Sometimes a patient and I will begin to discuss the option of surgery to help relieve his or her pain. At these times, a particular question will often pop up: “What about laser surgery?”
Everybody knows that lasers have found their way into medicine, and that they represent the “cutting edge” of medical technology. However, it seems that few people know what a laser is, why it’s supposed to be better, or even what the heck it’s used for during surgery. The uses of the laser in medicine vary greatly by specialty. What about lasers and spine surgery?
A laser is a device that can concentrate a beam of light into an intense point that can burn or vaporize tissue. There are two main advantages of the laser over conventional surgery. The first is that it can destroy tissue without actually cutting it. This can markedly cut down on bleeding and collateral damage. The second advantage is that laser energy can be carried by thin probes, and so certain operations can be done with a laser that used to require an incision and open surgery. In laser surgery, the thin probe can be inserted into the body by x-ray or video guidance.
There is laser surgery available for the spine. However, its uses are very limited to certain small ruptured disks. When a patient has a herniated or ruptured disk, a laser can be used to treat it without making an incision. The laser probe is inserted into the center of the disk, and the center is vaporized. This creates a hole in the center of the disk, and the ruptured disk material can fall back into this hole. It’s like knocking a house down by digging a hole underneath the house and letting the house fall into it. This will work only with fairly small ruptures, since large ruptures would require that too large a hole be made. In properly selected patients, it can work about 70% of the time; in the rest, the rupture can stubbornly refuse to fall back into the hole. In other spine operations, a laser doesn’t have much use.
There are a couple of problems with using lasers in the spine. First, the delicate spinal nerves are right next to the structures that need work. If we tried to use a laser, the nerves could get cooked! Second, much of the tissue that needs cutting is made of tough bone, cartilage, and ligament. These are the tissues that are resistant to lasers, and they would require too much energy to vaporize. Again, the surrounding tissues would be cooked before the job was done!
