Rochkind Shimon
Division of Peripheral Nerve Reconstruction, Department of Neurosurgery, Research Center for Nerve Reconstruction, Tel Aviv Sourasky Medical Center, Tel Aviv University , Tel Aviv, Israel .
Photomed Laser Surg. 2017 Nov;35(11):604-615. doi: 10.1089/pho.2017.4381.
This review summarizes personal experience with laser photobiomodulation and its potentials for the treatment of peripheral and central nerve system injuries.
Laser photobiomodulation was shown to induce nerve cell activation, have a positive effect on metabolism of the nerve cells, and to stimulate nerve sprouting processes. Studies investigating the effects of laser photobiomodulation on injured peripheral nerves in rats reported immediate protective effects which increase the functional activity of the nerve, decrease or prevent scar tissue formation at the injured site, prevent or decrease degeneration in corresponding motor neurons of the spinal cord, and significantly increase axonal growth and myelinization. A direct application of laser on the spinal cord had a positive impact on the corresponding injured peripheral nerve and promoted recovery. A 780-nm laser phototherapy was applied following peripheral nerve reconstruction using a guiding nerve tube. Results showed myelinated axons crossing through the nerve tube and the continuation of axonal sprouting through the tube toward the distal part of the nerve. In a double-blind, placebo-controlled randomized pilot clinical trial in patients with incomplete stable long-term peripheral nerve injury (PNI), 780-nm laser irradiation progressively improved peripheral nerve function and led to substantial functional recovery. Muscle atrophy represents a major challenge in restorative medicine. Laser phototherapy was shown to increase biochemical activity and improve morphological recovery in muscle and, thus, could have a direct therapeutic application, especially during progressive muscle atrophy resulting from PNI. The effectiveness of composite implants of cultured embryonal nerve cells and the role of laser irradiation on regeneration and repair of the completely transected rat spinal cord were examined. Results suggested that laser photobiomodulation treatment accelerates the axonal growth.
The significance of the performed experimental and clinical studies is in the provision of new laser technology in field of cell therapy and its therapeutic value for peripheral nerve and spinal cord injuries. Additional well-designed clinical studies are needed to evaluate the effectiveness and role of laser photobiomodulation treatment in a clinical setting.
本综述总结了激光光生物调节作用的个人经验及其治疗周围神经系统和中枢神经系统损伤的潜力。
激光光生物调节作用可诱导神经细胞活化，对神经细胞代谢产生积极影响，并刺激神经发芽过程。对大鼠受损周围神经进行激光光生物调节作用研究的报告显示，其具有即时保护作用，可增强神经的功能活性，减少或防止损伤部位瘢痕组织形成，预防或减少脊髓相应运动神经元的退变，并显著增加轴突生长和髓鞘形成。直接对脊髓进行激光照射对相应的受损周围神经有积极影响并促进恢复。在使用引导神经管进行周围神经重建后应用780纳米激光光疗。结果显示有髓轴突穿过神经管，并通过该管向神经远端持续轴突发芽。在一项针对不完全稳定的长期周围神经损伤（PNI）患者的双盲、安慰剂对照随机试点临床试验中，780纳米激光照射逐渐改善了周围神经功能并实现了实质性功能恢复。肌肉萎缩是修复医学中的一项重大挑战。激光光疗可提高肌肉中的生化活性并改善形态恢复，因此可能具有直接治疗应用价值，尤其是在PNI导致的进行性肌肉萎缩期间。研究了培养的胚胎神经细胞复合植入物的有效性以及激光照射对完全横断的大鼠脊髓再生和修复作用。结果表明激光光生物调节作用治疗可加速轴突生长。
所开展的实验和临床研究的意义在于在细胞治疗领域提供了新的激光技术及其对周围神经和脊髓损伤的治疗价值。需要更多设计完善的临床研究来评估激光光生物调节作用治疗在临床环境中的有效性和作用。
