Comparison of Er:YAG laser and piezoelectric osteotomy: An animal study in sheep

Objectives It was the aim of this study to compare the feasibility of complete osteotomy of long bones in sheep using a newly designed variable square pulsed Er:YAG laser and piezoelectric surgery. In addition to uneventful bone healing after laser osteotomy, the goal was to assess the possibility to cut thick bony structures with both techniques in a surgically acceptable time frame of 2–3 minutes. Material and Methods A tibia midshaft osteotomy was performed in 24 sheep using either an Er:YAG laser ( n  = 12) or piezoelectric device ( n  = 12). Laser and piezoelectric groups were divided in two subgroups ( n  = 6) with sheep sacrificed after 2 and 3 months, respectively. A complete radiological, histological and histomorphometric analysis was performed to compare the course of bone/fracture healing and remodelling. Results Laser and piezoelectric osteotomies of the sheep tibia up to a depth of 22 mm were possible without any thermal damage. Radiological and histological results after 2 months showed primary gap healing with distinct periosteal callus formation on the transcortex. After 3 months, radiological and histological analysis revealed less callus formation on the transcortex, with almost no visible osteotomy gap and a distinct formation of lamellar bone crossing the original osteotomy gap. Conclusion Er:YAG laser osteotomy can successfully be used in long bones with a depth of up to 22 mm, thus challenging the dogma of adverse effects of laser osteotomy due to thermal or other damages. Lasers Surg. Med. 42:743–751, 2010 © 2010 Wiley‐Liss, Inc.