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7th International IMLAS Congress - Vienna, Austria May 18-21, 2000
Report by Stephen Abelow
The 7th International Congress of IMLAS was held in Vienna, Austria at the Vienna Hilton from 18th through to 21ts May, 2000. The meeting was held in conjunction with the Austrian Trauma Society (OGU) and with the International Society for Musculoskeletal Shockwave Therapy (ISMST). Hartmut and Linda Pelinka were wonderful and gracious hosts as well as Andrea Janousek, who was the Congress Secretary.
The weather was terrific. The city of Vienna is imperial and the wine extraordinary.
Many outstanding papers were presented.
Many papers were presented on the use of lasers and electrothermal energy in the spine. It seems that the laser and electrothermal techniques are making a resurgence in the use of minimally invasive spinal surgery.
David Casper presented a great paper where he showed that there was an incidence of subchondral marrow changes after Ho:YAG. If there were wave guides used that had both lateral and vertical firing technique, the incidence of subchondral marrow changes in the vertebra was 52 per cent compared to an incidence of only 15 per cent using lateral only firing probes. The subchondral marrow changes did not appear to influence the resolution of back pain or the overall results of the treatment.
Johannes Hellinger from Munich, Germany presented his work continuing the use of Nd:YAG for percutaneous diskectomy.
Yuichiro Nishijima from Nakagawa, Japan reported on 15 cases of laser endoscopic percutaneous lumbar disc decompression in patients between the ages of 11 and 15 years. He presented a 92 per cent success rate and felt that Ho:YAG percutaneous lumbar diskectomy should be considered before open surgery in young patients with herniated nucleus pulposus.
Sangho Lee from Korea presented a great paper on percutaneous transforaminal endoscopic lumbar diskectomy, where he used the laser, as well as forceps, to do percutaneous lumbar spine surgery (even severely extruded disc herniations in selective cases).
Jorge Ramirez from Columbia presented 150 patients studied prospectively with low back and leg pain. Many patients underwent multiple-level surgery. The results were reported as 72 per cent good, 11 per cent poor; with 6 per cent of the patients re-operated on and a 5 per cent complication rate (motor impairment, headache causalgia).
Martin Knight from Manchester, England presented a great paper on endoscopic foraminoplasty, which was a prospective study of 250 consecutive patients. He felt that endoscopic laser foraminoplasty provided a minimalist means of exploring the extra foraminal zone, the foramen, and the epidural space as well as useful for performing a diskectomy, osteophytectomy and perineural neurolysis.
Jorge Ramirez also presented a paper using a transiliac technique for difficult surgical percutaneous L5/S1 approach.
Bill Thorpe from Cape Giradau, Missouri, USA presented a great paper on a blinded prospective randomized trial of thermal radiofrequency versus Ho:YAG laser capsular shift for shoulder instability. He found significant similarities between both groups of patients; however, patient satisfaction and technical issues appear to be in favour of the Ho;YAG.
Werner Siebert from Kassel, Germany presented 203 patients with chronic should instability. The Ho:YAG laser was used. Good results with excellent stability were achieved in approximately 90 per cent of the patients. (He also used a Suretac if there was a Bankart lesion).
An abstract was presented ion the influence of capsular shrinking with the laser and radiofrequency on terminal nerve endings of the glenohumeral joint by Ansgar Ilg from Dusseldorf, Germany. Capsular shrinkage was performed using a Ho:YAG and a diode laser, as well as radiofrequency (MITEK VAPR system) to reduction length of 10 per cent. Histological examination was then performed to study the immunohistochemistry of the nerves, as well as the extent of thermal necrosis. He found that the different techniques of capsular shrinkage showed comparable histological patterns of thermal damage. The shrinking procedure led to irreversible loss of most of the corpusular receptiors (Paccini-type receptors). They felt that sub-synovial free nerve endings and Golgi tendon organs were damaged. They felt that corpuscvular mechanoreceptors probably do not regenerate, but that there was in-growth of free nerve endings, which may follow neovascularization after repair of the thermal lesions. They felt that partial loss of sensory feedback can be assumed as a lasting result of capsular shrinkage, but "the clinical implications remain unclear".
