Low Level Laser Therapy to Reduce Comorbidity in Spinal Surgery

NCT02529657 | Completed DMC

• 1 other identifier: 12288113.1.0000.5511
• Study Type: interventional
• Target: 48
• Locations: 1 country
• Sites: 1

Brief Summary

Each year, more than one million individuals worldwide are submitted to laminectomies, with a failure rate higher than 40%. Postlaminectomy epidural adhesion is implicated as a main cause of ''failed back surgery syndrome'' and associated with increased risk of complications during revision surgery. The postoperative epidural scar can cause extradural compression or dural tethering, which results in recurrent radicular pain and physical impairment. Several studies in the literature are signalizing that Low-Level-Laser-Therapy (LLLT) is proven to be an effective tool to assist the inflammatory process and wound healing, as well to prevent infection. Thus, the objectives of this project are to delineate and evaluate the LLLT effects in spinal surgery. A prospective randomized, controlled trial with a total of 48 patients who underwent laminectomy, were divided into 2 groups. In the first group, 25 patients received LLLT during the surgical procedure over dura mater, over subcutaneous and on the skin, as well as 24h and 72h post surgery. In the second group, 23 patients were induced to think they will be getting the same treatment, although the laser is not operating. In those groups, C reactive protein, Lactate Dehydrogenase and Creatine kinase were evaluated in the second and fifth days after surgery, digital temperature will be measured and scores in visual analogue scale will be used, 5 minutes pre and 5 minutes post Laser application. The drainage output was collected in the first three days following surgery in both groups. Interleukins were evaluated in interstitial infiltrate drained in 24h and 48h. The data was evaluated for normality and subjected to appropriate statistical analysis, in order to seek representation, as same as the level of significance of the studied samples.

Conditions

Failed Back Surgery Syndrome

Keywords

Lower Level Laser Therapy (LLLT); inflammation; cytokines; wound healing; laminectomy; clinical study

Outcome Measures

Primary Outcomes (2)

• Immunochemistry to evaluate low level laser therapy anti-inflammatory mechanism 24 hours

  Interstitial infiltrate obtained of Lumbar Drain collected 24 hours after surgery, interleukins IL-1, IL-4, IL-8, IL-10 and TNF alfa were measured through Immunochemistry, using ELISA.

  24 hours after surgery

• Immunochemistry to evaluate low level laser therapy mechanism 48 hours after light delivery

  Interstitial infiltrate was obtained of Lumbar Drain collected 48 hours after surgery, in this infiltrate interleukins IL-1, IL-4, IL-8, IL10 and TNF alfa were measured through Immunochemistry, using ELISA.

  48h after surgery

Secondary Outcomes (2)

• Score in Visual Analogue Scale

  5 minutes pre LLLT

• Score in Visual Analogue Scale

  5 minutes post LLLT

Other Outcomes (4)

• Temperature of the skin in the healing scar

  pre and 1 minute post LLLT

• Values of Creatine Kinase in the blood

  pre operative, 24h and 48h postoperative

• Values of C reactive protein in the blood

  pre operative, 24h and 48h postoperative

Study Arms (2)

Placebo

PLACEBO COMPARATOR

23 patients were induced to think they will be getting the same treatment, although the LLLT is not operating.

Procedure: Placebo

Low level Laser Therapy

EXPERIMENTAL

25 patients were submitted to spine surgery and have received low level laser therapy during surgery, 24 hours after surgery and 48 hours after surgery.

Radiation: Low Level Laser Therapy

Interventions

Low Level Laser Therapy RADIATION

In 23 randomized patients, LLLT (B-Cure, Good Energies ®, Israel), with CW diode laser - semiconductor Gallium Arsenide and aluminum (GaAlAs) will be applied during surgery (λ = 804 nm ± 2 , total exposure time of 240 s, energy density of 2.48 J/cm2 , average power of 40 mW , spot area of 3,876 cm2), in contact mode, for 60 seconds on the laminectomy site, 60 seconds and 120 seconds in the subcutaneous tissue of the skin over the wound bed, respectively. In the first and second day post surgery, will be collected the drainage output for analysis of interleukin 1, 4, 6, 8 and 10 (IL- 1, IL-4, IL -6, IL-8 and IL -10 ) and tumor necrosis factor alpha ( TNF -alpha ).

Low level Laser Therapy

Placebo PROCEDURE

In the operating room, lumbar laminectomy will be performed in 46 patients. During the surgery, 24 hours and 48 hours after surgery, the patients received the regular treatment after laminectomy and were induced to thing that were receiving low level laser therapy in their wound.

Placebo

Eligibility Criteria

• Age: 10 Years - 90 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients undergoing to lumbar laminectomy

You may not qualify if:

• Active lumbar cancer
• Infectious disease
• Coagulation disorders
• Dural injury during the surgery

Sponsors & Collaborators

• University of Nove de Julho: lead

Study Sites (1)

Nove de Julho Universtiy

São Paulo, São Paulo, Brazil

Location

Related Publications (14)

• Farrokhi MR, Vasei M, Fareghbal S, Farrokhi N. The effect of methylene blue on peridural fibrosis formation after laminectomy in rats: an experimental novel study. Spine J. 2011 Feb;11(2):147-52. doi: 10.1016/j.spinee.2011.01.014.

