Laser Spine Surgery

A laser is a powerful focussed beam of light that is commonly used for cutting or burning tissue in the medical field. While laser surgeries have become popular and primary tools in areas such as eye surgeries, their role is limited in spine surgery. Laser spine surgery can be used in a limited subset of patients for treating conditions such as pinched nerves. They are generally not used in more common degenerative spine conditions.

Traditional Approach

Traditional spine surgeries involve an incision in the back, side, or front of the spine’s affected segment. The surgeon carefully dissects and separates the tissues to reach the involved segment. The surgeon may then correct the problem using instruments that may involve cutting, removing, or fusing bones.

While there are benefits of adequate visualization by anatomical landmarks in the traditional open approach, there may be increased postoperative pain and slower recovery. The more tissues are cut during the surgery, the longer the body takes to recover from the surgery.

Minimally Invasive Surgery

With the advent of newer instruments and tools, open spine surgeries have mainly been replaced with minimally invasive techniques. The minimally invasive procedures utilize smaller incisions and minimum trauma to the soft tissues to reach the spinal segment. Minimally invasive cervical fusion and minimally invasive lumbar fusion are done using tunnels that separate the tissues instead of cutting.

The minimally invasive spine surgery (MISS) techniques lead to a faster recovery and rehabilitation than open surgery. Endoscopic spine surgery is another form of minimally invasive spine surgery where an operating microscope can visualize the operating area through a keyhole incision.

Another advantage of minimally invasive surgery is that it may be performed in an outpatient setting, and the patients may go home the same day of the procedure. The rates of infection, post-operative pain, and other complications are also significantly less than an open technique.

Laser Spine Surgery

Laser spine surgery is a form of minimally invasive surgery that utilizes the laser’s heat energy instead of traditional instruments. A laser discectomy is a common laser spine surgery to shrink the size of the herniated intervertebral disc. The laser may also be used to remove structures other than discs, such as ligaments that may impinge upon the nerves.

A typical laser discectomy procedure may be performed in an outpatient setting. A local anesthetic may be used to numb the skin overlying the affected segment. The surgeon then introduces the laser probe through a percutaneous incision to the site of the affected spine. The laser probe’s position is determined via an intraoperative image intensifier.

The laser is then used to heat the targeted tissue to relieve the pressure off the impinged nerve. The target may be an intervertebral disc or any soft tissue structures such as ligaments. Laser spine surgery may also be used to target spinal tumors selectively.

The patients can quickly get back to their daily routines and report less postoperative pain compared to traditional surgery. The risks of intraoperative bleeding and post-op infection are also less as minimal tissue is cut during the surgery.

However, laser spine surgeries are not inherently safer than traditional or minimally invasive techniques. While less tissue is dissected or separated during laser spine surgery, the laser’s heat may damage the nerves/spinal cord if not appropriately directed. The laser energy also cannot maneuver around the tissues, adding to the dangers of inadvertent cartilage, bone, ligament, or nerve damage.

The laser energy cannot cut through the bone, so the patients with conditions such as spinal canal stenosis are not candidates for laser spine surgery. Similarly, laser spine surgery is not beneficial in patients with spinal deformity and other spine degenerative conditions.

While laser spine surgery may be successfully used to treat conditions such as discectomy, frequently, patients may need more laser procedures. Although laser spine surgery is promising, there is limited data to prove its efficacy over other surgical techniques such as minimally invasive spine surgery.