The Truth about “LASER” Spine Surgery

What exactly is “Laser Spine surgery”? Can Spine surgery be performed more effectively and with less complications using a Laser? Why is the word Laser almost synonymous with Spine surgery? Well of those three questions the last one is the easiest to answer. And that answer is marketing. Google anything regarding disc or spine surgery and you will immediately see advertisements about laser spine surgery. Watch much daytime television and you will see countless advertisements about laser spine surgery. So what about the first two questions? What is Laser Spine surgery and does it make Spine surgery more effective or safer?  Let’s discuss. 

First of all, Laser spine surgery is NOT a defined surgical procedure and subsequently it is not recognized specifically as a procedure by Medicare or private insurance companies. Microdiscectomy, Decompressive Laminotomy or Laminectomy are examples of defined surgical spine procedures accepted by insurers and Medicare.  The confusion really comes from associating, through marketing, the word Laser with  the concept of Minimally Invasive surgery. With out a doubt, microdiscectomy surgery and decompressive laminectomy or laminotomy surgery can be done successfully with minimally or least invasive techniques. So the real question is-does the Laser make spine surgery less invasive or safer than using a scalpel or electrocautery? The answer is absolutely unequivocally NO! For a sobering assessment about the subject, search Laser surgery criticisms or complications and read the articles by Bloomberg or Business Week. There is a reason why the Laser is not routinely used as a tool for spine surgery in Peer reviewed institutions like the Mayo Clinic or UAB Hospital and that also includes our local institutions Huntsville Hospital and Crestwood Hospital, and that reason is that a laser does not make spine surgery better or safer. 

Let’s reset the discussion. New technology and advancing surgical procedures is one of the pillars of modern medicine. No better example of that is surgery for gall bladder disease. In the early 1980’s, cholecystectomy surgery was done with a large abdominal incision. I have some painful memories as a medical student holding a Dever retractor with two hands while the attending surgeon removed the gallbladder with an open technique. In just a matter of a few years with the development of minimally invasive laparoscopic techniques the paradigm completely changed and the laparoscopic technique became the standard of care.

In Spine surgery, there has been a tremendous amount of new technology in the last few decades. Kyphoplasty, Artificial Disc technology, advances in fusion techniques with better instrumentation are all examples of peer reviewed technology that has been proven safe and effective and therefore incorporated into mainstream spine surgery throughput the world. You may have read recently about the Mazor robot or the O-arm which are a couple of new technologies recently introduced into the Huntsville spine market. The laser as a surgical tool is not one of them. A laser is essentially a cutting tool that can be used to cut soft tissue.  As a spine application it can be used to perform a procedure called facet or dorsal rhizotomy which is a non surgical pain management procedure to treat back pain, but the laser has not been shown to perform that procedure any better than radio frequency or electrocautery. 

Using a laser as a surgical tool to treat nerve pain related to disc herniations or spinal stenosis has not been proven safer or more effective than a scalpel or electrocautery and further does not make disc or spinal stenosis surgery anymore mimimally invasive. Let’s keep it simple, if the laser was a great tool that made spine surgery better, spine surgeons all over the country and that includes the local spine surgical community here in Huntsville would be using it. 

To conclude, most spine surgery for leg or arm pain caused by a disc herniation or spinal stenosis can be performed with a small incision and as an outpatient procedure. In our community, spine surgeons perform these procedures and send people home the same day every day. Just remember that in most cases, is not the surgeon that makes the procedure large or small, it is the diagnosis that makes the procedure necessary to fix it large or small.