  PMID: 21296299 BACKGROUND

• Yildiz KH, Gezen F, Is M, Cukur S, Dosoglu M. Mitomycin C, 5-fluorouracil, and cyclosporin A prevent epidural fibrosis in an experimental laminectomy model. Eur Spine J. 2007 Sep;16(9):1525-30. doi: 10.1007/s00586-007-0344-8. Epub 2007 Mar 27.

  PMID: 17387523 BACKGROUND

• Temiz C, Temiz P, Sayin M, Ucar K. Effect of cepea extract-heparin and allantoin mixture on epidural fibrosis in a rat hemilaminectomy model. Turk Neurosurg. 2009 Oct;19(4):387-92.

  PMID: 19847760 BACKGROUND

• Oehmichen M. Vitality and time course of wounds. Forensic Sci Int. 2004 Sep 10;144(2-3):221-31. doi: 10.1016/j.forsciint.2004.04.057.

  PMID: 15364394 BACKGROUND

• Shah JM, Omar E, Pai DR, Sood S. Cellular events and biomarkers of wound healing. Indian J Plast Surg. 2012 May;45(2):220-8. doi: 10.4103/0970-0358.101282.

  PMID: 23162220 BACKGROUND

• Wang R, Ghahary A, Shen Q, Scott PG, Roy K, Tredget EE. Hypertrophic scar tissues and fibroblasts produce more transforming growth factor-beta1 mRNA and protein than normal skin and cells. Wound Repair Regen. 2000 Mar-Apr;8(2):128-37. doi: 10.1046/j.1524-475x.2000.00128.x.

  PMID: 10810039 BACKGROUND

• Lee JH, Lee SH. Clinical effectiveness of percutaneous adhesiolysis using Navicath for the management of chronic pain due to lumbosacral disc herniation. Pain Physician. 2012 May-Jun;15(3):213-21.

  PMID: 22622905 BACKGROUND

• Tao H, Fan H. Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions. Eur Spine J. 2009 Aug;18(8):1202-12. doi: 10.1007/s00586-009-1013-x. Epub 2009 Apr 30.

  PMID: 19404691 BACKGROUND

• Sobottke R, Schluter-Brust K, Kaulhausen T, Rollinghoff M, Joswig B, Stutzer H, Eysel P, Simons P, Kuchta J. Interspinous implants (X Stop, Wallis, Diam) for the treatment of LSS: is there a correlation between radiological parameters and clinical outcome? Eur Spine J. 2009 Oct;18(10):1494-503. doi: 10.1007/s00586-009-1081-y. Epub 2009 Jun 27.

  PMID: 19562386 BACKGROUND

• Sandoval MA, Hernandez-Vaquero D. Preventing peridural fibrosis with nonsteroidal anti-inflammatory drugs. Eur Spine J. 2008 Mar;17(3):451-455. doi: 10.1007/s00586-007-0580-y. Epub 2008 Jan 3.

  PMID: 18172695 BACKGROUND

• Rochkind S, Drory V, Alon M, Nissan M, Ouaknine GE. Laser phototherapy (780 nm), a new modality in treatment of long-term incomplete peripheral nerve injury: a randomized double-blind placebo-controlled study. Photomed Laser Surg. 2007 Oct;25(5):436-42. doi: 10.1089/pho.2007.2093.

  PMID: 17975958 BACKGROUND

• Bae CS, Lim SC, Kim KY, Song CH, Pak S, Kim SG, Jang CH. Effect of Ga-as laser on the regeneration of injured sciatic nerves in the rat. In Vivo. 2004 Jul-Aug;18(4):489-95.

  PMID: 15369190 BACKGROUND

• Keskin F, Esen H. Comparison of the effects of an adhesion barrier and chitin on experimental epidural fibrosis. Turk Neurosurg. 2010 Oct;20(4):457-63. doi: 10.5137/1019-5149.JTN.3205-10.2.

  PMID: 20963694 BACKGROUND

• LaRocca H, Macnab I. The laminectomy membrane. Studies in its evolution, characteristics, effects and prophylaxis in dogs. J Bone Joint Surg Br. 1974 Aug;56B(3):545-50. No abstract available.

  PMID: 4421702 BACKGROUND

Related Links

• Related Info

MeSH Terms

Conditions

Failed Back Surgery Syndrome; Inflammation

Interventions

Low-Level Light Therapy

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Back Pain; Pain; Neurologic Manifestations; Signs and Symptoms

Intervention Hierarchy (Ancestors)

Laser Therapy; Therapeutics; Phototherapy

Study Officials

• Maria Cristina Chavantes, PhD

  Nove de Julho University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MD, MS

Study Record Dates

• First Submitted: November 22, 2013
• First Posted: August 20, 2015
• Study Start: February 1, 2013
• Primary Completion: November 1, 2015
• Study Completion: June 1, 2018
• Last Updated: June 18, 2018

Record last verified: 2018-06

Locations

BR (1)