When is Laser Spine Surgery Necessary?
According to the International Society for Minimal Intervention in Spinal Surgery (ISMISS) and the International Society of Orthopedic Surgery and Traumatology (SICOT), laser spine surgery (or specifically endoscopic spinal surgery) is the “gold standard” for the surgical treatment of back pain, lumbar, thoracic, and cervical disc herniations with radicular symptoms. The treatment of choice for these conditions is microsurgical microscopic disc surgery, or simply microdiscectomy.
Other indications for minimally invasive or endoscopic spinal procedures are lateral spinal canal (recess) and foraminal stenoses with radicular (or nerve root) symptoms, and degenerative facet joint cysts with radicular symptoms.
Imaging techniques are particularly helpful in determining which cases are amenable to endoscopic spine surgery. These include up-to-date MRI and CT scans, specifically those using fluoroscopy-guided, contrast-enhanced diagnostic injection. Neurophysiologic studies may also help in evaluating nerve damage or in detecting other compressed nerves.
Among the contraindications for endoscopic spinal surgery specified in the 2008 Guidelines of ISMISS are…
- Clinically relevant instabilities
- Central spinal canal stenosis
Relative contraindications include large disc herniations with cauda equina syndrome or a fresh motor deficit. Adequate decompression may not be achieved unless the interlaminar windows are large and there is good interlaminar endoscopic access.
The Importance of Physician-Competence in Conducting Laser Spine Surgery
Laser spine surgery is not without its complications, even though their occurrence is not as great in comparison with major open surgeries. Same as with major operations, according to spine institute the doctor should anticipate possible complications with the procedure, such as some bleeding, infection, dural tears and nerve root damage.
Laser Spine Surgery – What to Expect?
ISMISS recommends that surgeons should have enough experience in traditional spinal surgery techniques before getting training in endoscopic procedures. Spine surgery — whether done traditionally or via an endoscope — is still a delicate procedure and requires years of hands-on experience. ISMISS has still noted grievous errors in the operative approaches of novice surgeons in both traditional and endoscopic procedures, such as operating on the wrong side or operating on the wrong level, thus not giving any treatment to the patient at all.
Also, even though minimal complications are expected with this procedure, a surgeon should be prepared to perform major surgery in the event that the patient’s condition is more serious and could not be handled by laser spine surgery.
