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 Multimedia spots position laser spine surgery as THE modern, effective alternative to outdated open neck or back surgery techniques.
Unfortunately, the reality of the surgery, when you look past all of the marketing hype, is often much different.
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.
Lasers have a limited role in spine surgery
Lasers do not magically fix back problems. Surgeons can use the intense heat that they produce to remove portions or reduce the size of soft tissue that may be impinging a nerve, but this is only possible in a limited number of cases.
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.
In the hands of an inexperienced surgeon, lasers can cause nerve damage that leaves patients feeling more discomfort and pain than they were before their operation.
This may seem like an anomaly, but according to an investigation by Bloomberg, the use of lasers in spine surgery is not regulated by a national regulator, like the FDA, meaning that anyone in healthcare, regardless of their training or speciality, can use a laser to perform spine surgery.
This same article researched public insurance records and found that there is an astoundingly high rate of malpractice claims made against laser spine surgical companies.
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.
Many laser spine surgical companies will compare their incision technique against an outdated, old-fashioned surgical technique known as "open spine surgery" to tout the benefits of their minimally invasive operation.
Open spine surgery was somewhat widely used in the 20th century for spine surgery. The operation involved opening up a large portion of the back over the affected area of the spine (usually several inches) and pulling back all the soft tissue and muscles around the area in order for the surgeon to be able to properly see the operating site.
This technique was not only dangerous because it caused a large amount of intraoperative blood loss, but often caused patients a lot of pain in their recovery because it impacted a significant portion of their back.
In other words, anything compared to open spine surgery is an improvement and isn't a good litmus test for comparing modern approaches to spine surgery. It's like comparing a car created in the 1950s to one created in 2019. Of course the newer model is going to be better technically, but it doesn't mean it's the best car available.
The truth about laser spine surgery is that, when compared to other technologies that are available to trained neurosurgeons, it simply does not compare.
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 endoscopes, 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 different 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:
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 is not Always accepted by major insurance carriers
What many patients who are considering laser spine surgery don't often understand is that many insurance companies still consider the procedure to be experimental, meaning that they're not willing to cover the costs associated with it.
This is a significant because laser spine procedures can range anywhere from $4,000-$90,000 and many patients are shocked when they find out that they're not covered by their insurance and are left to foot the bill on their own.
For example, the now defunct Laser Spine Institute, charged approximately $30,000 for its spine surgery, which is more than double what insurance career Aetna would cover and Cigna won't cover the laser portion of the surgery at all.
What about all the positive laser spine reviews online?
Laser spine surgery is a very profitable industry. According to Bloomberg, Laser Spine Institute's profit margins beat Google's in 2011.
However, it is an industry that thrives off of marketing dollars and incentivizing surgery to users who could almost certainly have been treated using more conservative methods.
According to Terri Briseno, a writer at HowStuffWorks, "Marketing and search engine experts know that many people turn to the Internet for answers to medical questions and self-diagnosis. Outpatient spinal clinics of all stripes pay big money to keep their centers at the top of search results and often on the sides and borders of just about every Web site a potential patient visits. Finding testimonials from patients and business affiliates isn't hard; finding endorsements from major medical governing bodies and teaching hospitals, however, is nearly impossible."
LASER SPINE SURGERY DOES NOT EQUAL MINIMALLY INVASIVE SPINE SURGERY
There's a common misconception that laser spine surgery is synonymous with minimally invasive spine surgery, or that it is the only type of minimally invasive surgery available.
Laser spine surgery is simply a subset of a much wider surgical field of minimally invasive spine surgery. A field that is dedicated to helping patients free themselves from their back pain and get them back to their normal lives as quickly and painlessly as possible.
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 endoscopic spine surgery.
Endoscopic spine surgery is a minimally invasive spinal procedure that uses micro incisions as well as specialized visualization and surgical tools to treat a wide variety of spinal conditions.
This cutting-edge technique is used at the affected portion of the spine with minimal muscle and tissue disruption. A small camera, known as an endoscope, allows the surgeon to view what they’re doing without opening up large portions of the back.
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.
To learn more about endoscopic 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.