Laser Spine Surgery: What Does the Science Say?

“Is there a laser option available?” It is a question Shekar Kurpad, MD, hears often during his clinic hours. The truth is, laser spine surgery can be a controversial topic for spine care professionals. The Froedtert & MCW neurosurgeon and clinical director of the SpineCare Program says powerful marketing for certain procedures has given people the wrong idea.

How does laser spine surgery compare to other methods?

“People think a laser beam shoots through their skin and their pain is gone,” Dr. Kurpad said. “But, as with other minimally invasive techniques, such as endoscopic or precision microsurgery, there is an incision involved in laser spine surgery, too. There is also a greater risk of damaging nerves or tissue with a laser, and most importantly, there is no scientific evidence to suggest laser spine surgery is in any way superior to a non-laser approach.”

One of the most common spinal procedures to relieve neck or back pain is a lumbar discectomy. The surgery is minimally invasive and is typically done with an endoscope or a microscope. Through an incision less than an inch long that goes through the skin and into the muscle, the surgeon resects the source of compression — herniated disc material pressing on a nerve or the spine. This particular procedure is often marketed as a “laser discectomy”, and it is a common misconception that the entire procedure is done with a laser. Surgical instruments are still required. “A laser is a focused beam of light,” Dr. Kurpad said. “In this case, the laser is only shrinking the source of the compression.”

Proponents of laser spine surgery say the procedures allow the patient to go home the same day, with minimal downtime and a less than 1-inch incision. But, an endoscopic or microscopic spine surgery is also an outpatient procedure. The incision is approximately the same size and the recovery time is the same as laser spine surgery (return to work in one week to 10 days).

A critical difference between a laser approach and an endoscopic or microscopic approach is the physician’s ability to visualize structures in and around the spine. “The purpose of the laser is to burn the source of compression the beam is directed at,” Dr. Kurpad said. “But it is not precise because the beam cannot maneuver around nerves or tissue — structures we need to protect. In inexperienced hands, the risk of an adverse event during laser surgery is greater, and there is no clear benefit to this approach.”

Is laser spine surgery superior to a non-laser approach?

All you need to perform spine surgery is a medical license — you don’t have to be a trained surgeon. This can make the consequences of adverse effects even more serious. According to a 2016 study published in Surgical Neurology International, more and more frequently, the physicians performing laser disc decompression surgeries are not surgeons, but instead, “pain management specialists” like anesthesiologists, radiologists or physiatrists. The researcher says “the laser vaporizes/shrinks a small portion of disc tissue that lowers intradiscal pressure/volume, and thereby provides symptomatic relief but the surgeries were “ineffective for managing acute/chronic pain in these patients.” Without surgical training, the pain management specialists were unable to address surgical complications.¹ In a different study, the researcher wrote “to date, laser discectomy may be more effective in attracting patients than treating them.”² In one study, outcomes were seen to be noninferior compared with conventional surgery; however, the study did show a higher speed of recovery with the conventional surgery and the number of reoperations was significantly reduced with conventional surgery.³ There are no randomized controlled trials that prove the superiority of a laser approach over a non-laser approach.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5234304/
2. https://www.spine.org/Portals/0/Documents/KnowYourBack/LaserSurgery.pdf
3. https://www.ncbi.nlm.nih.gov/pubmed/25614151

The body has natural mechanisms to reduce the amount of compression in the spine. With time, disc herniations can become dehydrated and shrink in size (from the size of a grape to the size of a raisin). “Surgery is not the only option, and it is not always the best option,” Dr. Kurpad said. “It is important to see a specialist who can help guide you to the approach that is best for you.”

Learn more about Froedtert & MCW SpineCare clinics.

SpineCare