±0.63、2.23±1.02、1.37±0.39和0.94±0.41（中位数±标准差）。1908nm组与其他所有组之间的差异具有统计学意义（p<0.05）。1908nm激光的残余热损伤不太明显，980nm激光波长的残余热损伤更明显。波长为1908nm的激光被认为是髓核汽化最有效的，其次是1470、808和980nm的激光波长，并且被证明对激光髓核切除术有用。
