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  • Rivervadas
    Participant
    Post count: 26

    Hi Doc,
    Wondering what your opinion is on Endoscopic Laser surgery for disc herniations?

    I’m assuming even if it does have some positive outcomes that it may not help for foraminal stenosis and bone Spurs.

    Thank you

    Donald Corenman, MD, DC
    Moderator
    Post count: 8455

    Endoscopic laser surgery is really a combination of endoscopic surgery and laser surgery. The whole purpose of any herniated disc surgery is to safely decompress the nerve root. A microdiscectomy or “minimally invasive” surgery are really the same surgery with the incision basically the same size and within 15 mm of each other. In either of these two surgeries, the herniated disc fragment is gently separated from the nerve root and mechanically removed by use of a pituitary rongeur (a grabber device). Both of these surgeries have compatible success rates.

    Laser surgery is really just a way to obliterate the disc fragment with heat to vaporize this material. It can be safe but there are dangers. Too much heat next to a nerve root can put the root in jeopardy. Sometimes, a fragment is wedged underneath the root and needs to be mechanically dislodged before it is ablated.

    Endoscopic approaches can be either from the foramen (nerve exit hole) or from the interlaminar (posterior) approach. There is no mechanical way to enter the disc space to remove loose fragments that could be potential recurrent herniation fragments if the approach is from the foramen which is a disadvantage.

    The endoscope will not allow a large enough field of view to determine lateral recess stenosis or bony foraminal stenosis. I think in the right hands and the right disorder, this technique could be comparable to microdiscectomy but does have some disadvantages.

    Dr. Corenman

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