Everything You Want to Know About Laser Back Surgery

Laser back surgery is a form of spinal operation that differs from other approaches, such as traditional open back surgery and minimally invasive spine surgery (MISS).

Read on to understand more about laser back surgery, its possible advantages and disadvantages, and alternative treatment choices.

How does laser back surgery differ?

There are several surgical approaches to the spine, including the conventional open technique, MISS, and laser-guided procedures. Below we outline what sets each method apart.

Traditional

In conventional back surgery, the surgeon creates a long incision in the back. Muscles and other tissues are moved aside to reach the diseased segment of the spine. This approach typically involves a lengthier recovery and carries risk of soft-tissue injury.

MISS

MISS involves a much smaller incision than traditional surgery. Surgeons use a tubular retractor to form a narrow channel to the surgical site. Specialized instruments are then introduced through this tunnel during the operation.

Because MISS is less invasive, it often results in reduced postoperative pain and a quicker recovery period.

Laser

In laser back surgery, a fine fiber-optic laser is used to remove part or all of the central nucleus of a herniated intervertebral disc to relieve pressure on the spinal cord and adjacent nerve roots. Unlike other methods, laser surgery is suitable only for particular scenarios, for example when nerve compression is the main source of pain. Laser techniques are not appropriate for every person with low back pain.

Laser procedures and MISS are frequently confused or thought to be identical. Part of the confusion stems from the fact that MISS may occasionally, but not always, use laser technology.

Laser back surgery has been slow to become widely accepted by spine surgeons, many of whom achieve satisfactory results with MISS. A 2021 review of 58 laser back surgery cases reported good outcomes in carefully selected patients with back pain.

What to expect

When a nerve is compressed it can produce pain and discomfort.

In the spine, issues such as a herniated disc or a bone spur frequently cause nerve compression. Sciatica is one example, where the sciatic nerve becomes compressed, causing pain that radiates from the lower back into the leg.

Lasers can be employed to decompress nerves with the goal of pain relief. The procedure is performed under local anesthesia, which numbs the skin and nearby back muscles. Sedation may also be offered.

One well-studied laser technique is percutaneous laser disc decompression (PLDD). In PLDD, a laser is used to remove disc material that may be pressing on a nerve and causing pain.

During PLDD, a thin probe housing the laser is advanced into the nucleus of the affected disc using imaging guidance. Laser energy is then applied to selectively vaporize disc tissue that’s compressing the nerve.

Benefits

An advantage of laser back surgery is that it is less invasive than traditional open surgery. It can often be done in an outpatient setting under local anesthesia. In many respects, it resembles MISS.

There is limited data comparing the overall effectiveness of laser back surgery to other surgical options.

One 2017 study compared PLDD with microdiscectomy and found similar outcomes over a two-year follow-up period.

However, the authors of that PLDD study considered subsequent follow-up operations after PLDD to be part of the expected course when evaluating outcomes.

Drawbacks

Laser back surgery is not recommended for certain problems, such as degenerative spinal disorders. More complex spinal pathology usually warrants a conventional surgical approach.

One drawback of laser procedures is the potential need for additional surgery. A 2015 study reported that microdiscectomy had fewer reoperations compared with PLDD.

Additionally, a 2017 meta-analysis of seven surgical techniques for lumbar disc herniation ranked PLDD among the less successful options and middle-of-the-pack for reoperation rates.

Side effects

As with any operation, laser back surgery carries risks and potential complications.

A key potential complication is collateral tissue damage. Because heat is produced by the laser, nearby nerves, bone, and cartilage may be harmed.

Infection is another possible complication during probe insertion if sterile technique is inadequate. Sometimes surgeons will give prophylactic antibiotics to reduce infection risk.

Recovery time

Recovery varies by person and by the exact procedure performed. Some patients resume normal activities quickly, while others need longer convalescence. How does recovery after laser back surgery compare to other approaches?

Traditional open back surgery typically requires a hospital stay and a recovery that can span many weeks. The Johns Hopkins Spine Service suggests patients undergoing traditional spine operations may miss 8 to 12 weeks of work.

By contrast, MISS is commonly an outpatient procedure, allowing discharge the same day. On average, those who have MISS may return to work in roughly six weeks.

Although you may have read that laser back surgery leads to a quicker recovery, research comparing recovery durations is sparse.

Indeed, the 2015 study mentioned earlier found faster recovery after microdiscectomy than after PLDD.

Cost

There is limited information about the cost and cost-effectiveness of laser back surgery versus other spinal procedures.

Expenses vary by location and provider. Insurance coverage depends on the insurer and your specific plan. Before any surgery, check with your insurance company to determine whether the procedure is covered.

Alternative treatments

Many people with back pain do not require surgery. In fact, unless there is progressive neurological decline or loss of bowel or bladder control, doctors typically advise trying conservative treatments first.

There are numerous nonoperative options to help with pain from conditions like sciatica, including:

Medications

Your physician can prescribe different drug therapies for pain control. These might include:

• nonsteroidal anti-inflammatory drugs (NSAIDs)
• muscle relaxants
• short-term opioid pain relievers (for brief use only)
• tricyclic antidepressants
• anticonvulsant medications

Steroid injections

Corticosteroid injections placed near the affected nerve can reduce inflammation and relieve pain. Their effect is usually temporary, often lasting a few months, and the number of injections you can receive is limited because of side-effect risks.

Physical therapy

Physical therapy helps build strength and flexibility and may reduce the chance of recurrent problems. It typically includes targeted exercises, stretches, and posture correction.

At-home care

Home remedies such as heat or cold packs can soothe pain. Over-the-counter NSAIDs like ibuprofen can also be helpful for many people.

Alternative medicine

Some individuals turn to acupuncture or chiropractic care for back pain relief. If you pursue these options, seek care from a licensed and experienced practitioner.

For patients exploring options, discussing treatments such as laser gum surgery may be unrelated to spinal care, but speaking with your physician about all available modalities ensures you choose the most appropriate plan for your needs.

The bottom line

Laser back surgery uses a focused laser to remove disc tissue that may be compressing or irritating a nerve. It is less invasive than traditional open surgery but can be associated with the need for additional follow-up operations.

To date, limited definitive evidence shows that laser back surgery is superior to other surgical techniques, and cost-effectiveness comparisons are lacking.

If you are considering back surgery, review all options with your doctor so you can select the treatment that best fits your situation.