Laser Spine Surgery

Laser Spine Surgery for Spinal Stenosis?

2010-09-08T01:55:00.000-07:00

Q: My mother suffers from spinal stenosis in her lumbar and cervical spine. She has balance issues and falls often, and the last time she broke a bone in her right hand. Medications haven't worked, and at 78 years old, she is in constant pain. Open back surgery is not an option at this time. What do you know about laser spine surgery? Would that be a possibility for her?
— Nancy, Pennsylvania

A:Whether laser spine surgery would be beneficial for your mother's (or anyone else's) spinal stenosis, depends on the following factors:

What is causing the stenosis?
What are the specific symptoms, including their duration and evolution?
What does the physical examination show?
What do imaging studies show?
What is the exact location of the stenosis?
What structure/s is/are being compressed?
What treatment has been received, and what was the response?

To fully understand treatment options, I think some background information on spinal stenosis would be helpful:

Spinal stenosis is a narrowing of the spinal canal, which is a tube created by the vertebrae. In the cervical spine (in the neck), the spinal canal contains the spinal cord and part of the nerve roots that form the nerves of the arms. In the lumbar spine (in the lower back) the canal contains the nerve roots for the pelvis and legs. Lumbar spinal stenosis usually occurs after age 50 and may affect up to 9 percent of those over age 70. Cervical spinal stenosis is much less frequent.

The major cause of spinal stenosis is osteoarthritis (OA), the most common type of degenerative arthritis. Osteoarthritis usually occurs after age 50, or in younger persons after a joint injury (this is known as traumatic arthritis and often seen in athletes). OA causes the formation of bony spurs (osteophytes) at the margins of joints and barlike osteophytes in the spinal canal, as well as degenerated discs. The discs are "cushions" interposed between the bones of the spine (vertebrae); they have a strong, fibrous outer ring with a soft, jellylike center. When OA causes discs to degenerate, "cracks" form in the fibrous ring, allowing the jellylike center to bulge (herniate) and press upon nearby structures -- including the spinal cord or nerve roots in the cervical spine, nerve roots in the lumbar spine, and ligaments in both locations. Disc degeneration can actually start in a person's late 20s or 30s. In addition, the strong ligaments in the spine may thicken, contributing to the pressure on the spinal cord and nerve roots. Rheumatoid arthritis of the upper cervical spine can also cause pressure through slippage of the vertebrae.

The symptoms of spinal stenosis depend on the location where the spine has narrowed and which structures are being compressed. Cervical spinal stenosis is more dangerous than lumbar stenosis, because the cervical spinal cord and its blood supply could be compressed. This may result in exaggerated and abnormal reflexes, weak and spastic muscles, limb pain, numbness, difficulty walking, loss of bladder and bowel control, and even paralysis of the legs (paraplegia), or of all four extremities (quadriplegia).

Lumbar spinal stenosis may cause pain, muscle weakness and numbness, especially when standing or walking, and decreased reflexes. Muscle weakness and numbness may be relieved by sitting or lying down.

Physicians who can best diagnose spinal stenosis include neurologists, neurosurgeons, rheumatologists, rehabilitation specialists, and spine orthopedic surgeons. The best diagnostic study is magnetic resonance imaging (MRI), which can pinpoint the location of the stenosis and the nervous system structures affected.

If there are no symptoms, the patient should be followed up every three months or so. In cervical spinal stenosis with mild symptoms, a cervical collar may be worn and might be of some help. A cervical collar is worn around the neck and provides stability: It may be made of plastic, lined with a soft material, but it is rigid and some patients do not tolerate it well. Another type of cervical collar is made of firm, but soft, foam enveloped in material, and it is better tolerated.

Epidural steroid (cortisone-like) injections for lumbar spinal stenosis may offer temporary relief for a few months. With severe symptoms, however, the most effective treatment of cervical or lumbar stenosis is surgery by a neurosurgeon or a spine orthopedic surgeon. Assessment of heart and lung function before an operation is very important. Laminectomy is the usual type of surgery performed, but if there is also spine instability, fusion is needed. Over time, symptoms may recur in a small number of patients. If the spinal stenosis is in a very limited area, the surgeon may be able to perform arthroscopic surgery, through two or three small incisions on the back, avoiding a long incision. The choice of open or arthroscopic surgery depends on the actual anatomic configuration and extent of the stenosis, and on the judgment of the operating surgeon.

Laser spine surgery is useful for removal of herniated discs but cannot be used for removal of osteophytes causing spinal stenosis.

What Is Laser Spine Surgery?

2010-09-07T13:23:00.000-07:00

Laser spine surgery involves the use of laser, which is actually a ray of light that has a high fusion of energy. The damaged tissues are cured when the laser beam transfers its energy to the affected part and cures any kind of problem such as eruptions or marks, etc. Lasers are produced through the use of a material whose properties support the creation of and magnification of light. This light is then reflected back through this material using two mirrors. Laser spine surgery is the most generally used surgery.

