Introduction: Avascular necrosis (AVN) of the femoral head is a devastating disease that often leads to the destruction of the hip. Core decompression of femoral head is the commonest of all conservative surgical treatments where an 8-10 mm cylindrical core of bone is removed from antero-lateral segment of the femoral head. But it is employed only in early stages of the disease and its results are still of controversial efficacy and most of patients ultimately require total hip arthroplasty. Laser irradiation stimulates the reparative process in the bone and marrow while local hyperthermia produced by the laser vaporizes some of necrotic areas leading to a reduction of the intraosseous pressure which is the fulcrum of AVN regardless of the cause. Objectives: The aim of this experimental study was to evaluate the outcome of core decompression by laser osteoperforation for AVN of the femoral head. Subjects and methods: The study was carried out at the Institute of Laser Surgery and Hospital, Dhaka, Bangladesh which included 62 hips with AVN in 40 patients.  Preoperative and Postoperative Clinical assessment and Radiological staging were done using ‘Harris Hip Score (HHS)’ and ‘Ficat and Arlet staging’ respectively. Under spinal anesthesia and Fluoroscopic guidance all hips were subjected to ‘Core decompression by Laser Osteo-perforation’ using 970 nm Diode laser through 18G spinal needle via trans-trochanteric and trans-capital approach. Results: All patients were followed up at intervals of three weeks, three months, six months and then yearly (cases with minimum 3 follow ups were included in this study). According to HHS our results are as : 40.3% - excellent; 21.0% - good; 29.0% - fair; 9.7% - poor. No significant side effects or complications were observed so far. Conclusion: Core decompression by laser osteoperforation has been proven so far to be an effective, safe and minimally invasive treatment modality for AVN of the femoral head.

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The purpose of this paper is to assess the clinical effectiveness of percutaneous laser disc decompression (PLDD) for patients with radicular pain due to intervertebral disc hernia and to describe our experience in this field in Bangladesh.PLDD is a procedure in which herniated intervertebral discs are treated by the reduction of intradiscal pressure by laser energy. This is introduced by a needle inserted into the nucleus pulposus under local anesthesia and fluoroscopic monitoring. Small volume nucleus vaporization results in a sharp fall in intradiscal pressure, with the consequent migration of herniation away from the nerve root. PLDD has been reported to be a safe, effective, minimally invasive treatment option for patients with a herniated disc.This observational random prospective analysis was carried out during the period from November 2007 to December 2011. PLDD was performed on 4622 herniated discs of 2580 patients (1420, male; 1160, female), whose age ranged between 18 and 85 years. A total of 47 cases were failed back surgery syndrome (FBSS). All patients were followed up (ranging from 1 month to 36 months, with a median of 12 months) and were evaluated according to MacNab criteria.Amongst the 2580 patients, 2296 (89.0%) reported immediate pain relief, 230 (8.9%) patients were uncertain and the remaining 54 (2.1%) did not have immediate pain relief. In the subsequent follow up, according to MacNab criteria a good response was seen in 1935 (75.0%) cases and a fair response in 335 (13.0%) cases. The response to the treatment was poor in 310 patients (12.0%). A second session of PLDD was performed on 292 (11.3%) patients made up of 162 patients (6.3%) due to multi-level (>2 discs) prolapse, 102 patients (3.9%) due to an extensive prolapse of one or two discs and 28 patients (1.0%) because of a relapse. In two cases of a prolapsed dorsal spine (TPLDD is an effective and minimally invasive procedure which has almost no side effects or complications, can be performed under local anesthesia, results in no scarring or spinal instability, and still does not hinder the scope of open surgery in failed cases. PLDD is also effective in cases of FBSS.

Introduction: Avascular necrosis (AVN) of the femoral head is a devastating disease that often leads to the destruction of the hip. Core decompression of femoral head is the commonest of all conservative surgical treatments where an 8-10 mm cylindrical core of bone is removed from antero-lateral segment of the femoral head. But it is employed only in early stages of the disease and its results are still of controversial efficacy and most of patients ultimately require total hip arthroplasty. Laser irradiation stimulates the reparative process in the bone and marrow while local hyperthermia produced by the laser vaporizes some of necrotic areas leading to a reduction of the intraosseous pressure which is the fulcrum of AVN regardless of the cause. Objectives: The aim of this experimental study was to evaluate the outcome of core decompression by laser osteoperforation for AVN of the femoral head. Subjects and methods: The study was carried out at the Institute of Laser Surgery and Hospital, Dhaka, Bangladesh which included 62 hips with AVN in 40 patients. Preoperative and Postoperative Clinical assessment and Radiological staging were done using 'Harris Hip Score (HHS)' and 'Ficat and Arlet staging' respectively. Under spinal anesthesia and Fluoroscopic guidance all hips were subjected to 'Core decompression by Laser Osteo-perforation' using 970 nm Diode laser through 18G spinal needle via transtrochanteric and trans-capital approach. Results: All patients were followed up at intervals of three weeks, three months, six months and then yearly (cases with minimum 3 follow ups were included in this study). According to HHS our results are as : 40.3% -excellent; 21.0% -good; 29.0% -fair; 9.7% -poor. No significant side effects or complications were observed so far. Conclusion: Core decompression by laser osteoperforation has been proven so far to be an effective, safe and minimally invasive treatment modality for AVN of the femoral head.

Introduction: Avascular necrosis (AVN) of the femoral head is a devastating disease that often leads to the destruction of the hip. Core decompression of femoral head is the commonest of all conservative surgical treatments where an 8-10 mm cylindrical core of bone is removed from antero-lateral segment of the femoral head. But it is employed only in early stages of the disease and its results are still of controversial efficacy and most of patients ultimately require total hip arthroplasty. Laser irradiation stimulates the reparative process in the bone and marrow while local hyperthermia produced by the laser vaporizes some of necrotic areas leading to a reduction of the intraosseous pressure which is the fulcrum of AVN regardless of the cause. Objectives: The aim of this experimental study was to evaluate the outcome of core decompression by laser osteoperforation for AVN of the femoral head. Subjects and methods: The study was carried out at the Institute of Laser Surgery and Hospital, Dhaka, Bangladesh which included 62 hips with AVN in 40 patients. Preoperative and Postoperative Clinical assessment and Radiological staging were done using 'Harris Hip Score (HHS)' and 'Ficat and Arlet staging' respectively. Under spinal anesthesia and Fluoroscopic guidance all hips were subjected to 'Core decompression by Laser Osteo-perforation' using 970 nm Diode laser through 18G spinal needle via transtrochanteric and trans-capital approach. Results: All patients were followed up at intervals of three weeks, three months, six months and then yearly (cases with minimum 3 follow ups were included in this study). According to HHS our results are as : 40.3% -excellent; 21.0% -good; 29.0% -fair; 9.7% -poor. No significant side effects or complications were observed so far. Conclusion: Core decompression by laser osteoperforation has been proven so far to be an effective, safe and minimally invasive treatment modality for AVN of the femoral head.