Laser on Hard Tissue


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Laser on Hard Tissue

  1. 1. “ Laser in Orthopedic Surgery” (Part-4) Interaction & effects of Laser (UV-IR) radiation on Biological Hard Tissues and its application in Orthopedic Surgery. Presented by Dr. Md Nazrul islam. Assistant Registrar, Orthopedic and Traumatology Dep't.Shaheed Suhrawardy Hospital, Sher-E-Bangla Nagor, Dhaka-1207. Bangladesh. [email_address] .
  2. 2. <ul><li>“ Progress in surgical medicine is often related to an improved technique of performing osteotomies, i.e.bone excisions. </li></ul><ul><li>Standard tools in orthopedics are saws, milling-machines and mechanical drills. All of them operate in contact mode and possibly induce severe mechanical vibrations and hemorrhage. It is thus straightforward to ask whether lasers might represent a considerable alternative in orthopedic surgery”. </li></ul><ul><li>Markolf H. Niemz </li></ul><ul><li>Laser-Tissue Interactions, Fundamentals and Applications. </li></ul>
  3. 3. <ul><ul><li>Basics of Hard Tissue: </li></ul></ul>Hard tissue Basics of Hard tissue
  4. 4. Types of Hard Tissue: <ul><li>Compact bone or (Cortical bone): </li></ul><ul><li>The hard outer layer of bones is composed of compact bone tissue, This tissue gives bones their smooth, white, and solid appearance, and accounts for 80% of the total bone mass of an adult skeleton. </li></ul><ul><li>cancellous (Trabecular bone): </li></ul><ul><li>Filling the interior of the organ is the trabecular bone tissue (an open cell porous network also called cancellous or spongy bone), Trabecular bone accounts for the remaining 20% of total bone mass but has nearly ten times the surface area of compact bone . </li></ul>Tissue that has become mineralised, having a firm intercellular substance, e.g., cartilage and bone. Basics of Hard tissue:
  5. 5. Mean composition of Human Bone: <ul><li>Matter C onstituent Percentage </li></ul><ul><li>Anorganic Hydroxyapatite 0 – 60% </li></ul><ul><li>Water 15 – 20% </li></ul><ul><li>Carbonates 5% </li></ul><ul><li>Phosphates 1% </li></ul><ul><li>Organic Collagen 20% </li></ul><ul><li>Proteins 1–2% </li></ul>Basics of Hard tissue
  6. 6. Basics of Hard Tissue: Basics of Hard tissue
  7. 7. Basics of Hard Tissue: Basics of Hard tissue :
  8. 8. Radio Anatomy of Bone: Basics of Hard tissue
  9. 9. <ul><li>Laser: General </li></ul><ul><li>View- </li></ul>General View-
  10. 10. Types of laser act on Hard Tissue: <ul><li>A. Cold Laser: </li></ul><ul><li>Cold Laser is the common term used for a Low Level Laser Therapy (LLLT) device. It is considered cold laser because it will not increase the thermal temperature of what it is contacting. Cold lasers deliver power from 1mW to 500mW. </li></ul>A 100W Nd: YAG laser and optical fibre. Laser: General View.
  11. 11. Types of laser act on Hard Tissue: <ul><li>B. Hard Laser. </li></ul><ul><li>Most lasers used by medical professionals on the market are “HOT” lasers or high powered lasers. Hot lasers are lasers that have an output larger than one Watt (1000mW). </li></ul>Laser: General View. .
  12. 12. Types of laser act on Tissue: Laser: General View.
  13. 13. Laser theory: <ul><li>Biological field theory. </li></ul><ul><li>Cellular oscillation theory. </li></ul><ul><li>Bio luminescence theory. </li></ul>Laser: General View.
  14. 14. Laser theory: Bio luminescence theory- <ul><li>Bio luminescence theory - according to Russian researchers, DNA replication emits light at 630 nm. Since this is very close to the wavelength of the He Ne-laser light, it is postulated that laser may accelerate DNA replication via photic stimulation. Laser irradiation at this frequency is said to be non mutagenic since it is not in the range to alter the genetic program by affecting chromosomal ultra structure. The latter is more likely to occur at ultra-violet light irradiation at 300 to 400 nm. </li></ul>Laser: General View.
