Application of holmium:YAG laser in epiduroscopy:: Extended practicabilities in the treatment of chronic back pain syndrome
Application of holmium:YAG laser in epiduroscopy:: Extended practicabilities in the treatment of chronic back pain syndrome
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DOI：
10.1089/104454702760230528
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发表时间：
2002-08-01
期刊：
影响因子：
--
通讯作者：
Godolias, G
中科院分区：
文献类型：
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作者：
Ruetten, S;Meyer, O;Godolias, G
目的：微创和内窥镜技术在慢性背痛综合征的治疗中具有优势，可以提供扩大的适应症和可视化。硬膜外腔镜显示硬膜外腔仍存在技术问题。现有的机械设备，加上狭窄的工作管道，造成了明显的限制。本研究的目的是评估在腰椎硬膜外镜检查中使用钬激光的可能性和技术要求。背景资料：自20世纪30年代以来，硬膜外镜已被用于腰椎硬膜外腔的可视化。已经进行了研究，以评估硬膜外镜检查在慢性背痛中的作用和可能性。他们中的大多数只描述解剖方面。材料与方法：采用钬激光对47例患者进行硬膜外镜检查和治疗，发现相应的硬膜外粘连。检查的重点是钬激光在硬膜外镜检查中的一般适用性和该程序所需的技术参数。治疗的临床评价是前瞻性的，与术前状态进行比较，并与以往研究中已有记录的组进行比较。结果：只有小于300微米的激光纤维才能达到不影响外膜镜的弯曲行为，因此选用直径为265微米的激光纤维作为标准。在8hz的频率下，达到充分烧蚀效果所需的激光器的最小能量输出为0.8 J。总输出能量为0.256 ~ 1.4 kJ。术中及术后均未发生并发症。随访检查未见患者病情恶化。没有发生相关的激光相关水肿或粘连。对疼痛状况产生积极影响的比例与仅通过机械手段治疗的对照组相对应。结论：钬激光大大拓展了治疗的可能性，有助于解决硬膜外镜的技术难题。使用过程中无不良影响。
Objective: Minimally invasive and endoscopic techniques offer advantages in the treatment of chronic back pain syndrome and may provide for expanded indications and visualization. Epiduroscopy for the visualization of the epidural space still is burdened with technical problems. The mechanical instruments now available, coupled with the narrow working canal, result in marked limitations. The aim of this study was to assess the possibilities and technical requisites for the use of the holmium:YAG laser in lumbar epiduroscopy. Background Data: Epiduroscopy has been used for visualization of the lumbar epidural space since the 1930s. Studies have been performed to evaluate the effects and possibilities of epiduroscopy in chronic back pain. Most of them only describe the anatomical aspects. Materials and Methods: Forty-seven patients were epiduroscopied and treated, for findings of corresponding epidural adhesions, with the holmium:YAG laser. The examinations concentrated on the general applicability of the holmium:YAG laser in epiduroscopy and the technical parameters necessary for this procedure. The clinical evaluation of therapy was made prospectively in comparison with the preoperative status and compared to already recorded groups in previous studies. Results: Bending behavior without negative impact of the epiduroscope was only attained with laser fibers less than 300 mum, so a fiber with a diameter of 265 mum was used as the standard. The minimum energy output of the laser required for an adequate ablative effect was 0.8 J at a frequency of 8 Hz. The total energy output was 0.256-1.4 kJ. Complications did not occur intraoperatively nor following the procedure. The follow-up examinations showed no deterioration of the complaints in any patient. There was no occurrence of relevant laser-related edemas or adhesions. The proportion of painful conditions that could be positively influenced corresponded to that in a control group treated only by mechanical means. Conclusion: The results show that the holmium:YAG laser considerably expands therapeutic possibilities and aids in solving the technical problems of epiduroscopy. No negative effects occurred when the laser is used.