Blood cellular and biochemical changes after extracorporeal shock wave lithotripsy

Shock wave therapy (Orthotripsy) in musculoskeletal disorders

Extracorporeal shock wave therapy, which now is used routinely for urolithiasis, has gained increasing acceptance in Europe for some musculoskeletal problems and has led to the inception of clinical studies in the United States. The authors have reviewed the available literature to assess the biologic effects of shock waves on human musculoskeletal tissues, the credibility of published studies on therapeutic applications, and the potential for more widespread application of this modality to various skeletal and near-skeletal disorders. The primary advantage of extracorporeal shock wave therapy is its noninvasive nature and seemingly minimal complications when applied to musculoskeletal tissues.

Altered neutrophil permeability following shock wave exposure in vitro

Human neutrophils were exposed to varying numbers of shock waves using the Dornier XL-1 experimental lithotripter. Cellular changes were observed with as few as 60 shock waves generated with 20 KV at a frequency of one per second. A graded reduction in cell numbers and cell viability was observed up to 300 SW. With exposure to 140 SW or above a decrease in mean cell size occurred. When cells were shocked in the presence of adriamycin or after loading with fluorescein, flow cytometry revealed that influx of extracellular components and efflux of cytoplasmic components had occurred. An ultrastructural and functional analysis of cells exposed to 60 SW, where cellular disruption and loss of viability were minimal, revealed several types of cellular changes which may precede SW-induced cell death. Electron microscopic examination revealed in some cells a loss of staining intensity. Plasma membrane rupture and leakage of cytoplasmic components were occasionally evident. The adherence of shocked cells to glass, and the spreading of cells that had adhered, were also reduced. From these studies, it is concluded that cellular permeability and other vital cellular functions in neutrophils are perturbed by SW exposure.