The term “laser” may conjure up images of short, bloodless, and highly precise procedures that allow patients to walk out the door pain-free. As a result, “Laser Spine Surgery” has been widely marketed as an alternative to traditional open surgical treatments. Advertisements touting a minimal incision promote relief for chronic back and neck pain. Multimedia spots position laser spine surgery as THE modern, effective alternative to outdated open neck or back surgery techniques.
The truth behind all of the marketing surrounding laser spine surgery is that there is only a limited role for using a laser in treating spinal disorders. A laser, as most people know, is a focused beam of light of the same wavelength that can generate intense heat. The problem with using laser for spine surgery is that this intense, focused heat source must be controlled with enough precision to be used around the spinal cord and nerves. Nerves are essentially a physiologic electrical system and are therefore very susceptible to damage from heat. Anyone who has left an electrical device in the car on a hot day knows the damage sunlight amplified by the windshield can inflict. Imagine how much damage a much more powerful focused beam of light from a laser can wreak on spinal nerves.
Laser Spine Surgery Involves Making an Incision
While lasers can be used in spinal surgical procedures, they are simply a tool that is used in the procedure itself. Like any other surgical tool, in order for a laser to be used effectively, it has to be inserted into the body via an incision. Depending on the technique, lasers could be inserted percutaneously (3mm), through an endoscope (8mm), through a minimally invasive tubular retractor (14-18mm), or through an open incision (3 inches or more). The size of the incision depends less on the tool being used and more on other minimally invasive techniques that can be practiced with or without the use of a laser.
Other Tools are Just As Precise As Lasers, and Sometimes Preferred
While lasers may seem high tech and may seem more elegant when compared with drills, scalpels, and electrocauteries, the truth is that using a laser is not always advantageous. In many cases it is easier and more efficient to use the traditional and low tech instruments that can be used at angles and corners (lasers are straight), don’t produce heat (that can damage nerves), and have a fixed length (if kept stationary for too long lasers can damage structures below the area of treatment). Additionally, lasers cannot be used to remove thickened ligaments or bone spurs that is commonly responsible for lumbar or cervical stenosis.
Data on Lasers and Spine Surgery
Lasers have been used in spine surgeries for over 20 years, but have largely been studied only in the role of disc decompression.
The official Blue Cross of Idaho position on laser disc surgery concluded:
Evidence on decompression of the intervertebral disc using laser energy consists of observational studies. Given the variable natural history of back pain and the possibility of placebo effects with this treatment, observational studies are insufficient to permit conclusions concerning the effect of this technology on health outcomes.
What this means:
There are some studies in medical literature describing some success using lasers to shrink bulging discs but the studies are limited by poor design, small sample size or both. Consequently, lasers are not used by mainstream spine surgeons in the United States.
Laser Spine Surgery Does Not Equal Minimally Invasive Spine Surgery
While lasers can be used in procedures using minimally invasive techniques, other tools can as well. The misconception is that all laser spine surgeries are also minimally invasive, or that to be minimally invasive it must be laser spine surgery. In truth, the vast majority of all minimally invasive spine procedures in the U.S. are performed without the use of a laser.
A More Promising Alternative to Laser Spine Surgery
When patients ask about laser spine surgery, what they really want to know is, what are the most current, proven, surgical techniques and technologies that will give them the best results with a minimal amount of recovery time. Our answer is minimally invasive spine surgery coupled with robotics.
Minimally Invasive Spine Surgery
When compared to open surgery, minimally invasive spine surgery offers all of the following advantages:
- Smaller incisions
- Minimal scarring
- Less blood loss
- Shorter hospital stay
- Less postoperative pain
- Less need for narcotics
- Faster recovery time
The biggest challenge with minimally invasive spine surgery is that there is a very steep learning curve for surgeons. Since the anatomical structures are not open and visible, surgeons must navigate using endoscopic cameras and intraoperative X-Rays, resulting in long radiation exposure times for both surgeon and patient.
How Robotic Spine Surgery Is Changing The Game
Enter robotic spine surgery. With robotics, preoperative planning reduces the need for intraoperative X-Rays and results in a much higher rate of accuracy. While a surgeon’s expertise remains incredibly important, robotics are eliminating the variability of “free hand” placement of spinal hardware, resulting in more precise outcomes with less risk.
To learn more about robotic spine surgery or minimally invasive spine surgery, or to see if you might be a surgical candidate, contact our office to set up an initial consultation.