Lasers and Spine Surgery – Fact and Fiction

Ads for Laser spine surgery appear everywhere you turn. What is this laser technology, and is it right for you?

The word “Laser” is an acronym for ‘light Amplification by Simulated Emission of Radiation’. In other words, a laser is highly concentrated light that creates heat and has several uses in surgical procedures, but limited use in spine surgery. A surgical laser might be used to remove cataracts in ophthalmology procedures, or might be used to remove tumors under some circumstances.
Lasers are not typically used in spine surgery by most surgeons because lasers create heat. Heat will significantly damage nerves, and that can be a devastating occurrence in spine surgery where nerves are abundant. The majority of patients who present with typical degenerative spine disease or stenosis suffer from pain caused by nerve impingement. Their nerves are compressed by bone and/or disc, and the surgeon’s goal is to relieve the pressure on the nerve by decompression. This means creating more space around the nerve. A surgeon may not be able to open the space and relieve pressure because additional bone has grown. The key to good outcomes in surgery is getting a nerve decompressed without getting it damaged or injured by heat or other damaging forces. While a laser can be used in limited surgical settings as a curettage (cutting) type device, it is never used to perform an entire spinal surgery. In fact, it’s not used in majority of the cases, as the heat can cause damage to surrounding nerves and tissue when used as a cutting tool. In fact, well over 95% of the spinal surgeries in the United States are performed without the use of lasers, due to the deleterious effects of lasers.

In 2014, the North American Spine Society made the following policy recommendation:

“Due to lack of high quality clinical trials concerning laser spine surgery of the cervical and lumbar spine, it cannot be endorsed as an adjunct to open, minimally invasive, or percutaneous surgical techniques.”

Lasers are a great marketing tool, and have an aura about them where patients feel that lasers are somehow better, and more advanced, than conventional surgical techniques. It would be nice if we had a magic light or science-fiction based device that could diagnose and treat patients, but that’s simply not the case today. Minimally invasive techniques, new implants, biologics, and training are the real advancements a patient should know about. There is no substitute for an experienced surgeon.

Lasers are also touted as a minimally or non-invasive procedure. Even a basic procedure such as an epidural steroid injection is by definition invasive. Non-invasive would imply something where you are not making insertion or putting a needle into the skin. If you are having a surgical procedure, then, by definition, it is invasive. The question a patient should ask is whether the procedure is minimally invasive or a traditional open spine surgery. However, there is no such thing as a “non-invasive surgical procedure”. When a patient says they are having non-invasive treatment, this would imply physical therapy, chiropractic manipulation, medications, or perhaps traction. Those types of modalities do not involve making an incision or putting the needle into the skin or spine.

Shining a hot, bright light on your skin wouldn’t accomplish much more than a burn, which might take your mind off your back pain, but not do much to help it.

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