“Laser in Orthopedic Surgery” Inflammation, pain and tissue healing:

LASER L. light A. amplification via S. Stimulated E. Emission of R Radiation Laser (L.A.S.E.R) is an acronym for light amplification via Stimulated Emission of Radiation. This means that the photons are amplified by the physical processes of the laser design

LASER LLLT is a complementary form of treatment and, therefore, is not intended to replace other electrotherapeutic modalities, such as medication, Physiotherapy, ultrasound, interferential therapy, and magnetic therapy. In a number of therapeutic applications, however, LLLT has been rated more highly in its effectiveness than these other modalities (Baxter et al, 1991).

Where it acts ?

Where it acts ? (Continues

Where it acts ? (Continues:)

Laser Construction A laser is constructed from three principal parts: An energy source (usually referred to as the pump or pump source),pump A gain medium or laser medium, andlaser medium Two or more mirrors that form an optical resonatoroptical resonator

A laser is constructed from three principal parts: An energy source (usually referred to as the pump or pump source),pump A gain medium or laser medium, andlaser medium Two or more mirrors that form an optical resonatoroptical resonator

Soft tissue surgery: CO2, Er:YAG laserSoft tissue surgeryCO2Er:YAG laser Hard tissue application: Inflammation, pain and tissue healing( including bone pain and bone regeneration) Cosmetic surgery (removing tattoos, scars, stretch marks, sunspots, wrinkles, birthmarks, and hairs): see laser hair removal. Laser types used in dermatology include ruby (694 nm), alexandrite (755 nm), pulsed diode array (810 nm), Nd:YAG (1064 nm), Ho:YAG (2090 nm), and Er:YAG (2940 nm).tattoosbirthmarkslaser hair removaldermatologyrubyalexandrite NdHoEr Medical Application of Lasers

Eye surgery: LASIK (laser vision correction)LASIK LASEK (laser-assisted sub-epithelial keratectomy)LASEK PRK (photorefractive keratectomy)PRK Laser scalpel (General surgery, gynecological, urology, laparoscopic)Laser scalpel Dental procedures Photobiomodulation (i.e. laser therapy)Photobiomodulation "No-Touch" removal of tumors, especially of the brain and spinal cord. Acupuncture.Acupuncture In dentistry for caries removal, endodontic/periodontic procedures, tooth whitening, and oral surgery.dentistrycariesendodonticperiodontictooth whiteningoral surgery

Laser Tissue Interactions: Thermal Caused by elevated temperature after absorption of laser energy Nearly all wavelengths and exposure durations Photochemical Caused by chemical reactions within body tissue after absorption of laser energy Only with wavelength less than  m Dominant effect for exposure durations greater than 10 sec Laser Bioeffects And Concepts of NHZ, MPE, etc. Shockwave (Acoustic) An explosive effect when short pulses are absorbed on the retina Pulse duration less than 10  sec

Laser Tissue Interactions : Photochemical Interaction The laser energy is absorbed by metabolically active pigments of the mitochondria in various cutaneous and subcutaneous layers: here involved are the two enzymes of the oxidation chain, Cytochrome a/a3 and Flavoprotein with absorption maxims of wavelengths applied. It is supposed that the changes in the stereochemical conformation induced by an electro magnetic field leads to an increase in activity and improves the concentration of ATP by up to 200%. In addition, an increase in oxygen and glucose metabolism is observed. The main effect is an optimized function of the Na-K pump at the cell membrane, an increased protein synthesis (prostaglandin, enzyme) and a significantly higher rate of mitosis.

Cellular Activities Increased cell metabolism (Increased cell function) Increased collagen synthesis (Increased healing of soft tissues) Increased osteoblast production (Increased healing of bone) Increased circulation Increased formation of new capillaries (tiny blood vessels) by release of growth factors Increased T-cell production (Increased immune function) Increased production of neurotransmitters such as endorphins, serotonin, ACTH etc. (Increased nerve function) Increased chronic pain threshold through decreased C-fiber activity (Decreased pain)

Physiological Effects of Laser Accelerated tissue healing and repair by 40% Increased tensile strength in tissue repair Increase callous and bone formation Reduced or eliminated pain Decreased edema and inflammation Improved immune response Stimulates nerve function Promotes Cellular Oxygenation/Detoxification

Diagrammatic events Diagrammatic events how laser reduces inflammation & pain, and affects tissue healing: a. Inflammation b. pain c. Tissue healing

Stages of reduction of inflammation by Laser:

Subsides inflammation by: 1. Stabilization of cellular membrane 2. ATP production and synthesis 3. Vasodilatation is stimulated via Histamine, Nitric Oxide (NO) and Serotonin. Acceleration of leukocytic activity. 5. Increased Prostaglandin synthesis, 6. Reduction in Interleukin 1(IL-1). 7. Enhanced lymphocyte response. 8. Increased angiogenesis. 9. Temperature modulation. 10. Enhanced superoxide dismutase (SOD) levels. 11. Decreased C-reactive protein and neopterin levels.

Stages of pain management by Laser

Reduces pain by: 1. Increase in b-Endorphins. 2. Blocked depolarization of C-fiber afferent nerves. 3. Increased nitric oxide production. 4. Increased nerve cell action potential. 5. Axonal sprouting and nerve cell regeneration. 6. Decreased Bradykinin levels. 7. Increased release of acetylcholine. 8. Ion channel normalization.

Stages of Tissue healing by Laser

Reduces healing time by: 1. Enhanced leukocyte infiltration. 2. Increased macrophage activity. 3. Increased neovascularization. 4. Increased fibroblast proliferation. 5. Keratinocyte proliferation. 6. Early epithelialization. 7. Growth factor increases. 8. Enhanced cell proliferation and differentiation. 9. Greater healed wound tensile strength.

Conclusion Over the past 20 years, laser and LED devices has been widely being used in medical science with proved & promising success for treatment of a variety of medical conditions including carpal tunnel syndrome, cervical neck pain, low back pain, joint pain, frozen shoulder, generalized muscle pain. and acceleration of wound healing. Besides orthopedic application, Laser is being successfully used in other medical branches ( Surgery, Eye, ENT, Gastroenterology, Neurosurgery etc.). There are thousands of research, study and medical applications, that LASER is a very effective modality of treatment. It is being widely used all over the world with promising and successful also in Orthopedic surgery which is very target oriented, convenient and cost effective. NASA are currently using technical light therapy( Laser) for medical conditions in space applications. All of these events validate the growing acceptance in mainstream medicine for the medical efficacy of laser therapy as a viable, often superior therapeutic treatment modality.