SEARCH

SEARCH BY CITATION

Keywords:

  • cartilage;
  • intervertebral disc;
  • Nd:YAG laser;
  • nucleus pulposus;
  • spine surgery

Abstract

Background and Objective

To examine the biophysical effects of photothermal heating on herniated intervertebral discs during laser decompression surgery.

Study Design/Materials and Methods

Ex vivo bovine nucleus pulposus specimens were irradiated with a Nd: YAG laser (λ = 1.32 μm, 100 seconds exposure time, 9–31 W/cm2, 4.8 mm spot diameter), whereas changes in tissue thermal, mechanical, and optical properties were monitored by using, respectively, infrared radiometry, tissue tension measurements, and diffuse reflectance from a HeNe probe laser. Morphologic changes and mass reduction were monitored by recording shape changes on video and weighing specimens before and after laser exposure.

Results

At power densities below 20 W/cm2, evaporation of water and specimen volume reduction (shrinking) were consistently observed on video during irradiation. In contrast, above 20 W/cm2, vapor bubbles formed within the specimen matrix and subsequently ruptured (releasing heated vapors). When radiometric surface temperature approaches approximately 60 to 70°C (denaturation threshold for tissue), tissue tension begins to increase, which is consistent with observations of specimen length reduction. The onset of this change in tissue tension is also reflected in characteristic alterations in diffuse reflectance. With cessation of laser irradiation, a sustained increase in tissue tension is observed, which is consistent with changes in specimen length and volume. Higher laser power results in a faster heating rate and subsequently an accelerated tension change. Specimen mass reduction increased with irradiance from 19 to 72% of the initial mass for 9–31 W/cm2, respectively. Irradiated specimens did not return to their original shape after immersion in saline (48 hours) in contrast to air-dried specimens (24 hours), which returned to their original shape and size.

Conclusion

These observations suggest that photothermal heating results in irreversible matrix alteration causing shape change and volume reduction (observed on video and evidenced by the increase in tissue tension) taking place at approximately 65°C. Inasmuch as high laser power results in vapor bubble formation and specimen tearing, the heating process must be controlled. Diffuse reflectance measurements provide a noncontact, highly sensitive means to monitor dynamically changes in tension of nucleus purposus. Lasers Surg. Med. 28:248–254, 2001. © 2001 Wiley-Liss, Inc.