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Minimally Invasive Spine Surgery pp 127–137Cite as

Lasers

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Abstract

Lasers are often portrayed as a “miracle cure” for many painful spinal conditions, and many patients seek “laser surgery” to treat their spine problems. The reality is that in most instances the laser is an alternative tool replacing an equally effective mechanical or electrothermal instrument. Lasers are simply one of many tools at the disposal of spine surgeons to cut, shrink, coagulate, or remove tissue including the bone. In minimally invasive spine surgery, especially endoscopic spine surgery, there is a limited working area for tools and lasers that can effectively treat tissue without obscuring the surgeon’s view. Lasers do have the advantage of being very small and precise tools, thus allowing a truly minimally invasive surgical approach/exposure to limit iatrogenic morbidity. The holmium:yttrium-aluminum-garnet (Hol:YAG) laser is the most commonly used laser in spine surgery. It is delivered through small fiber optics and has different probes with both side-firing and steerable straight-firing capabilities to treat even hard-to-reach areas within the surgical view. The treatment area is very precise, and lasers can be safely used in close proximity to sensitive structures such as nerve roots. The surgeon can see exactly where the laser beam is aimed and focused at prior to turning it on. The probe can even be touching the nerve while aiming the beam away from it. This is compared to drills that could jump/bounce off of the bone and radio-frequency probes that cannot control the direction of their thermal energy. In spine surgery, lasers are most useful for endoscopic lumbar discectomies, foraminal decompression (foraminoplasty), facet nerve ablation, and debulking spinal tumors. Potential complications of lasers include neurologic injury, vertebral osteonecrosis, and aseptic discitis.

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Author information

Authors and Affiliations

  1. Department of Orthopedic Spine Surgery, Desert Institute for Spine Care, Phoenix, AZ, USA

    Christopher A. Yeung & Anthony T. Yeung

Authors
  1. Christopher A. Yeung
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  2. Anthony T. Yeung
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Corresponding author

Correspondence to Christopher A. Yeung .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Frank M. Phillips

  2. Texas Back Institute Texas Health Presbyterian Hospital Plano Scoliosis and Spine Tumor Center, Plano, TX, USA

    Isador H. Lieberman

  3. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA

    David W. Polly Jr.

  4. Department of Neurological Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA

    Michael Y. Wang

Appendices

Quiz Questions

  1. 1.

    What is the most commonly used laser in spine surgery?

    1. (a)

      KTP

    2. (b)

      Nd: YAG

    3. (c)

      Hol:YAG

    4. (d)

      CO2

  2. 2.

    True or false: Lasers are useful in treating soft tissue, but not bone.

  3. 3.

    True or false: The use of lasers in spine surgery is only a recent phenomenon, is a gimmick, and is a result of the Internet and its ability for surgeons to attract patients with this high-tech procedure.

  4. 4.

    The many uses for lasers in spine surgery include the following:

    1. (a)

      Debulk metastatic tumors that are compressing the spinal cord

    2. (b)

      Remove the ligamentum flavum and bone to alleviate stenosis

    3. (c)

      Ablate small sensory nerves that innervate the facet joints

    4. (d)

      Assist in directly visualized disc removal during mechanical endoscopic discectomy

    5. (e)

      All of the above

    6. (f)

      None of the above

Answers

  1. 1.

    c

  2. 2.

    False. Lasers are capable of removing bone and are useful tools to complement other mechanical decompressive tools like burrs and Kerrisons.

  3. 3.

    False. It is true that there is a widespread promotion of high-tech surgical options on the Internet. This includes “laser surgery.” But lasers have been used in spine surgery since the 1980s and have useful, legitimate uses in MIS spine surgery.

  4. 4.

    e

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Yeung, C.A., Yeung, A.T. (2019). Lasers. In: Phillips, F., Lieberman, I., Polly Jr., D., Wang, M. (eds) Minimally Invasive Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19007-1_12

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  • DOI: https://doi.org/10.1007/978-3-030-19007-1_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-19006-4

  • Online ISBN: 978-3-030-19007-1

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