Because of the appearance of TV ads about laser spine surgery, we are often asked by patients and other family physicians about our use of lasers in spine surgery and if there is benefit to the patient who may need spine surgery.
Everyone wishes for a miracle drug or miracle surgery for a herniated disc, or back pain and neck pain symptoms. Spine surgery has seen lots of innovations and fads — from chymopapain (an enzyme injection to dissolve herniated discs) in the 1970s, to percutaneous discectomy in the 1980s, the emergence of IDET (intradiscal electrothermic therapy to heat the disc) in the 2000s and lastly a variety of artificial discs that attempt to replicate the shock absorption capabilities of the normal healthy disc in the spine.
Many of these new techniques or spine surgeries generated incredible media interest at the beginning, combined with TV and magazine ads, along with new surgeons who use this new “technology”. Historically, most of these “advances” have been shown to have limited benefit for most patients. Some of the above, have actually proved to be harmful to some patients.
Laser spine surgery is a new buzzword that has been the subject of TV ads and publicity. Using a laser in spine surgery is not necessarily modern, as the laser typically is used by the surgeon as a cutting device. The only real difference between how traditional or minimally invasive spine surgery is performed, compared to laser disc removal, is how the damaged disc tissue is removed. In a typical spine surgery, a window through bone is created to enable the spine surgeon to remove the herniated disc. Under traditional spine surgery, the surgeon may use a microscope or endoscope to visualize a herniated disc that is pressing on a nearby nerve root. The surgeon then removes the problematic disc tissue with a tiny cutting tool.
With laser spine surgery, the surgeon uses the laser to heat and then vaporize the disc tissue. Additionally, laser surgery works best as a cutting tool against soft tissues but is not the ideal instrument for removing bone spurs that are can be present with older patients who have stenosis.
The other concern some detractors may cite for laser spine surgery is that the laser has limitations in the three dimensional manner a laser cuts through tissue, and how depth of the incision is controlled with a laser. While a spine surgeon can easily control depth with a traditional cutting tool with pressure, the same is not the case with a laser which can perforate.
Secondly, if you were to also consider industrial lasers are used to cut through metal and steel, would you really want such a cutting tool around your spinal cord?
Our position at The Reading Neck and Spine Center is consistent with the nation’s largest association of spine surgeons: North American Spine Society (NASS). NASS recently published a position paper that cautioned consumers about laser spine surgery. According to the NASS position paper:
“Laser spine surgery in the cervical or lumbar spine is NOT indicated at this time. Due to lack of high quality clinical trials concerning laser spine surgery with the cervical or lumbar spine, it cannot be endorsed as an adjunct to open, minimally invasive, or percutaneous surgical techniques. There are no high quality studies to support a recommendation for cervical or lumbar laser spine surgery.”
Another area that concerns us about laser spine surgery, is that the TV ads encourage a person to have laser spine surgery when they may not need surgery at all. Some experts in the United States estimate that 50% of spine surgery may be unnecessary. That’s why health insurance companies may require a second opinion.
In summary, at this time, we don’t see any real clinical benefit to laser spine surgery over minimally invasive spine surgery. As a result, we do NOT perform laser spine surgery, nor do we use lasers during spine surgery simply for the sake of advertising.
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