Myths of Laser Spine Surgery for the Cervical Spine Overview
Decompression Spine Surgery
The purpose of a typical decompression spine surgery is to remove any offending compressive structures (bone spur, disc herniation or ligament) that push against the sensitive nerve root. The safest way to mechanically remove the offending structure is under direct visualization. That is-directly observing the nerve while decompressing the structures that cause the compression.
A secondary way to decompress the nerve root is with “indirect decompression”. This normally involves a fusion where the vertebrae are realigned using spacers and/or screws .The realignment should by itself decompress the nerve or canal.
A good surgeon is like a sculptor and opens pathways for the nerve roots by physically removing compressive structures. Any mechanical technique for spine surgery requires “good hands”. The safest way to treat nerves is with small delicate tools to remove adhesions and free the nerve root under direct visualization.
Direct decompression is normally performed under the microscope. The surgeon finds the “plane” between the compressing structure and the nerve root, separates the nerve from the compressive mass with a surgical instrument to protect and retract the nerve safely. The surgeon then removes the compressive mass with another tool such as a bur (like a “Dremel”), a curette (a scraper-like device), a kerrison (a small “biter” device) or an osteotome (a chisel-like device) while the nerve is being protected by the assistant. The assistant looks at the same image as the surgeon through the microscope.
There are structures (ligaments or small veins) that might need to be cauterized near the nerves. These can be safely cauterized with a tool called bipolar cautery. This tool looks like a long thin pair of tweezers. The tips of these tweezers will heat up the area only immediately between the two ends. The surgeon can grasp the problematic structure (normally an adhesion or a small blood vessel) that needs to be cauterized and only this tissue in between the two forceps tips will be impacted with this heat.
The structure that needs to be cauterized can be held away from any nerve and the heat can be produced safely. The heat is only generated between the two tips so that any tissue away from these two tips is not affected. This bipolar cautery method is much more precise than the use of a laser.