My thirty year study of the use of lasers in Orthopaedics
Howard B. Cotler, MD., FACS, FABOS, FAAOS
In 1984 as a spine fellow at Northwestern University in Chicago, I had the opportunity to work with Dr.
Leonard Cerullo. Dr. Cerullo was a neurosurgeon studying the use of lasers (CO2 and YAG) for spine and
neurosurgery. We found that the use of these surgical lasers was slow for exposures, able to cut easily
thru bone, destructive to discs, but extremely good at hemostasis. In 1985 as a trauma fellow with Dr.
Ted Hansen in Seattle and subsequently practicing with Dr. Bruce Browner in Houston, I developed an
appreciation for the importance of the soft tissue envelope surrounding the skeletal system. Now jump
forward to 2014 where one out of three Americans is in chronic pain each year.1 2 This costs the country
$600 billion a year in medical bills, missed work and lost productivity primarily due to orthopaedic
pathology.3
During that interval, from 1984 to the present, Dr. Robert Furchgatt was the first to describe light
mediated vasodilatation in his nitric oxide research for which he was awarded the Nobel Prize in 1998. 4
5
In 2001, while using light emitting diodes (LED) technology developed by National Aeronautics and
Space Administration (NASA). Whelan demonstrated increases of growth in mouse fibroblasts, rat
osteoblasts, rat skeletal muscle cells and human epithelial cells (Navy volunteers).6 Chow et al in 2007
explained how an 830nm laser could block nerve function and give an analgesic effect. 7 8In 2009, Huang
el at showed a biphasic dose response.9 During this period of scientific discovery in 2003 FDA cleared
lasers for use in the United States.
Low level laser therapy (LLLT) is currently a state of the art pain treatment which applies specific
wavelengths of light to promote tissue repair and reduce inflammation in a non-invasive, non-surgical
way. Common clinical targets for LLLT are;
-
Site of injury to promote healing, remodeling and reduce inflammation10
Lymph nodes to reduce edema and inflammation11 12
Nerves to induce analgesia or pain relief13 14 15
trigger points to reduce tenderness and relax contracted muscles16
Due to the non-invasive nature of LLLT, it is directly applicable to those seeking relief in an accelerated
manner. Key benefits of LLLT include efficiency, reduction of muscle damage and fatigue, cost
effectiveness and alleviating the need for injections or pain medications and removing risk of ulcers due
to long term non-steroidal anti-inflammatory or steroid usage.
In my practice, I am currently using LLLT for symptomatic treatment of the non-operative patient, and in
my post-operative spine patients to decrease pain thereby avoiding narcotics, improve range of motion
and to accelerate healing of surgical incisions in order to return patient back to work, school or sports in
a more rapid fashion.
About Dr. Howard B. Cotler:
Dr. Howard B. Cotler is an orthopaedic surgeon whose, Gulf Coast Spine Care, is well known in the
Houston area. Dr. Cotler’s expertise has long been in the areas of spine surgery and trauma. He received
his medical education from Jefferson Medical College of Thomas Jefferson University in Philadelphia,
one of the country’s renowned centers for orthopaedic surgery with fellowships in acute spinal cord
injury surgery at Northwestern University and orthopaedic trauma at the University of Washington. For
many years he taught orthopaedic surgery at UT’s Medical School in Houston. He has practiced in the
Texas Medical Center for the past 29 years, the largest complex for healthcare in the world. In April, Dr.
Cotler opened Laser Health Spa, LLC, a facility offering LLLT that complement his existing orthopaedic
practice. Dr. Cotler welcomes inquiries from fellow physicians and sports medicine professionals.
References
1. Phillips LH. Sports injury incidence. BJ sport med 34 (2) 133.
2. Misra A. Common sports injuries: incidence and average charges. ASPE Office of Health
Policy, March 17, 2014.
3. Szalavitz M. Report: chronic, untreated pain affects 116 million Americans. IOM report,
June 29, 2011
4. Ehrreich Sj, Furchatt RF, Relaxation of mammalian smooth muscles by visible and
ultraviolet radiation, Nature 218(1968) 682-4.
5. MitkaM. 1998 Novel Prize winners are announced: three discoveries of nitric oxide
activity. JAMA 1998: 280:1648.
6. Eells JT, Wong Riley MTT, Nerhaeve J. Henry M, Buchman EV. Kane MP, Gould LJ, Das R,
Hodgson BD, Margolis D, Whelan HT. Mitochondrial signal transduction in accelerated
wound and retinal healing y near-infrared light therapy. Mitochondria 2004; 4(5-6):559-567.
7. Chow RT, David MA, Armati PJ, 830nm laser irradiation induces varicosity formation,
reduces mitochondrial membrane potential and block fast axonal flow in small and medium
diameter rat dorsal root ganglion neurons: implications or analgesia effects of 830 laser, J.
Peripher Nerv Syst. 2007 Mar; 12 (1) 28-39.
8. Chow RT, Johnson M, Lopes-Martins RAB, Bjordal JM, Efficacy of low-level laser therapy
in the management of neck pain: a systematic review and meta-analysis of randomized
placebo or active-treatment controlled trials, Lancet. 2009 Dec 5; 374 (9705): 1987-1908.
9. Huang, YY, Chen ACH, Carroll JD. Hamblin MR, Biphasic Dose Response in Low Level
Light Therapy, Dose Response, 2011; 9(4): 602-18.
10. Aimbre F, Albertini R, Pacheco MTT, Castro-Faria-Neto HC, Leonardo PSLM, Iversen W,
Lopes-Martins RAB, Bjordal JM. Low-level laser therapy induces dose-dependent reduction
in TNFa levels in acute inflammation. Photomed Laser Surg 2006; 24(1):33-37.
11. Omar MTA, Shaheen AAM, Zofar H. A systematic review of the effect of low-level laser
therapy in the management of breast cancer-related lymphedema. Support Care Cancer
2012; 20(11) 2977-2984.
12. Stergioulas A. Low level laser treatment can reduce edema in second degree ankle
sprain, JClin Laser Med Surg 2004; 22(2) 125-128.
13. Palacios-Callender M. Quintero M. Hollis vs Spinget RJ, Moncada S. Endogenous. No
regulates superoxide production at low oxygen concentrations by modifying the redox
states of cytochrome oxidase. Proc Matl Acad Sci USA 2004; 101 (20); 7630-7635.
14. Sharma SK, Kharkwal GB, Sajo M, Huang YY, De Taboada L, McCarthy T. H amblin MR.
Dose response effects of 810nm laser light on mouse primary cortical neurons. Laser Surg
Med 2011; 43 (8): 851-859.
15. Konstantinovic LM, Cutovic MR, M, Milovanovic AN, Jovic Sj, Dragin AD, Letic MD; ,
Miller VM, Low-level laser therapy for acute neck pain with radiculopathy; a double-blind
placebo-controlled randomized study. Pain Med. 2010 Aug; 11(8): 1169-78.
16. Chen K-H, Hong C-2, Kuo F-C, Hsu H-C, Shieh Y-L. Electrophysiologic effects of a
therapeutic laser on myofascial trigger spots of rabbit skeletal muscles. Am J Phys Med
Rehabil 2008; 87(12) 1006-1014.