“Does Laser Spine Surgery Work?”

…a question often asked by our patients.

Here’s the answer:

Spine surgery is typically done to relieve pain and other symptoms by decreasing pressure on a compressed nerve or by stabilizing the spine.  In the case of a herniated or ruptured disc, a discectomy may be done to remove the damaged portion of a disc in the spine; or a laminectomy may be done to remove bone spurs or other spinal growths. In cases where the spine is unstable, a spinal fusion can be performed to secure together two or more of the vertebral bones so that they “fuse” together.  These surgeries are now often performed using minimally invasive techniques that minimize damage to the surrounding tissue and allow for a faster recovery with much less blood loss. Laser spine surgery is often promoted as being minimally or even noninvasive and risk-free.  However, these laser spine procedures do require incisions and the laser itself can result in serious complications.

Laser spine surgery has never been studied in a controlled clinical trial to determine its effectiveness. Marketing pitches for spine surgery performed with a laser often make bold promises of pain relief for chronic neck and back pain and a quick return to normal life; sometimes in a matter of days. What is often not clear from marketing hype, is that laser spine surgery does actually involve surgery.  An incision is required to allow access to the spine.  A focused beam of light (laser) is then used only to remove the soft tissues over the spine.   Bone and ligament are then removed in order to free the nerve from compression using small instruments.  The laser in laser spine surgery actually plays a very minor role.

Lasers are certainly not new technology.  Lasers have been available for use in medicine since 1973.  However, they have not been widely adopted as a tool to be used in spinal surgery.  The fact is that most neurosurgeons do not use or recommend the use of lasers for spine surgery because there are no clear benefits and there are other well-established and documented studies proving the effectiveness of more modern and established spine surgery techniques.

The Importance of a Proper Diagnosis

It is important to have a proper diagnosis of your problem before deciding to undergo spine surgery.  Most cases of back and neck pain are muscular in origin and do not require or benefit from surgery. Unless severe pain or muscle weakness is making walking or performing daily activities extremely difficult, surgery is rarely the first line of treatment. Anti-inflammatory medication, physical therapy and exercise, lifestyle changes and other noninvasive treatment modalities such as therapeutic massage are often successful at resolving back and neck pain.

If conservative treatments fail to reduce back pain, then surgery may be necessary, depending on your diagnosis. For example, if you have a herniated disk with leg or arm pain as a major symptom that hasn’t been relieved with other treatments, discectomy may be appropriate. If surgery is recommended, get a clear explanation of your diagnosis and how the surgery will help relieve your symptoms.

Traditional spine surgery has been tested in numerous clinical trials.  The vast majority of patient who undergo discectomy for treatment of a herniated disc experienced relief from pain and other symptoms.  In elderly patients diagnosed with spinal stenosis, laminectomy is also a highly effectively procedure. Very few neurosurgeons regard laser spine surgery as a viable alternative to conventional spine surgery techniques. ONS neurosurgeons do not use or recommend laser spine surgery.

Mayo Clinic Opinion on Laser Spine Surgery

 

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19 Responses to “Does Laser Spine Surgery Work?”

  1. Peter Diaz says:

    Does ONS and/or it’s doctors work with workers comp patients? If so how do I proceed with treatment to payment?

  2. LISA Holmes says:

    I have seen many hospitals and have an osteophyte at the C5c6 area of my back and c7. NO DOCTOR has been able to help me with any injections into the epidural area. It is the facedt joint. IT is all blocked up and stiff grinding. I am so fed up. Had trigger point injections. I went to Mass General and they don’t inject that joint with a needle to break up the pain.

    Western Mass doctors were not effective with fact joint blocks.
    NOW what can I do? any advice.
    Mass General told me the SPINAL cord stim may help.
    thxmuch

    • sfrank says:

      Laser spine surgery is a marketing term used by doctors to attract patients for surgery. The important word in the term “laser spine surgery” is “surgery”. In laser spine surgery as in regular surgery, an incision is made and bone, ligament, and sometimes disc is removed using biting tools and or a drill. So what does the laser do in laser spine surgery? In reality, not much. The laser is used to burn and remove the soft tissues off the bone covering the spine. This is actually a step that is not necessary with the more modern minimally invasive techniques and when it is used, the electrocortory performs this step more efficiently and effectively than a laser. So while laser spine surgery sounds noninvasive and futuristic, in the spine community it is viewed at best as a gimmick that misleads patients.

      If your pain does come from a pinched nerve in the neck that causes neck and arm pain, the first treatment to try is physical therapy. Physical therapy often can improve and even completely ameliorate the pain. For those patients who do not get better with physical therapy, surgery is an option. Surgery can often be done minimally invasively on an outpatient basis. Spinal cord stimulators can be effective in decreasing the pain by covering the area of pain with a “buzzing” sensation. However, the implantation of a spinal cord stimulator often involves more surgery than the actual surgery that would fix the problem.