It is important for the doctor to see that he makes use of lasers sensibly and avoids any kind of risks linked with it. Laser is used by surgeons to make incisions in the body. Irritation may result after laser spine surgery, which can be treated through the use of topical creams. Laser spine surgery involves an slit in the body through the use of laser and to reach the pretentious area.

Patients usually rely on the laser technique to cure all their back problems since they observe lasers to be more effective in spine surgical treatments. However, moderately, much more cases of laser spine surgery are on record in which patients have complained about the persistence of pain even after substantial time had elapsed from the completion of laser spine surgery.

Based on this experience, patients understand that their illness requires other treatment options. The major problem that arises in laser surgery is limited exposure and lesser ability to deal with the cause of pain. It also fails to remove the bone that is the cause of pressure on the nerve root and leads to pain. Lasers are able to cut through disc tissues, It is also easier and much more consistent through the help of lasers to grab the fragment of the disc and remove it to prevent compression of the nerve.

As discs are located nearby to the nerve root there are chances of damage to the nerve root due to the laser beams inadvertent incidence on the nerve root. Lasers also fail to cut through bone and as a result all problems related to the spine cannot be treated through the use of laser spine surgery.

Laser spine surgery is also known as microdiscetomy. This procedure is minimally invasive. The laser fiber is passed through the use of a needle, and is placed in the pretentious disc to vaporize its inner core.

One advantage of laser spine surgery is that the patient, who undergoes the surgery, does not have to suffer as much pain as he/she would have to tolerate in the case of other surgical methods. Another plus point of laser spine surgery is that it does not demand much of your time and is completed almost within no time.

The patient is back to the normal work routine the very next day. These advantages are available, since laser spine surgery is minimally invasive.

What Is Laser Back Surgery?

2010-09-07T13:21:00.000-07:00

Spine or back is an tremendously sensitive organ in the human body that requires good care and attention so as to remain healthy. Or else, one might need to face the risk of going under the surgeon's knife. For years, surgeons have practiced back surgery as a lengthy and painful procedure that requires large incisions to be made on the back. As a result of this invasive treatment, patients had to remain hospitalized for weeks. Many times, patients also had to suffer an extensive and painful treatment program so as to recover from the effects of surgery.

Modern medical science has come a long way since then. With the growth and use of Arthroscopic or Laser back surgery, treating spinal disorders is no more a difficult process both for the doctor as well as the patient.

Arthroscopic or laser therapy was first used in the 1970s while operating on knees and shoulders. This treatment involves use of arthroscope, a tiny tube that is inserted into the body through a small incision made around the area that needs to be treated. Over this small tube, a series of large tubes are serially placed. The last tube that enters the hole is of the size of a pencil. The entire objective of this procedure is to open the skin and the internal muscle tissues rather than tearing them away. Once the last tube is inserted, all the other tubes are removed. Through the final transparent working tube are inserted fiber optic cameras, lasers, suction and other microscopic instruments using which the entire operation is performed by the surgeon. All these instruments can be automatically operated and are connected to a robotic arm.

At present, there are four different arthroscopic or laser back surgery procedures being practiced around the world. These include:

Foraminotomy:
Used for treating conditions such as nerve root compressions, foraminal stenosis, pinched nerves, herniated discs, scar tissue formation, spinal arthritis and sciatica.

Laminotomy:
This procedure is used for removing neural compression and other conditions that can lead to spinal stenosis. This procedure is also used for herniated discs, bone spurs (osteophytes) herniated discs, scar tissue formation and spinal arthritis.

Percutaneous Arthroscopic Disectomy:
In this procedure, pressure that develops on the spinal cord and nerve roots is removed surgically using a laser.

Facet Thermal Ablation:
This procedure is used in the treatment of facet disease. Also, conditions such as facet joint syndrome, facet hypertrophy, facet arthritis, and degenerated facet joints can be treated using this procedure. In this surgery, a surgeon uses a laser beam for destroying a spinal nerve that causes pain in the joints.

Laser back surgery is mostly an endoscopic procedure that is advantageous in many ways. Most importantly, this procedure neither involves any large incisions on the skin nor requires the administration of general anesthesia. The entire surgery is performed through a small hole and gets completed within one hour under the influence of contained anesthesia. In this procedure, there is minimal amount of muscle and other soft tissue damage.

Other benefits include less bleeding during surgery, minimal amount of blood loss at the time of surgery, less scar tissue formation and quick revival. Even the risks or complications are very low with laser back surgery. Also, the patient is not required to spend days and weeks in the hospital and undergo the postoperative discomfort.

