As a physiatry PA, I view the world from the perspective of conservative treatment first, procedures second and if there is no relief/resolution of symptoms or the problems are more severe the “S” word…Surgery as a last resort. This is not to say I view surgery as a bad thing, but just a later step in the hierarchy of treatment steps. With this thought framework in mind, I often get asked, “do I qualify…what do you think of laser surgery?” Honestly, up until this point my answer has always been a qualified, “I don’t know the specifics of the laser procedures, but my belief is that we have several qualified surgeons in the region, I don’t really see an upside.” Given the amount of questions I receive on the laser aspect, I decided it was time to dig deeper and find out what the “buzz” was about. As with all my blogs, I did some research to find gain further information on the concept, so I could formulate a good, qualified understanding and deliver to you what I felt was a non-biased report on the matter. A caveat though, this was not an exhaustive, doctorate dissertation---just generalized research; therefore, I do not claim to be an expert on this matter. In looking at different facilities that offered laser based surgery, here is a brief list of the following conditions treated:
- Disc protrusions/ruptures
- Neck pain---typically disc protrusions/ruptures
- Spinal stenosis---caused by disc protrusions/ruptures or instability
- DDD or degenerative disc disease
- Sciatica---caused by disc protrusions/ruptures or instability
The Procedures performed were:
- Discectomy---removal of the protruding disc
- Laminectomy---Trimming/Removal of the bone to provide more room/ease compression or provide better access
- Fusion of levels---To stabilize a level of vertebrae.
In a general sense the laser is used to shrink the damaged disc material and relieve pressure on the nerves. In essence the laser is used instead of a scalpel. It is touted by its users as a better approach due to the fact that the surgery is minimally invasive---meaning the access/incision is usually smaller---so the patient heals quicker.
You certainly don’t need to look hard or far to find advertising or testimonials on these procedures. “All the doctors we work with are industry-leading, board-certified physicians who specialize in the minimally invasive approach to spine surgery, allowing for faster recovery than traditional surgery. The focus is specifically on minimally invasive surgery, not on illness and infection. With an infection rate that is less than 1%, your risk of developing an infection or an illness is far lower than it would be at a large hospital. Thanks to our highly trained doctors, 95% of our patients would recommend their physician.”
1. On the other side of the laser debate is traditional surgery and non-surgical interventions such as regenerative injections. I found a web article by Dr. Michael R. McLaughlin a spinal surgeon who had the following words for why he doesn’t use a laser in his practice and prefers the traditional scalpel approach. “In fact, one recent study published in 2016 examined percutaneous endoscopic laser diskectomy (PELD), percutaneous lumbar disc decompression (PLDD), and target percutaneous laser disc decompression (T-PLDD) in patients with minimal/mild disc herniations. The study found that not only were lasers significantly less effective than minimally invasive microdiscectomy, but that they also resulted in a near doubling of the need for a subsequent surgery. Certainly, these are not the kind of results that would lead me to change my thoughts on the use of lasers in spine surgery.”
2. Another perspective is from Dr. Chris Centeno---an expert in regenerative medicine, he writes: “This LASER surgery is widely promoted as the holy grail for patients with disc problems, yet I continue to see many patients who benefit about as much from this expensive surgery as they do with a traditional low back surgery, which is not much. I recently saw a patient from the south who underwent laser spine surgery as a low back surgery alternative, only to get much worse. While this can happen to any patient, I was curious to see how the surgery was documented via the notes. Looking at these operative notes, the disc was bathed in high dose steroids as the surgeon exited the area. The goal of this seems to be to reduce local swelling caused by the high temperatures generated by the LASER. The problem is that the outer disc is composed of fibrocyte cells that make fibrous tissue. For the surgery to be successful, these fibrocytes and other fibroblast cells in the back of the disc need to heal the area cut out by the LASER. What happens to fibroblasts when they’re blasted by high doses of steroids? They die off, just like many cells that are treated with high dose steroids. Since the goal of the surgery is to “repair” the disc, adding high dose steroids is likely doing the opposite, reducing the already weak healing properties of the disc. So why use a LASER at all? Your guess is a good as mine, as I can’t come up with a reason why a LASER would be any better than a scalpel or other cutting device, other than it’s sounds really cool.”
So, is laser surgery superior to traditional or conservative measures for spinal related pain? I come from a non-surgical background, so my bias is towards the conservative measures. But in regards to actual surgery---my thought is if the laser was truly superior, every surgeon would use one and you wouldn’t need to travel to get the treatment. Furthermore, I think it is more important to select the right surgeon, someone who is skilled in the specific procedure you need than the tools they use. Finally, in one article I read brought up the point, lasers work in a straight plane, so turning corners is not possible----whereas a scalpel in the right hands allows for more flexibility in treatment.