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Laser discectomy. Comparison of systems
M R Quigley1, J C Maroon, T Shih
1Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania.
Spine
|February 1, 1994
Summary
A new in vitro model using disc elastance accurately quantifies lumbar disc removal. The automated suction device showed superior efficacy over lasers in swine models, though clinical relevance is debated.
Area of Science:
- Minimally invasive spine surgery
- Biomedical engineering
- Surgical device development
Background:
- Percutaneous lumbar disc removal is increasingly popular.
- Nd:YAG and Ho:YAG lasers are emerging discectomy technologies.
- A standardized experimental model for comparing discectomy devices is lacking.
Purpose of the Study:
- To develop and validate an in vitro disc elastance model for quantifying lumbar disc removal.
- To compare the efficacy of automated suction and laser discectomy devices.
- To identify key parameters influencing discectomy effectiveness.
Main Methods:
- An in vitro disc elastance model was designed using an infusion pump and a static air column.
- Disc removal was measured by changes in disc elastance (pressure/volume).
- Automated suction, Nd:YAG, and Ho:YAG laser devices were tested in juvenile swine discs.
Main Results:
- Both mechanical and laser devices demonstrated a reproducible treatment plateau.
- Total energy, not power, was the primary determinant of disc removal with lasers.
- The automated suction device removed more disc mass than lasers in the swine model.
Conclusions:
- Disc space elastance provides a rapid, reproducible method to quantify disc removal.
- The developed model can potentially reduce the need for clinical trials comparing discectomy techniques.
- Further research is needed to clarify the clinical applicability of laser discectomy compared to suction devices.