Is LASER surgery a back surgery alternative? The picture above of Dr. Evil is arguably the world’s most famous air quote. He does this as he describes the laser he has placed on the moon to disintegrate the earth. I feel a little like making this air quote as I speak to some patients about “LASER” Spine surgery as an alternative to traditional back surgery. This LASER surgery is widely promoted as the holy grail for patients with disc problems, yet I continue to see many patients who benefit about as much from this expensive surgery as they do with a traditional low back surgery, which is not much. I recently saw a patient from the south who underwent laser spine surgery as an low back surgery alternative, only to get much worse. While this can happen to any patient, I was curious to see how the surgery was documented via the notes. Looking at these operative notes, the disc was bathed in high dose steroids as the surgeon exited the area. The goal of this seems to be to reduce local swelling caused by the high temperatures generated by the LASER. The problem is that the outer disc is composed of fibrocyte cells that make fibrous tissue. For the surgery to be successful, these fibrocytes and other fibroblast cells in the back of the disc need to heal the area cut out by the LASER. What happens to fibroblasts when they’re blasted by high doses of steroids? They die off, just like many cells that are treated with high dose steroids. Since the goal of the surgery is to “repair” the disc, adding high dose steroids is likely doing the opposite, reducing the already weak healing properties of the disc. So why use a LASER at all? Your guess is a good as mine, as I can’t come up with a reason why a LASER would be any better than a scalpel or other cutting device, other than it’s sounds really cool. The upshot? LASER in my opinion isn’t a viable alternative to traditional low back surgery. In fact, I now have to give the above air quote when I talk about “LASER” spine surgery with my patients. Save your money and seek out non-surgical alternatives.
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