Dr. Donald Corenman Discusses Myths of Laser 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.
What to Know About Laser Surgery
Lasers are simply tools that create light-originating heat-generating forms of energy. These intense beams of light work by cauterization (burning) of tissues. The concept of using lasers as a surgical tool is acceptable. However the problem is that these beams of light can cause thermal damage to nearby structures that are heat sensitive. Nerves unfortunately are very heat sensitive structures so lasers are not ideal for vaporizing tissues immediately next to these roots. Bone spurs cannot be removed with lasers as bone chars but does not vaporize.
Lasers can be used for decompression but have significant risks and drawbacks. The general objection to laser surgery is lack of precision. You wouldn’t use a blowtorch to hem your pants if you had a scissors in hand to precisely cut the material. You can watch the edge of the scissors to know exactly where it is. The risk of injuring a nerve is not eliminated but magnified with a laser. You cannot see the “edge” where the beam is focused so precision is not there. It is not a bad tool for certain uses but there are much better tools at a spine surgeon’s disposal for accuracy. I find that the laser is more of a marketing tool for public consumption than a useful tool for spine surgery.
If you live in the Vail, Aspen, Denver and Grand Junction, Colorado communities and would like to learn more about common myths of laser spine surgery, please contact the office of spine surgeon and back specialist Dr. Donald Corenman.