Lasers

Abstract

Lasers are often portrayed as a “miracle cure” for many painful spinal conditions. In reality the use of laser is only a portion of the overall procedure and is not typically the determining factor in the overall success or failure of the treatment. Lasers are simply one of many tools at the disposal of spine surgeons to cut, shrink, coagulate, or remove tissue including bone. In minimally invasive spine surgery, especially endoscopic spine surgery, there is a limited working area for tools and lasers can effectively treat tissue without obscuring the surgeon’s view. The 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. In spine surgery, lasers are most useful for endoscopic lumbar discectomies, foraminal decompression (foraminoplasty), and facet nerve ablation. Potential complications of lasers include neurologic injury, vertebral osteonecrosis, and aseptic discitis. These complications can be avoided by selective targeting of the laser beam to avoid focusing it directly on a nerve or the vertebral endplates and avoiding prolonged continuous firing which can cause heat buildup in adjacent tissue.