      Scott Simon, MD

  3. Anthony says:

    I have Spondylolisthisis L4-L5, and its been bothering me for quite a few months. I have tried Physical therapy and Chiropratic, they did not help. I spoke with a Nurosegen that i used to work with. He expail the surgey to me that involve disectomy, lamonectomy and the part I really dont like( hate) placing 4 scrows and 2 bracket in my back. I am very afraid to lose my ability to do things afterwards or go running and play Soccer with my friends and my kids or just work around the house. When I watch the procedures from Laser Spine procedure, I saw insted of cuting, they insert a bore catheter and graduely make it bigger to remove the disc and fill it with a fuser. What do think about that ? Please help me and give me some advise. Thank you very much.

    • sfrank says:

      Your aversion to the screws and rods is very common and understandable. Spondylolisthesis is a common condition where there is instability in the spine that results in a slip of one vertebra on another. This slip causes back, and often, leg pain due to the abnormal motion in the spine and the resultant nerve pinch. The way to fix this problem is to decompress the nerve and re-establish stability at the level of this slip. This is called a laminectomy and fusion. The laminectomy is the removal of the bone and ligament that are compressing the nerves. The fusion is the knitting together of the vertebra with bone to re-establish stability.

      The pain is often much better after surgery, but the knitting of bone can take several months or even a year to fully mature (like cement that hardens very slowly). Movement can hinder or even prevent this knitting from occurring. If the bones do not fuse together, then the pain can come back and another operation would be necessary. In order to facilitate this fusion, the bones are secured together. When you break your arm, the arm is casted or pinned to facilitate the knitting of bone that occurs across the fracture. In the spine the most common and effective means of securing the bones is with screws and rods. The entire procedure, from laminectomy and fusion to screw and rod fixation can often be done minimally invasively. A variety of non-screw and rod devices are also available for use in fusing and securing the spine, however they are not as effective and because of this, there use is often not reimbursable through insurance.

      A good comparison between the two procedures could be made to asking whether you want your house built with screws to hold it together or tape. Again, I understand the concern. Surgery is scary. That’s why, if you do need to undergo surgery, you should have the best surgery possible. I have seen too many people who have travelled to a “special place” for their surgery, only to require another operation to fix the problem.

      If a surgical technique is only offered at a few places and is not covered by insurance, very often the reason for this is that the technique is actually inferior to the standard surgical techniques. Its just like my grandfather use to tell me, “if it looks too good to be true, it probably is.”

      Scott Simon, MD

  4. Albert crisafulli says:

    I have been diagnosed with a narrowing in my neck. No MRI yet, only x-Ray. Some neck pain, minor shoulder pain, and occasional numbness in my upper right arm. I am 67 years old but a very active weight lifter,have been all my life. I notice a slight weakness on my right side. Six weeks of physical therapy gas been helpful, along with daily use of Advil. What should be my next step?

    • sfrank says:

      If physical therapy has been helpful, then I would stick with the exercises that your Physical Therapist has given you to do at home. Often the cervical retractions that are demonstrated on our website [http://onsmd.com/healthy-back-exercises/] are helpful. Usually, the symptoms (including the weakness) will continue to improve, but it can take months. If the symptoms worsen, then I would recommend that an MRI of the cervical spine be done in order to confirm the diagnosis of a pinched nerve and to help plan future management of your condition.

      Scott Simon, MD

  5. carol zink says:

    Does laser surgery help when spurs are touching the spine and the chance of them penitrating the spine is very real, which could lead to paralisis. My sister was diagnosed with this condition and told that eventually she will be in a wheel chair. She is trying the pain patch and taking percocete, which helps for a day or so. Is there anything that can be done. Thank You

    • sfrank says:

      The term “laser spine surgery” implies to many people that surgery is accomplished without an incision. This is a common misconception. The important word in “laser spine surgery” is the word surgery. In laser spine surgery, as in traditional surgery, an incision is made and bone, ligament, and sometimes disc are removed using traditional surgical tools. The laser is used only to remove the soft tissues over the spine, a step that is often unnecessary in more modern minimally invasive techniques. When the soft tissues do need to be removed over the spine, it is more effectively accomplished by use of the electrocautery. The laser is in fact just a light that burns soft tissues and is unable to remove bone. It is actually much less precise than the more modern surgical tools and is unable to remove bone spurs. However, bone spurs that press on nerves or the spinal cord are easily taken care of through minimally invasive spine surgery. The outcomes are excellent and patients often go home the same day as their procedure.

  6. Kathryn says:

    I spoke with a laser spine institute rep this morning and she said they don’t cut me open at all. The laser is directed through a hollow needle and used to shave off the bone spurs and the bulge on my disks. No plates or screws or incision needed and you go home after 3-4 hrs. I also wouldn’t have to wear a neck brace for 6-8 weeks. In fact, no brace at all. The problem is solved without being cut open. Also, the success rate for traditional surgery is 50% when I was told 95%. So it seems like someone is lying to try to get my “business”. It’s very confusing when both sides of the issue is trying to get more customers and only presenting the good side on both ends. What is your opinion??

