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What's Real And What's Fake About Laser Spine Surgery?

A lot of patients who have back pain have seen the ads: laser spine surgery is proposed to be an outpatient alternative to "traditional" spine operations. Sometimes, patients ask me about this "band aid" spine surgery: would it work for them?

Let's start with the basics. A laser -- like a scalpel, or anything else in the operating room -- is simply a tool. And as a tool, it can be useful in the right situation. In the wrong situation, however, it may be not do the job, or potentially be harmful!

Secondly, the laser is only useful and relevant when you are doing the work on the spine -- say, removing a herniated disc -- and has little or nothing to do with HOW you get to the site of the pathology in the first place. And people often conflate the laser with minimally invasive surgery. They may not be the same thing. For example, the laser is often used in brain tumor removal procedures that may require an open surgical approach, but the laser aids in the precision of the surgery: https://www.texasoncology.com/types-of-cancer/brain-cancer/surgery-for-brain-tumors/

All types of minimally invasive spine surgery: endoscopic, microscopic, percutaneous, laser, and others, have a very simple objective: get to the spine pathology and take care of it with as little disruption of the surrounding tissues (muscles, ligaments, nerves) as possible. Some techniques are less disruptive to the tissues than others. On the other hand, some patients' spine problems need a wider surgical technique than can be achieved with a tiny incision, or an endoscope, or a laser.

For example, in the image below on your right, the stenosis (spinal compression) is so severe that a laser may be an inappropriate instrument for dealing with the problem.

Bottom line: the surgeon ought to use the MOST appropriate technique for the patient's individual problem, and then apply less invasive techniques wherever and whenever it is safe and possible.

Dr. Mohammad S. Shukairy


Advances In Minimally Invasive Spinal Surgery

If you have to have spinal surgery, minimally invasive options should be reviewed with you at the very least. 

Nowadays, with modern illumination, access tools, and scopes, spinal surgery can be accomplished with smaller incisions, lower blood loss, shorter hospital stays and less post operative pain. No longer does spinal surgery require a 3 or 4 inch incision. And as a result, many of the surgeries performed nowadays can be done as an outpatient, requiring less than a 24 hour stay. A few limited medical studies have shown that, in some cases, minimally invasive spinal surgery does show better outcomes than traditional approaches. 

But it does NOT mean spinal surgery is now risk-free. Many of the same risks of spine surgery apply, and in fact, the unique access and approaches of a few of the newer techniques introduce a new kinds of risks. So make sure you review with your surgeon all the options. Usually, there is more than one way to approach a surgical problem using modern techniques. If your surgeon favors (or offers only) one approach, you may want to inquire further as to other options. 

Minimally invasive surgery is not always the best option for some conditions. For example, in a patient with lumbar stenosis at multiple levels, say, 4 or 5, or with severe central stenosis, it might be advantageous to proceed with a traditional midline approach to the spine. 

In upcoming posts, I will be outlining different minimally invasive spinal surgery techniques, including advantages and disadvantages of each, so you can make an informed decision for yourself. 

Dr. Mohammad S. Shukairy