Benefits of Laser Spine Surgery

2010-09-07T13:18:00.000-07:00

Spine surgery is done on the patients suffering from back ache or ache connected to the spine. There are 2 types of surgeries that can be performed on the spine; one is invasive and the other is laser. The traditional procedure required huge cuts and muscle gets torn. In this kind of a operation the need for anesthesia, time and healing are all required to a very high extent. Simply invasive surgical methods make use of tiny incisions done in the skin by which tiny, specific instruments are added.

These methods cause least injuries to muscle tissues. Less harm means less hurting and a short time of hospitalization. The healing time is less too. The spine surgery using minimal invasion can be undertaken on any part of the spine. Only some of the spine surgery makes use of the latest laser technology. A laser is made use of to remove or disconnect the tissue.

The causes for back pain can be numerous. The pain can be liberated from areas like arms, neck, legs and lower back the minute the cause for the same is known. The initial step in the surgery is to make specific incisions for accessing the affected region. The latest laser technology is used to make the opening.

The state of broken and inflamed discs can also be rectified with a laser treatment. The term used to depict the surgery undertaken to remove either a part or the entire inter-vertebral disc is called discectomy or microdiscectomy. Discectomy is the open procedure as well as microdiscectomy is the minimally invasive process to eliminate a ruptured or herniated disc. The inner most part of the disc is inserted with a lase fiber needle so as to make some space in it with the microdiscectomy procedure. The procedure used to operate on the split disc is Laminotomy. The tear in the disc leads to compression of the nerve roots. The covering of the nerve root called lamina is uncovered in this operation. The affected area is cut with the help of a laser beam.

A laser spine surgery is minimally invasive process to perform laser surgeries of spine. The method is one is that is least dangerous and has no blood loss due to least surgical cuts.

The laser spine surgery gives the benefit of minimum pain and the recovery is also faster. The Laser spine surgeries are utilized to cure disorders as failed back syndrome, sciatica, arthritis, radiculopathy, foraminal stenosis and nerve entrapment conditions.

The patient is put under least sedation or localized anesthesia during the laser spine operation. Techniques such as microscopic, arthroscopic and endoscopic are used in such surgeries. The x-ray guidance is taken to put in a needle in the herniated disc. The disc area is distanced with the use of laser energy pushed through an optical fiber needle. The part of the spine is spawn to create a little vaccum making the swelling and pain to come down. The upshot is almost immediate. The care subsequent to the surgery is to be taken only for twenty four hours of bed rest and left with a small bandage.

Benefits of Laser Spine Surgery:

Minimally invasive
No scarring
No hospital stay
No cutting
No general anesthesia
Short recovery period
Costs 1/3 - 1/2 of normal surgery.

Risks of Laser Spine Surgery

2010-09-07T13:16:00.000-07:00

Since the 1980s, laser spine surgery has been touted by many as the safest, most effective noninvasive means of operating on the spine. Doctors at the Mayo Clinic report that the procedure has never been studied in a controlled, blind research trial, allowing for no scientific proof of its efficacy. They continue to report that most surgeons do not use laser spine surgery because there are no clear benefits over traditional spine surgical techniques. Those who do perform the operation warn patients of inherent risks of laser spine surgery, however.

Infection
As with any surgery, patients receiving laser spine surgery run the risks of infection at the site of the incision. Proponents of the procedure claim that the risks are reduced compared to open back procedure because the incision is much smaller. Risks can be especially high for wound and spinal infections because the procedure is performed on an outpatient basis, many times in treatment rooms versus antiseptic operating facilities.

Mistakes
Consultants at Spine Surgery report there is a high risk of patients having to undergo additional spine surgeries to repair damage that was not treated in a laser surgery. Endoscopic spine surgery leaves patients especially vulnerable to repeat open surgeries. Though lasers usually are tested for accuracy, any amount of deviance from proper placement of the laser can result in additional complications that could leave patients in worse condition than before they underwent the laser procedure. Laser malfunctions are a common cause for concern when patients consider the risks of laser surgery on the spine. Doctors at Atlantic Spinal Care report that because laser surgery is so highly specialized and requires intensive training, patients do run the risk of being treated by an insufficiently trained provider who could cause damage by tearing the spinal cord membrane or damaging the nerves.

Back Pain
Doctors at the West Texas Spine Center have been performing laser spine surgery since 2004, reporting great success with the procedure. They do, however, warn patients that laser spine surgery carries most of the same risks as traditional open spine operations. Patients may leave the operation with continued or additional pain and need to go through more surgeries. There is an inherent risk of spinal fluid leakage, numbness and spinal instability. Bleeding also can be a risk when undergoing laser or any other spine surgery. By using technologically advanced laser equipment, there is no option for cutting through the bone if necessary during the surgery. Lasers only cut through tissue.