The Extent of Tissue Damage in the Epidural Space by Ho / YAG Laser During Epiduroscopic Laser Neural Decompression

Background: Lasers have recently become very useful for epiduroscopy. As the use of lasersincreases, the potential for unwanted complications with direct application of laser energy to nervetissue has also increased. Even using the lowest laser power to test for nerve stimulation, there arestill risks of laser ablation. However, there are no studies investigating tissue damage from laserprocedures in the epidural space.Objective: This is a study on the risks of Ho/YAG laser usage during epiduroscopy.Study Design: Observatory cadaver study.Setting: Department of anatomy and clinical research institute at the University Hospital.Methods: We used 5 cadavers for this study. After removing the dura and nerve root from thespinal column, laser energy from a Ho/YAG laser was applied directly to the dura and nerve rootas well as in the virtual epidural space, which mimicked the conditions of epiduroscopy with thedura folded. Tissue destruction at all laser ablation sites was observed with the naked eye as wellas with a microscope. Specimens were collected from each site of laser exposure, fixed in 10%neutral formalin, and dyed with H/E staining.Results: Tissue destruction was observed in all laser ablation sites, regardless of the length ofexposure and the power of the laser beam.Limitations: A cadaver is not exactly the same as a living human because dura characteristicschange and tissue damage can be influenced by dura thickness according to the spinal level.Conclusion: Even with low power and short duration, a laser can destroy tissue if the laser beammakes direct contact with the tissue.Key words: Epiduroscopic laser neural decompression, epiduroscopy, Ho/YAG laser, laserdamage, neural decompression, dura histology