The application of laser osteoperforation in the treatment of spondyloarthrosis of the lumbar spine: a preclinical and a prospective clinical study

Introduction: a backache in the lumbar region takes one of the leading positions of all types of pain all over the world. Spondyloarthrosis is considered as a common cause of the vertebrogenic pain syndrome. A conservative/nonoperative management can be applied, yet its efficiency doesn’t always meet expectations. However an operative treatment also has significant limitations and imperfections, such as postoperative complications and high invasiveness. Purpose of the study: investigation and analysis of the results of zygapophyseal joints’ laser osteoperforation.Materials and methods: the pre-clinical phase of this study was executed in March 2020. In the preclinical phase animal models (Miniature Pigs) were used for laser osteoperforation of zygapophyseal joints, and after harvesting of bone material histological examination were performed. In the clinical phase 26 patients were included in the study for laser osteoperforation of zygapophyseal joints performed according to our developedmethod. The clinical phase lasted from April to June 2020, the follow-up period lasted 12 months. No patient was dropped out during the follow-up period.The clinical results were estimated according to Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) right before the operation and 3, 6, and 12 months after the surgery. All the patients underwent certain investigations: CT- and MR-scanning preoperatively; CT-scanning on the first day after the surgery and 12 months after the surgery. Statistical data were processed using the Statistica 10.0 software for Windows (StatSoftInc., USA).Results: according to the histological results of the preclinical phase we optimised characteristics of laser radiation for further clinical procedures. During the clinical phase of the study a pronounced regression of vertebrogenic pain symptoms was registered in all 26 patients, it was already registered in 3 months after the surgery with slight tendency towards increasing of pain symptoms 12 months after the surgery. Themeanageofthepatientswas 57.8 years. According to CT-scans, arthrodesis of operated zygapophyseal joints was formed 12 months after the surgery in all patients.Conclusion: The presented laser osteoperforation of zygapophyseal joints based on our method shows a pronounced improvement of treatment outcomes by lower degree of invasion, lesser surgery duration and decreased vertebrogenic pain syndrome compared to existing surgical approaches.