“Is there a laser option available?” It is a question Shekar Kurpad, MD, hears often during his clinic hours. The truth is, laser spine surgery can be a controversial topic for spine care professionals. The Froedtert & MCW neurosurgeon and clinical director of the SpineCare Program says powerful marketing for certain procedures has given people the wrong idea. Show
How does laser spine surgery compare to other methods?“People think a laser beam shoots through their skin and their pain is gone,” Dr. Kurpad said. “But, as with other minimally invasive techniques, such as endoscopic or precision microsurgery, there is an incision involved in laser spine surgery, too. There is also a greater risk of damaging nerves or tissue with a laser, and most importantly, there is no scientific evidence to suggest laser spine surgery is in any way superior to a non-laser approach.” One of the most common spinal procedures to relieve neck or back pain is a lumbar discectomy. The surgery is minimally invasive and is typically done with an endoscope or a microscope. Through an incision less than an inch long that goes through the skin and into the muscle, the surgeon resects the source of compression — herniated disc material pressing on a nerve or the spine. This particular procedure is often marketed as a “laser discectomy”, and it is a common misconception that the entire procedure is done with a laser. Surgical instruments are still required. “A laser is a focused beam of light,” Dr. Kurpad said. “In this case, the laser is only shrinking the source of the compression.” Proponents of laser spine surgery say the procedures allow the patient to go home the same day, with minimal downtime and a less than 1-inch incision. But, an endoscopic or microscopic spine surgery is also an outpatient procedure. The incision is approximately the same size and the recovery time is the same as laser spine surgery (return to work in one week to 10 days). A critical difference between a laser approach and an endoscopic or microscopic approach is the physician’s ability to visualize structures in and around the spine. “The purpose of the laser is to burn the source of compression the beam is directed at,” Dr. Kurpad said. “But it is not precise because the beam cannot maneuver around nerves or tissue — structures we need to protect. In inexperienced hands, the risk of an adverse event during laser surgery is greater, and there is no clear benefit to this approach.” Is laser spine surgery superior to a non-laser approach?All you need to perform spine surgery is a medical license — you don’t have to be a trained surgeon. This can make the consequences of adverse effects even more serious. According to a 2016 study published in Surgical Neurology International, more and more frequently, the physicians performing laser disc decompression surgeries are not surgeons, but instead, “pain management specialists” like anesthesiologists, radiologists or physiatrists. The researcher says “the laser vaporizes/shrinks a small portion of disc tissue that lowers intradiscal pressure/volume, and thereby provides symptomatic relief but the surgeries were “ineffective for managing acute/chronic pain in these patients.” Without surgical training, the pain management specialists were unable to address surgical complications.¹ In a different study, the researcher wrote “to date, laser discectomy may be more effective in attracting patients than treating them.”² In one study, outcomes were seen to be noninferior compared with conventional surgery; however, the study did show a higher speed of recovery with the conventional surgery and the number of reoperations was significantly reduced with conventional surgery.³ There are no randomized controlled trials that prove the superiority of a laser approach over a non-laser approach.
The body has natural mechanisms to reduce the amount of compression in the spine. With time, disc herniations can become dehydrated and shrink in size (from the size of a grape to the size of a raisin). “Surgery is not the only option, and it is not always the best option,” Dr. Kurpad said. “It is important to see a specialist who can help guide you to the approach that is best for you.” Learn more about Froedtert & MCW SpineCare clinics.SpineCare
Randomized Controlled Trial Low-level laser therapy for acute neck pain with radiculopathy: a double-blind placebo-controlled randomized studyLjubica M Konstantinovic et al. Pain Med. 2010 Aug. AbstractObjective: The objective of the study was to investigate clinical effects of low-level laser therapy (LLLT) in patients with acute neck pain with radiculopathy. Design: Double-blind, randomized, placebo-controlled study. Setting: The study was carried out between January 2005 and September 2007 at the Clinic for Rehabilitation at the Medical School, University of Belgrade, Serbia. Patients and intervention: Sixty subjects received a course of 15 treatments over 3 weeks with active or an inactivated laser as a placebo procedure. LLLT was applied to the skin projection at the anatomical site of the spinal segment involved with the following parameters: wavelength 905 nm, frequency 5,000 Hz, power density of 12 mW/cm(2), and dose of 2 J/cm(2), treatment time 120 seconds, at whole doses 12 J/cm(2). Outcome measures: The primary outcome measure was pain intensity as measured by a visual analog scale. Secondary outcome measures were neck movement, neck disability index, and quality of life. Measurements were taken before treatment and at the end of the 3-week treatment period. Results: Statistically significant differences between groups were found for intensity of arm pain (P = 0.003, with high effect size d = 0.92) and for neck extension (P = 0.003 with high effect size d = 0.94). Conclusion: LLLT gave more effective short-term relief of arm pain and increased range of neck extension in patients with acute neck pain with radiculopathy in comparison to the placebo procedure. Similar articles
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Does laser treatment work for pinched nerve?In addition to back and neck pain, cold laser therapy can relieve pain and speed recovery for problems as diverse as TMJ, pinched nerves, and herniated discs.
What surgery is done for pinched nerve in neck?Anterior cervical diskectomy and fusion, or ACDF for short, is a type of surgery that's done to treat a pinched nerve or spinal cord compression. The surgeon will make the surgical incision at the front of your neck.
Can neck surgery be done with laser?Thanks to technological and medical advances, physicians are now able to treat a number of common back and neck conditions with laser spine surgery, which is often less painful and heals more quickly than traditional open spine surgery.
How long is recovery from surgery on pinched nerve in neck?Most people are able to return to a desk job within a few days to a few weeks after surgery. They may be able to return to full activities by 3 to 4 months, depending on the procedure. For some people, healing may take longer.
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Laser surgery for pinched nerve in neck
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