MR imaging of Ho:YAG laser diskectomy with histologic correlation

Twelve cadaveric vertebral specimens were imaged after holmium yttrium aluminum garnet (Ho:YAG) laser diskectomy to determine the usefulness of magnetic resonance (MR) imaging in evaluating treatment outcome. The Ho:YAG laser was operated at 1.0-2.0 J per pulse, 5 Hz, and 250-microseconds pulse width. The total energy varied between 600 and 2,700 J. Two distinct patterns emerged on MR images. Tissue ablation at higher power (1.5 and 2.0 J per pulse) produced discrete signal voids that correlated with areas of laser-induced ablation identified at gross inspection. More subtle changes, characterized by a high-signal-intensity ring, were seen in the specimens lased at 1.0 J per pulse. The latter appearance corresponded to incomplete vaporization of diskal tissue, a broader zone of minimal thermal injury, and sparing of adjacent vertebral endplates. Total mass loss did not appear to be affected by the choice of power setting (1.0 vs 1.5 J per pulse), with total laser energy held constant.