  15. 15. Laser theory: Cellular oscillation theory: <ul><li>Cellular oscillation theory - the laser beam carries electromagnetic oscillations of definite frequency. When it reaches the tissues the electromagnetic oscillations gradually &quot;swing and excite&quot; single cells. This is thought to eventually intensify the bionomical processes that ultimately regulate the performance of various vital organs. Soviet scientists go on to say that the cell itself begins to emit light similar to the rays of the laser, when the resonance sets in. </li></ul>Laser: General View.
  16. 16. Laser theory: Biological field theory. <ul><li>Biological field theory - connections between tissues and organs in the intact organism are not limited to humeral effects and nervous control mechanisms alone. Rather, there exist unique around every cell, tissue and organ and higher structural levels (organism, organ) exerting a normalizing influence on lower levels (tissue cells). The resonance effect of the low power laser is thought to restore the normal energetic status of the organism, that is, restore its normal physiological state . </li></ul>Laser: General View.
  17. 17. Tissue & Cellular Response: <ul><li>Red light affects all cell: </li></ul><ul><li>absorbed by the mitochondria present in all cells </li></ul><ul><li>Infrared light is more selective absorbed by specific proteins in the cell membrane & affects permeability directly. </li></ul>Laser: Hard Tissue View. Laser: General View.
  18. 18. Tissue & Cellular Response: <ul><li>Cytochromes (respiratory chain enzymes) within the mitochondria have been identified as the primary biostimulation chromophores ( primary light-absorbing molecules ). </li></ul><ul><li>Cytochromes function to couple the release of energy from cellular metabolites to the formation of high energy phosphate bonds in adenosine triphosphate (ATP) </li></ul><ul><li>Cytochromes also can absorb energy directly from illumination, it is possible that during LLLT light energy can be transferred to cell metabolism </li></ul><ul><li>via the synthesis of ATP. </li></ul>Laser: General View.
  19. 19. Tissue & Cellular Response: <ul><li>ATP is used to drive cell metabolism (maintain membrane potentials, synthesize proteins & power cell motility & replication). </li></ul><ul><li>Since enzymes are catalysts with the capability of processing thousands of substrate molecules, they provide amplification of initiation of a biological response with light. </li></ul>Laser: General View.
  20. 20. The Physiological Effects of Low Level Laser Therapy: <ul><li>Improved blood circulation & vasodilation.-Increases blood supply. </li></ul><ul><li>Increase collagen production: </li></ul><ul><ul><li>Develops collagen & muscle tissue </li></ul></ul><ul><li>Increase macrophage activity: </li></ul><ul><ul><li>Stimulates immune system </li></ul></ul><ul><li>Alter nerve conduction velocity: </li></ul><ul><ul><li>Stimulates nerve function. </li></ul></ul><ul><li>Increases ATP production </li></ul><ul><li>Biostimulation – </li></ul><ul><li>Improved metabolism, increase of cell metabolism- Increases speed, quality & tensile strength of tissue repair. </li></ul><ul><li>Analgesic effect- Relieves acute/chronic pain. </li></ul><ul><li>Anti-inflammatory & anti-edematous effects- Reduces inflammation. </li></ul><ul><li>Stimulation of wound healing: </li></ul><ul><ul><li>Promotes faster wound healing/clot formation </li></ul></ul><ul><ul><li>Helps generate new & healthy cells & tissue. </li></ul></ul>Laser: General View.
  21. 21. Laser: Short Term Effects- <ul><li>* Production and release of beta-endorphins (these are morphine like substances produced by various cells in the body that inhibit the sensation of pain). </li></ul><ul><li>* Cortisol production is increased (cortisol is the precursor of cortisone). This enables </li></ul><ul><li>the body to combat the stress associated with trauma or the disease process. </li></ul><ul><li>* The short-term effect is significant in 5-10% of cases during or after the conclusion of the initial treatment, but is not as important as the long term or cumulative effect. </li></ul>Laser: General View.
