Intraoperative clinical use of low-power laser irradiation following surgical treatment of the tethered spinal cord

摘要

Abstract: Based on previous experimental investigations which indicated that low-power laser irradiation has a significant therapeutic effect and treatment potential on the injured nerve tissue, the authors began using this method in clinical practice. This data represents the first clinical results in the treatment of four patients with tethered spinal cord resulting from fibrous adhesions at the site of previous myelomeningocele and lypomyelomeningocele repair, thickened filum terminale and spinal lipoma. After surgical release of the tethered spinal cord, stable evoked responses were recorded and the conus medullaris was subjected to direct laser irradiation (CW He-Ne laser, 632.8nm, 7Jcm $+2$/). The findings show intraoperative laser treatment increases evoked responses from 15-52% (mean 26.7%). In a previous work, it was shown that direct laser irradiation promotes restoration of the electrophysiological activity of the severely injured peripheral nerve, prevents degenerative changes in neurons of the spinal cord and induces proliferation of astrocytes and oligodendrocytes. This suggested a higher metabolism in neurons and improved ability for myelin production under the influence of laser treatment. It is well known that tethering of the spinal cord causes mechanical damage to neuronal cell membranes leading to metabolic disturbances in the neurons. For this reason, the authors believe that using low-power laser irradiation may improve neuronal metabolism, prevent neuronal degeneration and promote improved spinal cord function and repair.!