Application of the CO2 laser in surgery of cervical spndylosis and/or OPLL

Abstract

In order to obtain complete decompression of the cervical cord in the anterior approach for cervical spondylosis and/or ossification of posterior longitudinal ligament (OPLL), reactively thickened posterior longitudinal ligament must be removed after removing the osteophytes. This procedure, however, is not easy because the deep and narrow surgical field obliges the operator to use the scissors vertically to the ligament behind which dura and spinal cord is closely placed. Particularly in the case of OPLL, bony tissue involved in the ligament makes it more difficult.
On the other hand, a hard and fibrous tissue like this is a good indication of the carbon dioxide laser, especially when the target is placed vertically to the direction of the laser beam. The most important point is that the spinal cord behind the ligament should be completely protected from laser irradiation. For this purpose, we devised a special handpiece. A small spoon which is bent rectangularly at the neck is attached to the outlet of the handpiece. The tip of the small spoon is inserted between the ligament and dura through a small incision made on the ligament. The ligament is softly lifted up by the tip to make some space between the heated tip and the dura while lasing.
We have tried this new device in three clinical cases. In every case, the thickened ligament with or without bony tissue was effectivery and safely removed. We believe that such a little device will expand the indication of the lasers.