  22. 22. Laser: Long Term Or Cumulative Effect- <ul><li>* ATP (adenosine triphosphate) production is increased resulting in improved cellular Metabolism. </li></ul><ul><li>* DNA (deoxyribonucleicacid) production; protein building block of tissue is substantially increased. </li></ul><ul><li>* Neurotransmission is facilitated due to elevated levels of serotonin and aceytylecholine. </li></ul><ul><li>* Mitochondrial activity is stimulated resulting in cell replication etc. (i.e. replacement, regeneration and repair of abnormal cells). </li></ul><ul><li>* Modulation of macrophages, fibroblasts and other cells . </li></ul><ul><li>* Angiogenesis (formation of new blood vessels). </li></ul><ul><li>* Regulates cell membrane potential, essential in Na, Cl and K ion transfer (electrolyte balance). </li></ul><ul><li>* Cytokines and other chemicals enhancing cellular communications are released. </li></ul>Laser: General View.
  23. 23. Laser: Other Effects: <ul><li>* The immune response is stimulated. </li></ul><ul><li>* Lymphatic drainage is improved. </li></ul><ul><li>* The histamine response is positively altered. </li></ul><ul><li>* Production of growth hormone is increased. </li></ul><ul><li>* The body’s natural healing processes are enhanced. </li></ul>Laser: General View.
  24. 24. Advantages of laser surgery vs. traditional surgery- <ul><li>Unique capabilities. </li></ul><ul><li>No-touch technique. </li></ul><ul><li>Dry surgical field. </li></ul><ul><li>Reduced blood loss. </li></ul><ul><li>Reduced edema. </li></ul><ul><li>Limited fibrosis/stenosis. </li></ul><ul><li>Potential reduction in spread of metastasis. </li></ul><ul><li>Fewer instrument in the field. </li></ul><ul><li>Sterilization of the impact site. </li></ul><ul><li>Reduced postoperative pain. </li></ul><ul><li>Precision. </li></ul>Laser: General View.
  25. 25. Advantages of laser surgery vs. traditional surgery- <ul><li>Most laser surgeries can be performed on an outpatient basis. </li></ul><ul><li>Very small / precise incision. </li></ul><ul><li>No damage to surrounding areas. </li></ul><ul><li>Less bleeding /&quot;bloodless surgery,&quot; , and less swelling. </li></ul><ul><li>Less time consuming procedure. </li></ul><ul><li>Lower rate of local infections. </li></ul><ul><li>Reduce post-operative pain. </li></ul><ul><li>Reduce post operative recovery period. </li></ul>Laser: General View. <ul><li>* Non-invasive </li></ul><ul><li>* Non-toxic </li></ul><ul><li>* Easily applied </li></ul><ul><li>* Highly effective </li></ul><ul><li>* Cure rate > 95% </li></ul><ul><li>* No known negative </li></ul><ul><li>side effects. </li></ul>
  26. 26. Disadvantages of laser surgery vs. traditional surgery ? <ul><li>Cost. </li></ul><ul><li>Eye hazards. </li></ul><ul><li>Imprecisely aimed lasers can burn or destroy healthy tissue. </li></ul><ul><li>Needs special training/ arrangement. </li></ul><ul><li>Cardiopulmonary resuscitation (CPR) arrangement is recommended to avoid/ manage electrical incidence. </li></ul>Laser: General View.
  27. 27. CONTRAINDICATIONS: <ul><li>1. Pregnancy. </li></ul><ul><li>2. Patients with cancer. </li></ul><ul><li>3. Patients with pacemakers. </li></ul><ul><li>4. Directly looking into the light. 5. Growth plates in children10. </li></ul><ul><li>6. Over cardiac region & Vagus nerve. </li></ul><ul><li>7. Over & around thyroid gland & endocrine glands. </li></ul><ul><li>8 .Patients who have been pre-treated with one or more photo- sensitizers. </li></ul><ul><li>9. Organ transplantation: There is a possibility that the laser's positive effects on immune systems could compromise the immune suppression, which is critical to successful transplantation. </li></ul>Laser: General View.
  28. 28. Important parameters of laser of medical interest: Laser: General View.
