Laser and Back Surgery
What the deal with laser and back surgery? This is a common question we are asked by patients.
Our answer to this question is “not much” . The laser is a tool that has been used in surgery for over 35 years. Many associate the use of the laser as ultimate fix all as its use has been widely marketed in other specialties including eye surgery, dermatology, and even dentistry. For some procedures the use of the laser has been an invaluable tool to remove soft tissue with precision. In spinal surgery, the use of the laser is controversial as no clear benefit when compared to traditional surgery has been shown. This is especially the case when considering surgery to remove spinal stenosis (bone). Remember that there is no surgery that is completely risk free and noninvasive. Surgery should always be the last treatment option, regardless of the approach used.
As for the specific use of laser and back surgery, there is definitely a marketing aspect to its use. The goals of spine surgery remain the same for almost every situation. If the nerve is compressed, the goal is to eliminate the cause of compression. That goal can be achieved with many techniques. Traditional techniques include removing the disk material by direct visualization. By utilizing small knives, and curets, the compressing material is mechanically removed off the nerve. The compressing materials can be soft and gelatinous, like the soft nucleus of the disk, or firm like crab meat with the annulus. In the situation of spinal stenosis, actual bone spurs must be removes. Sometimes, it requires use of micro-chisels and high speed burs. In my experience, there is no substitute for direct visualization, for safety and effectiveness. The laser sounds like an attractive alternative, but it is not as precise as the other techniques for spine surgery. Lasers are widely used in eye surgery, and for ablation of softer tissues. Lasers work well in uniform tissues, that have a predictable reaction to the laser energy. But in the spine, the variability of structures causing compression on the nerves make laser use too unpredictable. To decompress the spine, often the surgeon will need to remove bone, then ligament, then fat, then disk material or additional bone. As the laser has different impacts on each of the materials, there is potential that use of the laser will cause unintentional damage to the nerves. If you are considering Laser spine surgery, please discuss the technique with your surgeon, and consider getting a second opinion.
- Zhao XL, Fu ZJ, Xu YG, Zhao XJ, Song WG, Zheng H. Treatment of lumbar intervertebral disc herniation using C-arm fluoroscopy guided target percutaneous laser disc decompression. Photomed Laser Surg. 2012 Feb;30(2):92-5. PubMed PMID: 22150064