Neurosurgeons Speak out Against Laser Spine Surgery

The term "laser spine surgery" has become very popular, but while the laser has created substantial medical improvements in the field of medicine, this is not in the case for spine surgery. Atlantic Neuro-Surgical Specialists (ANS) advises all patients to use caution when it comes to "advanced" laser spine surgery procedures.

Defined as surgery using a laser (instead of a scalpel) to cut tissue. Examples include the use of a laser scalpel in otherwise conventional surgery, and soft tissue laser surgery, in which the laser beam vaporizes soft tissue with high water content. Laser resurfacing is a technique in which molecular bonds of a material are dissolved by a laser. Laser surgery is commonly used on the eye. Techniques used include LASIK, which is used to correct near and far-sightedness in vision, and photo-refractive keratectomy, a procedure which permanently reshapes the cornea using an excimer laser to remove a small amount of tissue.

Americans love technology.

We are all attracted to shiny, new gadgets or the latest tech fad. This certainly holds true when looking at the recent marketing success of laser spine surgery. The idea of using a laser when performing surgery certainly sounds high tech. On the other hand, lasers are often used to burn through thick metal. Considering that, does one really want that type of cutting-edge device near their spinal cord

Atlantic Neuro-Surgical Specialists (ANS) does not believe laser spine surgery provides any clinical benefit over traditional, minimally invasive spine surgery (MISS). On the contrary, ANS surgeons believe laser spine surgery poses unnecessary risks to the spinal cord, and have seen patients damaged by this approach. As a result, ANS does not perform laser spine surgery, nor use lasers during spine surgery, nor do they recommend that technology.

To appreciate why the vast majority of the neuro-surgical spine community has not adopted laser spine surgery, it's important to first understand that the only real difference between laser spine surgery and MISS is how the damaged disc tissue is removed.

Why does this difference matter

As counterintuitive as it sounds, laser spine surgery is actually less precise than scalpel-based procedures.

During a procedure, a surgeon will often have to look around corners to see what is causing the problem.

A laser is a straight beam of light that cannot bend or remove tissue from around a corner. The importance of a surgeon's ability to delicately navigate angles cannot be underestimated. But there is more. While lasers destroy and cut tissue, they do so with heat that also causes water molecules to boil, which in turn can produce gas. This mixture of heat and gas can damage healthy nerves. A razor-sharp scalpel in the hands of a skilled surgeon maintains the same precision without the risk of inadvertent thermal injury. And lastly there is the issue of depth of penetration. Think of holding a knife up to a balloon and pressing softly. You can feel the give and take of the pressure you are applying against the balloon and thereby have a good idea of when that balloon will pop. Using a scalpel, surgeons can use this same tactile feedback to access the tissue and thereby achieve the exact depth of penetration. On the contrary, a laser will cut further down, depending on how long the beam sits at one part of the incision. Therefore, structures including nerves and healthy tissue can be inadvertently injured.

ANS advocates any undertaking that improves patient outcomes, and prides itself on being an early adopter of new, proven technologies and surgical techniques. ANS has invested heavily in minimally invasive spine surgery instruments and technology, as well as pioneering the way these procedures are performed. ANS will not, however, market itself with buzzwords that test well from a marketing standpoint, but don't offer clinical benefit. That is because ANS knows that technology is simply a means to an end - and that end is the well-being of our patients.