  29. 29. Important parameters of laser of medical interest: <ul><li>Ultraviolet : 100–400 nm </li></ul><ul><li>Visible Light : 400–700 nm </li></ul><ul><li>Near infrared: 700–2500 nm </li></ul><ul><li>Mid infrared: 2500 - 25000 nm </li></ul><ul><li>Far infrared: 25–1000 µm </li></ul>Laser: General View.
  30. 30. Important parameters of laser of medical interest: Laser: General View.
  31. 31. Different types of laser used in medical application: Laser: General View.
  32. 32. Interaction <ul><li>Laser interaction with Hard Tissue: </li></ul>Laser interaction with Hard Tissue:
  33. 33. Laser and Hard tissue interaction: Laser interaction With Hard Tissue:
  34. 34. Interaction of laser with Hard Tissue: Laser interaction With Hard Tissue:
  35. 35. Laser-tissue interactions: Laser interaction With Hard Tissue:
  36. 36. Laser-tissue interactions: Laser interaction With Hard Tissue:
  37. 37. Interaction of laser with Hard Tissue: Laser interaction With Hard Tissue:
  38. 38. Interaction of laser with Hard Tissue: Laser interaction with Hard Tissue:
  39. 39. Interaction of laser with biologic tissues: <ul><ul><ul><li>Scattering </li></ul></ul></ul><ul><ul><ul><li>Penetration </li></ul></ul></ul><ul><ul><ul><li>Absorption </li></ul></ul></ul><ul><li>Electromagnetic radiation in the UV-IR spectral range propagates into biologic tissues until it is either scattered or absorbed. </li></ul>Laser : Interaction with Hard Tissue:
  40. 40. Interaction of laser with biologic tissues: Laser : interaction with Hard Tissue:
  41. 41. Absorption of laser into biologic tissue- <ul><li>Laser absorption in biological tissues </li></ul><ul><li>( In IR-UV region of medical interest) predominantly depends on wavelength. </li></ul><ul><li>The absorption of laser is highest in water molecule. </li></ul><ul><li>Protein, Pigments and Melanin has different absorption coefficient depending their molecular structure. </li></ul>Laser : interaction with Hard Tissue:
  42. 42. <ul><li>Mode of action of Laser on Hard Tissue: </li></ul>Mode of Action: Mode of action of Laser on Hard Tissue:
  43. 43. Mode of action (Interaction) of laser with Hard Tissue: <ul><li>a. Photochemical/ Photo-biological Bio-stimulation, anti-inflammatory, Analgesic effects. </li></ul><ul><li>b. Thermal effects of laser- Incision, Coagulation. </li></ul><ul><li>c. Mechanical effects- Tattoo removal. </li></ul><ul><li>d. Photo-ablative effects- Percutaneous discectomy. </li></ul>Mode of action of Laser with Hard Tissue:
  44. 44. Photomedicine: Photochemical Effects- Laser light increases cell permeability Light is absorbed by mitochondria Leading to increased ATP production. Cascade of metabolic effects causes a number of physiological                           Improvement in Macrophage response and validity - Immune system boost/repair and increases in cellular proliferation. Mode of action of Laser with Hard Tissue:
  45. 45. Laser Effects: Photochemical/ Photobiological- <ul><li>Anti-inflammatory effects of Laser. </li></ul><ul><li>Analgesic effects of Laser. </li></ul><ul><li>Tissue healing/ regenerative effects of Laser. </li></ul><ul><li>Biomodulative/ Biostimulative effects of Laser. </li></ul><ul><li>Osseointegration effects of Laser on biomedical implant. </li></ul>Mode of action of Laser with Hard Tissue:
  46. 46. Schematic diagram of tissue healing by laser: Mode of action of Laser with Hard Tissue:
  47. 47. Laser: Biostimulative effects. Biostimulation is believed to occur at very low irradiances and to belong to the group of photochemical interactions. Wound healing and anti- inflammatory properties by red or near infrared light Typical energy fluences lie in the range 1–10 J/cm2. Mode of action of Laser with Hard Tissue:
