Surgical Treatment of Lumbar Vertebral Instability in Degenerative Spondylolisthesis Using a Diode Laser

The research is dedicated to the development of a methodology for minimally invasive surgical stabilization of lumbar vertebrae in degenerative spondylolisthesis using a diode laser. The relevance of the work is due to the high prevalence of osteochondrosis and associated neurological disorders, as well as the limited effectiveness of conservative treatment in the presence of instability of vertebral motor segments. In the work, morphological changes in intervertebral disk tissues after exposure to laser radiation with a wavelength of 970 nm were studied, a puncture method of laser impact was developed, and its effectiveness was evaluated in clinical conditions.

Relevance of the Topic

At present, vertebrology—the doctrine of osteochondrosis of the spine and its neurological manifestations—is developing rapidly. This is due to the wide prevalence of this pathology. Over 80% of the population suffers from back pain. The frequency of seeking medical care is high due to the loss of disability and limited physical activity of the most active social group in the 30-50 age range. Treatment of the pain syndrome is carried out by doctors of various specialties: neurologists, rehabilitologists, manual therapists, neurosurgeons, traumatologists, orthopedists, surgeons, which complicates the choice of a single tactic, and on many theoretical and practical questions, controversial views still exist to this day. All this dictates the necessity of differentiated treatment of neurological complications and anatomical changes in the spine during degeneration of intervertebral disks. At the initial stage of back pain treatment, preference is given to various methods of conservative therapy. When hernias of intervertebral disks and displacement of vertebrae of II-IV degree are detected, the choice falls on open surgical interventions. Traditional surgical treatment methods have a number of disadvantages: high trauma to surrounding tissues, the necessity of deep anesthesia, risk of damage to nerve roots of the spinal cord and the dura mater, spinal and nerve root vessels, blood loss, development of scar-adhesive processes, infectious complications.

The main task of spine operations is to eliminate compression of the nerve roots of the spinal cord and stabilize the vertebrae. In recent years, the views of many scientists have turned to various percutaneous methods of impact on intervertebral disks.

Special attention in choosing a treatment tactic deserves degenerative spondylolisthesis of the lumbar spine. Vertebral displacement, as a rule, reaches only I-II degree, but significant statico-dynamic, neurological, and visceral disturbances arise, often leading to prolonged loss of disability and invalidity. Patients with vertebral displacement up to 5-6 mm, small prolapses and protrusions of intervertebral disks, with pain syndrome in the lumbar region and lower extremities, are prescribed various types of conservative therapy, which do not give a significant effect. This is generally due to the presence of instability of vertebral motor segments. To date, methods of treating degenerative spondylolisthesis cannot be recognized as universal. The search continues for new, including minimally invasive, technologies for stabilizing vertebrae and eliminating compression of spinal nerve roots.

Goal of the Research

To develop a methodology for minimally invasive surgical stabilization of vertebrae using diode laser impact on intervertebral disks in degenerative spondylolisthesis to eliminate clinical manifestations of the disease.

Tasks of the Research

1. To study clinical manifestations and radiological features of lumbar vertebral displacement and instability.

2. To investigate morphological changes in the intervertebral disk after exposure to semiconductor (diode) laser radiation with a wavelength of 970 nm in experiment.

3. To develop a minimally invasive method of percutaneous impact on the intervertebral disk, using a medium-power diode laser with a wavelength of 970 nm, to restore its fixing function and eliminate compression of spinal nerve roots.

5. To evaluate the effectiveness of the laser treatment method for lumbar vertebral instability in the near and remote periods based on clinical-neurological and radiological data.

6. To develop a rehabilitation tactic for patients after laser impact on intervertebral disks.

Scientific Novelty

Morphological changes occurring in the tissues of the intervertebral disk when exposed to a laser beam with a wavelength of 970 nm were studied in experiment. For the first time, using minimally invasive, atraumatic, laser surgical manipulations performed with a medium-power semiconductor laser, stabilization of vertebral motor segments was achieved with simultaneous elimination of compression of nerve roots, the dural sac, and, accordingly, clinical manifestations of degenerative spondylolisthesis (a decision on granting a patent for the invention "Method for Treating Spondylolisthesis" was obtained).

Practical Value

Pathological mobility of lumbar vertebrae resulting from dystrophic changes in intervertebral disks, their displacement relative to each other, contributes to the appearance of a prolonged pronounced pain syndrome in the lumbar region and lower extremities. Conservative therapy often brings no relief. The results obtained in the treatment of patients with unstable degenerative spondylolisthesis in combination with protrusion or prolapse of disks allow considering the method of percutaneous laser impact on intervertebral disks as effective.

The method is minimally traumatic, performed under safe anesthesia. It allows reducing material costs. Postoperative rehabilitation periods and return to work are significantly shortened. Taking into account the execution technique, the treatment can be carried out in all medical institutions equipped with X-ray equipment.

Positions to be Defended:

1. Instability of vertebral motor segments is the main pathomorphological substrate of the pain syndrome and clinical manifestations of degenerative spondylolisthesis.

2. New domestic semiconductor laser devices of medium power generating radiation with a wavelength of 970 nm can be successfully used for percutaneous treatment of degenerated intervertebral disks.

3. The developed original variant of percutaneous laser impact on intervertebral disks allows avoiding total destruction of disk tissue (nucleotomy), since a mechanism is realized in which the main physical carriers of impact are heated aqueous solution and superheated steam.

4. The action of a medium-power laser on intervertebral disks in unstable degenerative spondylolisthesis in combination with protrusion or prolapse of disks up to 8 mm is an effective treatment method, leading to disk reconstruction and stabilization of the vertebral motor segment.

Implementation in Practice

The developed method of laser impact on intervertebral disks using semiconductor laser apparatuss of medium power with a wavelength of 970 nm is used:

1. In the outpatient surgery department of the State Institution PKDC of Vladivostok;

2. In the traumatology department of the Federal State Institution "SZOMC" of Roszdrav of St. Petersburg.

3. In the neurological department of the railway hospital of Khabarovsk;

4. In the "Center for Vestibulo-Vertebral Pathology" of Novosibirsk;

5. In the regional hospital of Samara;

6. In the neurosurgical department of the regional hospital of Blagoveshchensk.

Dissertation Defense

The main materials were reported:

1. In the collection "Notes of the St. Petersburg State Medical University named after Academician I. P. Pavlov", 2004, vol. XI, No. 4.

2. At the Far Eastern Regional Conference "Medical Physics and Novel Medical Technologies", Vladivostok, May 30-31, 2005.

3. At the Scientific and Practical Conference "Application of Semiconductor Lasers in Medicine" - St. Petersburg, May 25-26, 2006.

4. At the III International Pacific Congress on Traditional Medicine - Vladivostok, September 12-14, 2006.

5. At the Scientific and Practical Conference "Modern Technologies in Orthopedics and Neurosurgery" - Vladivostok, April 19, 2007.

Publications

Based on the dissertation materials, 7 scientific works were published, including 1 article in a journal, 1 monograph. A decision on granting a patent for the invention "Method for Treating Spondylolisthesis" was obtained.

Volume and Structure of the Dissertation The dissertation consists of an introduction, 5 chapters, discussion of the obtained treatment results, conclusions, bibliography, and publications. The dissertation is presented on 120 pages of typed text, illustrated with 20 tables, 37 figures, 3 graphs. The bibliography includes 123 domestic and 124 foreign sources.