Mayfield does not endorse or perform laser spine surgery

Lasers have been used in surgical procedures for several decades.  In fact, Mayfield neurosurgeons pioneered their use to vaporize previously inoperable brain tumors in the 1980’s.  After all of this time, however, there is still no scientifically proven benefit for spine disc removal by laser, as compared to other minimally invasive spine surgical techniques that our surgeons perform.

According to the North American Spine Society’s 2014 recommendations, "Due to lack of high quality clinical trials concerning laser spine surgery of the cervical and lumbar spine, it cannot be endorsed as an adjunct to open, minimally invasive, or percutaneous surgical techniques." 

It is no coincidence that more than 95 percent of minimally invasive spine procedures in the United States are performed without the use of laser. 

Still, laser spine surgery is a term that has been marketed well, and patients sometimes inquire about it as a potential option.  Promoters often call it noninvasive and risk free.  However, these spine procedures actually involve surgery.  They require incisions to allow access to the spine, and the laser is often only used to remove the soft tissues over the spine.  Bone and ligament are removed using more conventional surgical techniques.

Figure 1
Figure 1. In minimally invasive surgery, a series of progressively larger tubes are used to create a small tunnel through the muscles to the bone and disc.

The approach used in laser spine surgery is the same as that used in conventional spine surgery.  Both can be done with minimally invasive techniques (figure 1) and both have similar recovery times. Both involve a laminotomy or laminectomy to gain access to the disc.  Once the disc is visualized with either a microscope or endoscope, it is removed. This is where the difference occurs:  the laser vaporizes the disc with laser energy, or in some cases, a laser is used just to seal the edges after the disc is removed conventionally.  With conventional surgery, the disc is surgically removed with surgical instruments (figure 2).

Figure 2
Figure 2. The herniated disc material compressing the nerve root is removed with surgical instruments

When a laser vaporizes a disc, it obliterates tissue with intense heat. During this process, the heat can be transmitted to nearby anatomical structures and tissues and can damage nerves. In another drawback, the laser’s straight beams of light that cannot bend and are not easily navigated. By comparison, surgeons using scalpels with microscopes or endoscopes can easily navigate around healthy structures to find and fix a spinal problem.

It is no coincidence that more than 95 percent of minimally invasive spine procedures in the United States are performed without the use of laser.  For these reasons, Mayfield Clinic surgeons do not endorse the use of lasers in spine surgery.

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Revised: October 10, 2014