When Is The Use of Lasers in Spine Surgery the Right Approach?

The use of lasers in spine surgery is undoubtedly popular, but often misinterpreted. Over the last 3-5 years, public demand for “laser spine surgery” has increased sharply due to increased advertising. A common question that is often asked is if “laser spine surgery” is better than traditional spinal surgery techniques.

There is a misinterpretation of what lasers are actually used for in spinal surgery. The answer is that lasers are often used in conjunction with traditional techniques, not in lieu of them.

Despite the significant publicity on the use of lasers in healthcare, there is a distressing lack of rigorous clinical studies to support the use of this technology in spinal surgery.

While some doctors may use laser cutting or targeting instruments to treat a wide array of back, neck, and spine conditions, the benefits of this technology are largely unclear, and as of yet, not supported by clinical science.

In this article, we will review what is known (and not known) about using lasers during spine surgery, and discuss the conditions in which the use of these lasers may be effective.

Clinical indications for laser spine surgery

Dr. Michael Steinmetz of Cleveland Clinic’s Center for Spinal Health lists several spinal conditions where the use of lasers in surgery stands out.

• Tumors situated on the spinal cord itself
• Bone or soft tissue pressing or penetrating into the spinal cord
• Disc material impinging on a nerve

In each condition, a soft tissue structure (not bone) is in close proximity to an endangered nerve. It is thought that the precision of a laser could be superior to that of a scalpel to cauterize or ablate the soft tissue without causing bleeding; however, the clinical benefits of this ablation have not been substantiated and the clinical evidence does not support a long term benefit.

When not to use lasers for spine surgery

The three clinical conditions listed above make up a very small portion of all spine procedures, and the use of lasers in the remaining majority of spinal conditions is still debated in the respected spine surgery research societies.

Dr. Steinmetz believes minimally invasive procedures are not appropriate for 70% of spine surgeries. In the 30% that remain, lasers are not necessarily the best instrument.

These sentiments are shared by many orthopedic and neurosurgeons who specialize in spine surgery. Thus, laser surgery instruments are only appropriate in a small fraction of all spine surgeries.

Surgeon preference, surgeon experience, and the surgical problems are big factors in deciding the optimal surgical approach for a given patient’s symptoms.

A matter for debate

Despite its recent popularity, no convincing studies show the use of lasers in spine surgery to be superior to traditional methods. Efficacy and outcome studies are very much needed to answer that question.

Success hinges on whether the particular spine surgeon is comfortable and skillful with a laser instrument and can use it more effectively than a scalpel for a given indication. Prospective patients should be aware of these limitations when discussing the use of lasers with their spine surgeon.