    • sfrank says:

      Laser spine surgery is marketing term used by doctors to attract patients for surgery. The important word in the term laser spine surgery is surgery. Some type of incision is needed in order to use the laser on the spine; otherwise it would just burn the skin. If they say that they do not cut, but instead do the surgery through a needle, then you should ask what is the diameter of the needle used. Very often the surgery is done through a tube anywhere from 22mm to 14mm in diameter. This is the same type of tube that is used for any modern minimally invasive spine surgery. However, an incision, all be it a small one, is made in order to place the tube on the spine. In laser spine surgery, as in regular surgery, an incision is made and bone, ligament, and sometimes disc is removed using biting tools and or a drill. So what does the laser do in laser spine surgery? In reality, not much. The laser is used to burn and remove the soft tissues off the bone covering the spine. This is actually a step that is not necessary with the more modern minimally invasive techniques and when it is the electro cautery performs this step more efficiently and effectively. So while laser spine surgery sounds noninvasive and futuristic, in the established spine community it is viewed at best as a gimmick that misleads patients.

      If your pain does come from a pinched nerve in the neck that causes neck and arm pain the first treatment to try is physical therapy. Physical therapy often can improve and even completely ameliorate the pain. For those patients who do not get better with physical therapy surgery is an option. Surgery can often be done minimally invasively on an outpatient basis. No screws or plates are needed when a simple minimally invasive posterior cervical foramintomy is preformed and no brace is needed post-operatively.

  7. Deborah says:

    I fell at work – waiting tables over a year and a half ago. I got a lawyer and have been seeing the same Orthopedic Dr.s since.
    After not being able to work for 11 months- I was finally given the ok. I went back and in a matter of weeks had herniated what was protruding. ?? They aren’t the same?? I am on my second steroid pack in about a month. Mixed with pain pills an muscle relaxers.
    I cannot function when I am medicated and would like to know about getting a second opinion ? Based on my WC case-the hearing was postponed after my 1st re-injure. So I’m just going around in circles and am still experiencing a lot pain !!! Would this surgery be recommended for me?

    • sfrank says:

      It really depends on your symptoms and MRI. If you are having back AND leg pain in a distribution that corresponds to the herniated disc seen on your MRI and you are not getting better with physical therapy or steroids, then yes you would be a surgical candidate.

  8. Pamela McNutt says:

    My husband is in terrible pain with sciatica. They want to use a laser to remove a cyst and to fix a ruptured disc.

    We have had 2 opinions from other physicians and they want to put plates and screws in. the one today want to open him in the back and fix the ruptured disc and then cut him down the front to put some kind of cage in and remove the cyst.

    he can barely pick up his foot and is 60 years old and has had two other back surgeries and still in pain from those. he has also had a knee replacement that did not work that is still swollen and constant pain with that. He is diabetic, has Parkinson’s Disease and Hypertension.

    We do not know which way to go of what to do.

    • sfrank says:

      Surgery is never a sure thing, as your husband can well attest to. Assessing what kind of surgery to do is a bit of a balancing act. A bigger surgery may have the best chance of curing a problem permanently, but caries the most risks and has the longest recovery time. A smaller or minimally invasive surgery has the quickest recovery and smaller risks, but it has to accomplish the specific goals that are set out before surgery (ie. cure or at least reduction in pain). There are many circumstances where minimally invasive surgery is very appropriate, especially for removal of a unilateral synovial cyst, which is what it sounds like your husband has. If there is a slip of the vertebrae associated with this cyst (called a spondylolisthesis), then a fusion procedure may be needed with screws and rods. This procedure may also be done minimally invasively. I would avoid any surgeon that recommends laser surgery. Laser spine surgery is a marketing term used by some surgeons to attract patients. However, the important word in laser spine surgery is surgery. Laser surgery still requires an incision. The laser is usually used only for a very minor part of the surgery, such as removing a small amount of muscle over the spine. Lasers are much less precise than traditional surgical techniques and can cause serious damage when used near nerves. Lasers do a poor job of cyst removal. I think, if your husband has already failed two previous spine surgeries, now is not the time to cut corners. I would look for a surgeon who can explain the options well and give you realistic expectations, without trying to talk you or your husband into a surgery that seems too good to be true.

  9. Pingback: Does Laser Spine Surgery Work? | Dr. Thomas Barnes

  10. Merle Ohlhauser says:

    I have been seriously thinking about having laser surgery up until what read about all of the above information you said about this procedure. I will now consult with a back specialist through my health provider for more procedures to resolve my problems.
    Thank you .

  11. EG says:

    Thank you for the information about laser use in spinal surgery. I wondered what role the laser played.
    Now I know. Will stay away.

    Thank you again

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