  48. 48. Laser: Reduces Healing Time by- <ul><li>Enhanced leukocyte infiltration. </li></ul><ul><li>Increased macrophage activity. </li></ul><ul><li>Increased neovascularization. </li></ul><ul><li>Increased fibroblast proliferation. </li></ul><ul><li>Keratinocyte proliferation. </li></ul><ul><li>Early epithelialization. </li></ul><ul><li>Growth factor increases. </li></ul><ul><li>Enhanced cell proliferation and differentiation. </li></ul><ul><li>Greater healed wound tensile strength. </li></ul>Mode of action of Laser with Hard Tissue:
  49. 49. Laser: Thermal effects- Mode of action of Laser with Hard Tissue:
  50. 50. Laser: Thermal effects- Mode of action of Laser with Hard Tissue:
  51. 51. Laser: Thermal effects- <ul><li>Temperature Biological effect </li></ul><ul><li>37◦C Normal </li></ul><ul><li>45◦C Hyperthermia </li></ul><ul><li>50◦C Reduction in enzyme activity, </li></ul><ul><li>cell immobility </li></ul><ul><li>60◦C Denaturation of proteins and, </li></ul><ul><li>collagen,coagulation </li></ul><ul><li>80◦C Permeabilization of membranes </li></ul><ul><li>100◦C Vaporization thermal </li></ul><ul><li>decomposition (ablation) </li></ul><ul><li>> 100◦C Carbonization </li></ul><ul><li>> 300◦C Melting. </li></ul>Mode of action of Laser with Hard Tissue:
  52. 52. Summary of Thermal Interaction: <ul><li>Main idea: achieving a certain temperature which leads to the desired thermal effect </li></ul><ul><li>Observations: either coagulation, vaporization,carbonization or melting </li></ul><ul><li>Special applications: coagulation, vaporization, melting,thermal decomposition,treatment of retinal detachment,laser-induced interstitial thermotherapy. </li></ul>Mode of action of Laser with Hard Tissue: :
  53. 53. Summary of Thermal Interaction: <ul><li>Typical lasers: CO2, Nd:YAG, Er:YAG, Ho:YAG, argon ion and diode lasers </li></ul><ul><li>Typical pulse durations: 1 μs . . . 1min </li></ul><ul><li>Typical power densities: 10 . . . 106 W/cm2. </li></ul>Mode of action of Laser with Hard Tissue: :
  54. 54. Application of laser on Hard Tissue: Thermal effects- <ul><li>incision. </li></ul><ul><li>Cutting of Hard Tissue (Osteotomy). </li></ul><ul><li>Cauterization. </li></ul><ul><li>Bone Coagulation. </li></ul><ul><li>Tissue Vaporization. </li></ul><ul><li>Angiomas, known as port-wine stains </li></ul><ul><li>Cutaneous condylomas. </li></ul>Mode of action of Laser with Hard Tissue:
  55. 55. Mode of action of laser act on Hard Tissue: Mechanical effects- <ul><li>Nd:YAG lasers, a very high intensity of luminous flux over a small area (between 1010 and 1012 W/cm2) ionizes atoms and creates a plasma. </li></ul><ul><li>At the boundary of the ionized region, there is a very high pressure gradient which causes the propagation of a shock wave. It is the expansion of this shock wave which causes the destructive effect. </li></ul>Mode of action of Laser with Hard Tissue:
  56. 56. Application: Mechanical effects of laser on Hard Tissue: Mode of action of Laser with Hard Tissue:
  57. 57. Laser ablation Laser Micro Nano Ablation Cutting Dissection Surgery Scissors Laser: Mode action on Hard on Tissue:
  58. 58. Principles of photoablation: <ul><li>Absorption of high-energy UV photons </li></ul><ul><li>⇓ </li></ul><ul><li>Promotion to repulsive excited states </li></ul><ul><li>⇓ </li></ul><ul><li>Dissociation </li></ul><ul><li>⇓ </li></ul><ul><li>Ejection of fragments (no necrosis) </li></ul><ul><li>⇓ </li></ul><ul><li>Ablation. </li></ul>Mode of action of Laser with Hard Tissue:
