OPEN LASER-SURGERY ON THE LOCOMOTOR APPAR ATUS

The first applications of laser in surgery of the locomotor apparatus in the early 1980s used the haemostatic properties of laser to diminis h the amount of substitution of coagulation factors in haemophiliac pa tients. Only since the early 1990s has a device been available in corp orating the pulsed holmium:YAG laser which works in a fluid medium wit hout relevant side effects. Apart from haemostasis, the cutting functi on and tissue ablation, together with the thermal shrinking effect, ar e exploited in arthroscopy and percutaneous disc decompression. Now th at the biophysical mechanisms of action have been elucidated, nothing stands in the way of the use of infrared lasers in open surgery of the locomotor apparatus in some indications. In a prospective clinical st udy we included 30 consecutive patients who underwent open laser surge ry from November 1992 to August 1994, for the following indications: t he sparing haemostatic tissue ablation was used for synovectomy or for bony resection in osteophytes and osteochondromas of different locati ons, an osteoid osteoma and a painful sacral hyperplasia in the presen ce of incomplete sacral meningomyelocele. With bleeding eliminated, th e shaping was much easier. The non-ablative shrinking produced less ti ssue loss and a stabilizing strengthening of tissue at the margins of soft tissue resections, e.g. in jumper's knee, tennis elbow and Achill es tendon cysts. All laser functions that are useful in open surgery h ave also been used in sequestered disc herniations that are inaccessib le a percutaneous procedure and, in spinal decompression, for remodell ing of the posterior spine contour. An analgesic effect of laser limit ed the postoperative administration of analgesic drugs to an average o f 3 days. No complications related to the laser treatment were observe d. At follow-up 12-21 months after operation, 25 of the 30 patients in this heterogeneous population showed complete or near-total healing o f the operated pathological finding, and a further 3 patients showed s ignificant improvement. To what extent these very encouraging results will persist will be shown by long-term observation.