” Laser ” Surgery for Low Back Disc Bulges
Laser is arguably (like stem cells) a cool word. Who could forget Dr. Evil’s infamous “Laser” talk with hand parentheses! We often get asked by patients about “Laser” (hand parentheses included) low back surgery. We tell them that when you have a disc bulge pressing on a nerve, removing disc tissue is removing disc tissue, it doesn’t matter how it’s removed: with a scalpel, a surgical device, a needle based coblation tool, or a “Laser”. The removal of the back wall of the annulus fibrosis (the thick outer covering of the disc) weakens the back part of the disc and thus makes the disc more likely to fail. Discs don’t heal well, so unlike some areas of the body where removing a small amount of tissue might cause more to grow back, this generally doesn’t happen in the spine. In addition, disrupting important blood supply for this part of the outer disc can also have long-term adverse consequences on the long-term health of the disc. So using a laser to vaporize this disc tissue is no different than using anything else to remove it, the tissue is still removed and the disc is weakened. Our approach (and we believe the approach of all future biologic applications for the disc) is to rebuild the back of the disc by trying to get it to heal. We have seen evidence on MRI of healing of low back discs and reduction in the size of disc bulges. In summary, “Laser” low back surgery is all the rage, but still involves weakening the structure of the disc.