  59. 59. Summary of Photoablation: <ul><li>Main idea: direct breaking of molecular bonds by highenergy UV photons </li></ul><ul><li>Observations: very clean ablation, associated with audible report and visible fluorescence </li></ul><ul><li>Typical lasers: excimer lasers, e.g. ArF, KrF, XeCl, XeF </li></ul><ul><li>Typical pulse durations: 10 . . 100 ns </li></ul><ul><li>Typical power densities:107 .1010 W/cm2 </li></ul><ul><li>Special applications: Prolapsed Disc decompression, refractive corneal surgery. </li></ul>Mode of action of Laser with Hard Tissue:
  60. 60. Ablation curves of fresh and dried bone obtained with a CO2 laser. Ablation curves of fresh and dried bone obtained with a CO2 laser (pulse duration: 250 μs, wavelength: 10.6 μm). Due to its higher water content, freshbone is ablated more efficiently. Data according to Forrer et al. (1993). Mode of action of Laser with Hard Tissue:
  61. 61. Ablation curve of fresh bone obtained with an Er:YAG laser- (b) Ablation curve of bone obtained with an Er:YAG laser (pulse duration: 180 μs, wavelength:2.94 μm). Data according to Scholz and Grothves-Spork (1992). Mode of action of Laser with Hard Tissue:
  62. 62. Application: Photoablative Effects- <ul><li>Bone Tumor excision- </li></ul><ul><li>Benign – bony exoxtosis/ osteoid osteoma. </li></ul><ul><li>Malignant, no operation induced metastasis. </li></ul><ul><li>b. Bony tissue Biopsy. </li></ul><ul><li>c. Herniated disc removal/ laser decompression. </li></ul><ul><li>d. Arthroscopy-meniscectomy. </li></ul>Mode of action of Laser with Hard Tissue:
  63. 63. Application <ul><ul><li>Orthopedic Application of Laser . </li></ul></ul>
  64. 64. Modalities of Hard Tissue management: <ul><li>Conservative management. </li></ul><ul><li>General conservative procedure. </li></ul><ul><li>Laser conservative management. </li></ul><ul><li>Surgical management. </li></ul><ul><li>General operative management. </li></ul><ul><li>Laser operative management. </li></ul>Orthopedic Application of Laser.
  65. 65. Orthopedic Application of Laser: Nonoperative- Orthopedic Application of Laser. <ul><li>Pain management. </li></ul><ul><li>Fractures: enhancement of </li></ul><ul><li>union. </li></ul><ul><li>Burn healing </li></ul><ul><li>Wound care. </li></ul><ul><li>Healing Heel fissures. </li></ul><ul><li>Verrucae mnagement. </li></ul><ul><li>Plantar fascitis mnagement. </li></ul><ul><li>Fungal nail correction. </li></ul><ul><li>Arthoscopy(all types) </li></ul>
  66. 66. Orthopedic Application of Laser: Nonoperative- <ul><li>Neurogenic Pain </li></ul><ul><li>Herpes Zoster (Shingles) </li></ul><ul><li>Fibromyalgia </li></ul><ul><li>Post Traumatic Injury </li></ul><ul><li>Diabetic Neuropathy </li></ul><ul><li>Trigeminal Neuralgia </li></ul><ul><li>Radiculitis </li></ul><ul><li>Sciatica </li></ul><ul><li>Management of gout. </li></ul>Orthopedic Application of Laser.
  67. 67. Orthopedic Application of Laser: Non-operative <ul><li>Acute & Chronic Joint Problems: </li></ul><ul><ul><li>Osteoarthritis </li></ul></ul><ul><ul><li>Rheumatoid Arthritis </li></ul></ul><ul><ul><li>Ligament & Tendon injuries </li></ul></ul><ul><ul><li>Chondromalacail Patella. </li></ul></ul>Pain management- Orthopedic Application of Laser.
  68. 68. Orthopedic Application of Laser: Nonoperative: <ul><li>Chronic Back & Neck Pain Reduction of Inflammation: </li></ul><ul><li>Metatarsalgia </li></ul><ul><li>Trigeminal Neuralgia </li></ul><ul><li>Brachial Neuralgia </li></ul><ul><li>Plantar Fascia </li></ul><ul><li>Frozen Shoulder </li></ul><ul><li>Carpal Tunnel </li></ul>Pain management- Orthopedic Application of Laser.
