DOI QR코드

DOI QR Code

Temperature Distributions of the Lumbar Intervertebral Disc during Laser Annuloplasty : A Cadaveric Study

  • Lee, Min Hyung (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kim, Il Sup (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Hong, Jae Taek (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Sung, Jae Hoon (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Lee, Sang Won (Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea) ;
  • Kim, Daniel H. (Department of Neurosurgery, Memorial Hermann Hospital, University of Texas Health Science Center at Houston)
  • Received : 2016.02.02
  • Accepted : 2016.08.16
  • Published : 2016.11.01

Abstract

Objective : Low back pain, caused intervertebral disc degeneration has been treated by thermal annuloplasty procedure, which is a non-surgical treatement. The theoretical backgrounds of the annuloplasty are thermal destruct of nociceptor and denaturization of collagen fiber to induce contraction, to shrink annulus and thus enhancing stability. This study is about temperature and its distribution during thermal annuloplasty using 1414 nm Nd : YAG laser. Methods : Thermal annuloplasty was performed on fresh human cadaveric lumbar spine with 20 intact intervertebral discs in a $37^{\circ}C$ circulating water bath using newly developed 1414 nm Nd : YAG laser. Five thermocouples were attached to different locations on the disc, and at the same time, temperature during annuloplasty was measured and analyzed. Results : Thermal probe's temperature was higher in locations closer to laser fiber tip and on lateral locations, rather than the in depth locations. In accordance with the laser fiber tip and the depth, temperatures above $45.0^{\circ}C$ was measured in 3.0 mm depth which trigger nociceptive ablation in 16 levels (80%), in accordance with the laser fiber end tip and laterality, every measurement had above $45.0^{\circ}C$, and also was measured temperature over $60.0^{\circ}C$, which can trigger collagen denaturation at 16 levels (80%). Conclusion : When thermal annuloplasty is needed in a selective lesion, annuloplasty using a 1414 nm Nd : YAG laser can be one of the treatment options.