Michael Kunz from Saarlouis, Germany presented the use of the Ho:YAG laser in the ankle joint and the subtalar joint.
Bruno Gerber from Neuchatel, Switzerland presented a great paper on "What Works in Arthroscopic Laser Use and Why".
Takumi Yonezawa from Osaka, Japan presented the possibility of using a Er:TAG laser device for percutaneous lumbar diskectomy. They found good results in an experimental study using goats’ lumbar nucleus pulposus.
Bob Jackson from Dallas, Texas, USA presented his latest update on photodynamic collagen bonding and using a 1.8 naphthalimide dye activated by blue light in the 457 nanometer range with apparent covalent boding of collagenous tissue. They felt that with fresh tissue and fresh dye bonding, tensile strength of up to 1.3 kg/cm2 were able to be achieved. Right now, current exposure time of 30 min. produces optimal bonding strength.
A great paper was presented on the thermal and energetic effects of radiofrequency and laser on calf muscle by F.Frisee from Vienna, Austria. They found that using RF, the highest levels of energy for a minimum of time gave the best results with a minimum of damage. They felt that the temperature depended more on a duration and not on the chosen level of energy. By the way, Dr. Frisee spent three months with me when he was a medical student.
O.Sahap Atik from Ankara, Turkey presented a great paper attempting to evaluate the histological and MRI alterations after irradiation of the meniscus using the Ho:YAG laser. Dr. Atik opinioned that "when the Ho:YAG laser is used in an optimum does (optimum Joules and Hertz) with optimum technique (keeping the hand piece at an appropriate angle and distance) and in optimum time (avoiding overtreatment), lateral thermal damage and meniscal tissue in vivo does not extend beyond 500u.m. Dr. Atik has a paper that was published in the Hospital for Joint Diseases Annals in 1999. Dr. Atik presented 55 patients with cartilage problems in their knee. Thirty patients underwent laser meniscectomy (Ho:YAG) and 25 were conventionally instrumented. Magnetic resonance imaging was performed in all patients preoperatively and post operatively (third, sixth, and sixteenth month). None of the patients had or developed osteonecrosis following arthroscopic laser surgery, and the MRI changes of both knees were consistent.
An interesting and wonderful symposium was held on Extracoporal Orthopedic High Energy Shockwave Therapy given by the International Society for Musculoskeletal Shockwave Therapy. This was a four hour symposium.
IMLAS business goes on as usual. From a membership standpoint, we would like to increase the membership to all other emerging wavelengths of energy and emerging technologies. A long discussion as to a name change came about. This was left up to the committee. It is thought that we might be able to save the name IMLAS but change what the meaning of the acronym is. IMLAS, itself, has its own name recognition at this time.
Next year’s eighth Congress will be in Cartagena, Colombia the last week in May 2001. The 2002 meeting will be in San Diego in conjunction with SICOT.
It was decided by the membership that, at the present time, no clinical journal would be the official IMLAS journal.
From a financial standpoint, IMLAS is suffering now, as most of the laser industry support has all but vanished. It is possible that the IMLAS dues per member will have to be increased to make up from lack of industry support.
A long meeting was had with Coherent Laser on Saturday, May 20, 2000, where they seriously asked the question of our group "Should Coherent Laser Company even be involved in the field of orthopedic lasers with the advent of the new RF and electrothermal techniques?" If the answer is no IMLAS and other orthopedic laser societies such as OLSNA would suffer from lack of industry support. On the other hand, the laser companies have a multitude of labelings and I have absolutely no doubt that, in the future, lasers will be used in orthopedic surgery; and maybe it would not be so wise for the laser companies to abandon their Core Group of enthusiasts and investigators.
Once again, I would like to thank Hartmut and Linda Pelinka for their wonderful hospitality in Vienna. I can assure you with equal auathority that Jorge Ramirez will plan an equally wonderful meeting in Cartagena, Columbia at the end of May 2001.