  69. 69. Orthopedic Application of Laser: Nonoperative- <ul><li>Researchers at Massachusetts General Hospital are developing a method to heal surgical incisions with laser light. Surgeons Ying Wang and Min Yao position a metal frame that directs a green surgical laser over the incision. The frame keeps the instrument steady and at a measured distance from the skin. They shine the light onto the cut to activate the dye, leaving it on for three minutes. Credit: Porter Gifford </li></ul>Orthopedic Application of Laser. Laser healing:
  70. 70. Orthopedic Application of Laser: Nonoperative- Orthopedic Application of Laser. Wound Management <ul><ul><li>Open /Unhealthy wounds </li></ul></ul><ul><ul><li>Pressure/Bed Sores </li></ul></ul><ul><ul><li>Post Surgical Healing </li></ul></ul><ul><ul><li>Burns . </li></ul></ul>
  71. 71. Orthopedic Application of Laser: N onoperative: Wound Management: Partial tear of Tendoachilis (Approximately 50 percent) Orthopedic Application of Laser.
  72. 72. Orthopedic Application of Laser: Nonoperative- <ul><li>Laser application in burn is very promising and effective, It subsides burn pain, inflammation and promotes faster tissue healing without any scar. </li></ul>Orthopedic Application of Laser. Burn Management:
  73. 73. Orthopedic Application of Laser: Operative General- <ul><li>Scar excision. </li></ul><ul><li>Excision of cysts, corns, Callus. </li></ul><ul><li>Excision of Neuroma. </li></ul><ul><li>Excision of Heel Spurs. </li></ul><ul><li>Subungual heamotoma management. </li></ul><ul><li>Heamangioma management. </li></ul><ul><li>Matrixectomy. </li></ul><ul><li>Removal of tattoo. </li></ul>Orthopedic Application of Laser.
  74. 74. Orthopedic Application of Laser: Operative- <ul><li>Limbs- </li></ul><ul><li>Endoscopic nerve compression release- (carpal tunnel relese). </li></ul><ul><li>PMMA vaporization(joint revisions). </li></ul><ul><li>Enhancement of bone union/Regeneration. </li></ul>Orthopedic Application of Laser.
  75. 75. Orthopedic Application of Laser . Orthopedic Application of Laser: Spine-
  76. 76. Orthopedic Application of Laser: Operative- Spine- <ul><li>Herniated Disc </li></ul><ul><li>Bulging Disc </li></ul><ul><li>Degenerative Disc Disease </li></ul><ul><li>Arthritis of the Spine </li></ul><ul><li>Spinal Stenosis </li></ul><ul><li>Sciatica </li></ul><ul><li>Bone Spurs </li></ul><ul><li>Pinched Nerve </li></ul><ul><li>Scar Tissue </li></ul><ul><li>Foraminal Stenosis </li></ul>Orthopedic Application of Laser.
  77. 77. Orthopedic Application of Laser: Operative- <ul><li>Spine- </li></ul><ul><li>a.Cervical (Neck) Surgery: </li></ul><ul><li>Cervical Endoscopic Discectomy (CED) </li></ul><ul><ul><li>Anterior Cervical Discectomy (ACD) </li></ul></ul><ul><ul><li>Anterior Cervical Fusion (ACF). </li></ul></ul><ul><li>b. Lumbar (Back) Surgery Procedures: </li></ul><ul><ul><li>Lumbar Endoscopic Discectomy(LED/TA) </li></ul></ul><ul><li>Disc prolapse/Disc degeneration- Percutaneous L. Disc Decompression. </li></ul><ul><li>Interspinous Process Decompression </li></ul><ul><li>(X-STOP) </li></ul><ul><ul><li>Micro discectomy (MD) </li></ul></ul><ul><ul><li>Thermal Annuloplasty(TA). </li></ul></ul>Orthopedic Application of Laser.
  78. 78. <ul><li>See you next day with- </li></ul><ul><li>“ Laser in Orthopedic Surgery” (Part-5) </li></ul><ul><li>“ Double blind </li></ul><ul><li>noninvasive </li></ul><ul><li>application of Laser to </li></ul><ul><li>Enhance Bone Union ”. </li></ul>Thanks everyone for patience, Bye.
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