About laser spine surgery & minimally invasive spine surgery
There are lots of TV ads recently about “laser spine surgery”. We have family physicians asking us our opinion on using lasers for spine surgery and if it is of merit.
It’s certainly natural for the media and TV to spotlight new technology and recent cures for all types of health problems. For spine care, there have been lots of fads from chymopapain (an enzyme injection to dissolve herniated discs) in the 1970s, to percutaneous discectomy in the 1980s, the launch of artificial discs in the 1990s and the emergence of IDET (intradiscal electrothermic therapy to heat the disc) in the 2000s.
Many of these fads generated incredible media interest at the outset, lots of TV and magazine ads, but over the long haul most have shown through hindsight to be of little significant benefit for most patients. Some of the above have actually proved to be harmful to some patients.
Laser spine surgery is another item that has been the subject of TV ads and media publicity.
Using a laser in spine surgery is not necessarily modern, as the laser typically is used by the surgeon as a cutting device.
Something that we believe to be more newsworthy are the new “minimally invasive spine surgery” approaches used by fellowship-trained spine surgeons that shorten the incision, lessen time in the hospital, and speed the return to activity with a less painful recovery.
Another area of concern about laser spine surgery is that many of the people who are pursuing laser spine surgery because of the ads, perhaps don’t need surgery at all.
For example, at OrthoIllinois Spine Care — which is referred the most complex spine patients in the Northern Illinois region — 83% of patients in 2013 recovered from their symptoms WITHOUT SURGERY.
Health insurance plans have learned that if you go to a center that only has surgeons, you are likely to get a recommendation for spine surgery.
That is why our spine center has physical medicine doctors and internal spine therapists that provide NON-surgical treatment options that can include spine therapy and spinal injections that can make laser spine surgery — or any spine surgery — unnecessary.
In our opinion, OrthoIllinois Spine Care physicians currently believe there is no clinical benefit to laser spine surgery over minimally invasive spine surgery. As a result, our surgeons don’t perform laser spine surgery, nor do we use lasers during spine surgery for the purpose of advertising.
The only real difference between how traditional or minimally invasive spine surgery is performed, compared to laser disc removal, is how the damaged disc tissue is removed. In a typical spine surgery, a window through bone is created to provide access for the surgeon to remove the herniated disc. With traditional spine surgery, the surgeon may use a microscope or endoscope to see the part of the disc that is pressing on a nearby nerve root. The surgeon then removes the problematic disc tissue with a tiny incisor tool.
With laser spine surgery, the surgeon uses a laser to heat and vaporize the disc tissue. Additionally, laser surgery works best as a cutting tool against soft tissues but is not the ideal instrument for removing bone spurs that are can be present with older patients who have stenosis.
Our spine center is a huge advocate of new technology where it shows benefit to the patient. But more important is our philosophical belief that ideal spine care should exhaust non-surgical treatment options first, and use spine surgery as the last option. In that sense, an educated health care consumer is more likely to realize the best healthcare through their choice of a physician who shares information.