Keywords

References

  1. Alexandre A, Coro L, Paradiso R, Dall'aglio R, Alexandre AM, Fraschini F, et al. : Treatment of symptomatic lumbar spinal degenerative pathologies by means of combined conservative biochemical treatments. Acta Neurochir Suppl 108 : 127-135, 2011
  2. Arnold PM, Robbins S, Paullus W, Faust S, Holt R, McGuire R : Clinical outcomes of lumbar degenerative disc disease treated with posterior lumbar interbody fusion allograft spacer : a prospective, multicenter trial with 2-year follow-up. Am J Orthop (Belle Mead NJ) 38 : E115-E122, 2009
  3. Bogduk N : The lumbar disc and low back pain. Neurosurg Clin N Am 2 : 791-806, 1991
  4. Bono CM, Iki K, Jalota A, Dawson K, Garfin SR : Temperatures within the lumbar disc and endplates during intradiscal electrothermal therapy : formulation of a predictive temperature map in relation to distance from the catheter. Spine (Phila Pa 1976) 29 : 1124-1129; discussion 1130-1131, 2004 https://doi.org/10.1097/00007632-200405150-00014
  5. Buric J, Pulidori M : Long-term reduction in pain and disability after surgery with the interspinous device for intervertebral assisted motion (DIAM) spinal stabilization system in patients with low back pain : 4-year follow-up from a longitudinal prospective case series. Eur Spine J 20 : 1304-1311, 2011 https://doi.org/10.1007/s00586-011-1697-6
  6. Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD : Surgery for low back pain : a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine (Phila Pa 1976) 34 : 1094-1109, 2009 https://doi.org/10.1097/BRS.0b013e3181a105fc
  7. Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, et al. : Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain : an evidence-based clinical practice guideline from the American Pain Society. Spine (Phila Pa 1976) 34 : 1066-1077, 2009 https://doi.org/10.1097/BRS.0b013e3181a1390d
  8. Freeman BJ, Davenport J : Total disc replacement in the lumbar spine : a systematic review of the literature. Eur Spine J 15 Suppl 3 : S439-S447, 2006 https://doi.org/10.1007/s00586-006-0186-9
  9. Freeman BJ, Walters RM, Moore RJ, Fraser RD : Does intradiscal electrothermal therapy denervate and repair experimentally induced posterolateral annular tears in an animal model? Spine (Phila Pa 1976) 28 : 2602-2608, 2003 https://doi.org/10.1097/01.BRS.0000097889.01759.05
  10. Hayashi K, Thabit G 3rd, Vailas AC, Bogdanske JJ, Cooley AJ, Markel MD : The effect of nonablative laser energy on joint capsular properties. An in vitro histologic and biochemical study using a rabbit model. Am J Sports Med 24 : 640-646, 1996 https://doi.org/10.1177/036354659602400513
  11. Helm S, Hayek SM, Benyamin RM, Manchikanti L : Systematic review of the effectiveness of thermal annular procedures in treating discogenic low back pain. Pain Physician 12 : 207-232, 2009
  12. Jayasree RS, Gupta AK, Bodhey NK, Mohanty M : Effect of 980-nm diode laser and 1064-nm Nd : YAG laser on the intervertebral disc--in vitro and in vivo studies. Photomed Laser Surg 27 : 547-552, 2009 https://doi.org/10.1089/pho.2008.2304
  13. Kallewaard JW, Terheggen MA, Groen GJ, Sluijter ME, Derby R, Kapural L, et al. : 15. Discogenic low back pain. Pain Pract 10 : 560-579, 2010 https://doi.org/10.1111/j.1533-2500.2010.00408.x
  14. Kapural L, Mekhail N, Hicks D, Kapural M, Sloan S, Moghal N, et al. : Histological changes and temperature distribution studies of a novel bipolar radiofrequency heating system in degenerated and nondegenerated human cadaver lumbar discs. Pain Med 9 : 68-75, 2008 https://doi.org/10.1111/j.1526-4637.2007.00410.x
  15. Kleinstueck FS, Diederich CJ, Nau WH, Puttlitz CM, Smith JA, Bradford DS, et al. : Temperature and thermal dose distributions during intradiscal electrothermal therapy in the cadaveric lumbar spine. Spine (Phila Pa 1976) 28 : 1700-1708; discussion 1709, 2003
  16. Knappe V, Frank F, Rohde E : Principles of lasers and biophotonic effects. Photomed Laser Surg 22 : 411-417, 2004 https://doi.org/10.1089/pho.2004.22.411
  17. Lee SH, Kang HS : Percutaneous endoscopic laser annuloplasty for discogenic low back pain. World Neurosurg 73 : 198-206; discussion e133, 2010 https://doi.org/10.1016/j.surneu.2009.01.023
  18. Pauza K : Cadaveric intervertebral disc temperature mapping during disc biacuplasty. Pain Physician 11 : 669-676, 2008
  19. Peng B, Pang X, Wu Y, Zhao C, Song X : A randomized placebo-controlled trial of intradiscal methylene blue injection for the treatment of chronic discogenic low back pain. Pain 149 : 124-129, 2010 https://doi.org/10.1016/j.pain.2010.01.021
  20. Petersohn JD, Conquergood LR, Leung M : Acute histologic effects and thermal distribution profile of disc biacuplasty using a novel water-cooled bipolar electrode system in an in vivo porcine model. Pain Med 9 : 26-32, 2008 https://doi.org/10.1111/j.1526-4637.2006.00293.x
  21. Saal JS, Saal JA : Management of chronic discogenic low back pain with a thermal intradiscal catheter. A preliminary report. Spine (Phila Pa 1976) 25 : 382-388, 2000 https://doi.org/10.1097/00007632-200002010-00021
  22. Shah RV, Lutz GE, Lee J, Doty SB, Rodeo S : Intradiskal electrothermal therapy : a preliminary histologic study. Arch Phys Med Rehabil 82 : 1230-1237, 2001 https://doi.org/10.1053/apmr.2001.23897
  23. Wall MS, Deng XH, Torzilli PA, Doty SB, O'Brien SJ, Warren RF : Thermal modification of collagen. J Shoulder Elbow Surg 8 : 339-344, 1999 https://doi.org/10.1016/S1058-2746(99)90157-X
  24. Wegener B, Rieskamp K, Buttner A, Habiyambere V, von Schultze-Pellangahr C, Schaffer V, et al. : Experimental evaluation of the risk of extradiscal thermal damage in intradiscal electrothermal therapy (IDET). Pain Physician 15 : E99-E106, 2012
  25. Zhao Y, Wang YP, Qiu GX, Zhao H, Zhang JG, Zhou X : Efficacy of the Dynamic Interspinous Assisted Motion system in clinical treatment of degenerative lumbar disease. Chin Med J (Engl) 123 : 2974-2977, 2010

Cited by

  1. Lasers in Spine Surgery : vol.27, pp.17, 2016, https://doi.org/10.5435/jaaos-d-18-00001