What is Laser Spine Surgery and Can it Help Me? | Podcast Episode 137

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are going to talk about quote unquote, laser spine surgery here in Tampa, Florida. There are television commercials, billboards and much more promoting laser spine surgery. We are going to talk a little bit today about my experience of what that means. What is the procedure, what can it do, what can't it do? And some very interesting points for you to be able to have good quality conversations with your patients who ask you about it. One additional point, this was last week was the first week this podcast broke over 12,000 downloads in a single week. So that is completely outrageous. Thank you for listening. Always open to feedback. So if you have not left us a rating or review on itunes, would greatly appreciate that that helps us reach more and more docs as well. But for today we were going to talk a bit about laser spine surgery. What does it mean, what does it do? What are the limitations so you can have good, high quality conversations with your patients? If you're out there, you probably have seen some television commercials and I practiced in some surgery groups, including one that did have some procedures in that category. So I'm gonna generally, and not about any specific group because there are a lot of groups doing similar type procedures. I just want to give you a foundational knowledge of what I saw from the inside again so you can have great conversations with your patients who ask, so what the heck is laser spine surgery and why the heck is it being promoted so heavily in the last few years? Let's start there. So laser spine surgery typically is actually what many practices are calling their minimally invasive procedures. So this is in stark contrast to a traditional open procedure in a hospital based setting. So let's break that down a little bit. Typically in most practices that are advocating for laser spine surgery, it is done in an asc, that's an ambulatory surgery center that is out there patient. Now, depending upon the state that means you can be there, you know, anywhere from four hours to 24 hours, but not overnight. An ASE or an ambulatory surgery center is typically where these type of procedures, these minimally invasive spine procedures are performed. And when we say minimally invasive, what does that mean? Well, that truly depends on who you ask. So there are some groups out there that I have seen that used to, I'm not exaggerating with this, they used to do 12 inch incisions, they pulled it down to 8 and they're calling it minimally invasive invasive surgery. There are other groups out there that do all of their procedures through incisions less than half an inch, and they're calling that minimally invasive surgery. So there is no, you know, absolutes with that. So if a group in your area is also advocating for minimally invasive surgery, which if they're talking about a laser type procedure, it usually falls under that bucket, there can be wide variation, so keep that in mind. Number one, minimally invasive surgery means different things to different people. So make sure that you are asking tough questions or your patients on what does that mean to the person saying it to them that there can be a wide, wide variation. Now, what does the incision size matter? Well, quite frankly, the size of the incision doesn't. But what does matter is what happens next. What I mean by that is this. When there's a large scale incision, usually that means that there's a substantial amount of muscle disruption. Right. If you're trying to visualize an area as a surgeon, you will make an incision on the skin. Let's use a lumbar spine for an example. You'll make an incision on the skin. Sometimes it's vertical, sometimes it's horizontal. And then you will have to pull back the muscle. Remember your multifidus, those erectors lay in the gutters, you know, of the spine, between that spinous process and those transverse processes. So a lot of times those muscles are peeled back, ripped away, cut, however you want to describe that, to gain access to the lamina for a decompression or a variety of procedures that way. Whereas in a minimally invasive procedure, typically the goal is to spread the muscle fibers and, or use an endoscopic tube. So think of that tube. If you think about a knee surgery maybe 10 or 15 years ago, and everybody's using these tubes the size of a thumb, perhaps 15 millimeters, 16 millimeters in width or dimension. You know, that is where minimally invasive surgery or the portal by which minimally invasive spine surgery typically takes place, is through an endoscopic tube that allows direct visualization of the tissue without necessarily having to rip and tear all the muscle away to be able to get down to the backside of that lamina. Now, when we again, as we talked about at the top, well, where's the laser come into play? Lasers in a surgical context specifically related to musculoskeletal conditions are typically good for cutting, cauterizing, or vaporizing soft tissue. That's ligament, that's cartilage, fascia, et cetera. A laser used on in spinal surgery is almost never I will go there and say never utilized to take care of osteophytes or bony protuberances or bony obstructions. The amount of power generated by the laser to cut bone would be so great you destroy everything else around it, which would of course not be good. Right. So lasers are great when they're used for soft tissue of the spine. Now, typically when you think of a laser as well, I want you to keep in mind, and again, there are varying groups doing varying types of things out there. So I'm using generalities. The lasers are very commonly used similar to a soldering iron. So I don't want you to think of it like a gun, like it's shooting a laser beam out. It is much more like a soldering iron. So it's the touch of that laser to the tissue as you can now probably start to visualize kind of cuts or cauterizes or vaporizes the tissue depending upon the amount of power, let's say going through the device at that moment, which is controllable. So a lot of times, let's go full circle here. A lot of times. Many groups promoting a laser type spine surgery are often doing minimally invasive outpatient procedures that typically involve less muscle disruption than a traditional open procedure. So keep that in mind. And it's usually done through smaller incisions rather than larger incisions. That's just the scope of the work. Right. When you use a small incision, if you're using an endoscopic tube, you don't need to open the person up very much. You'll have everything you need with just an inch or so of space. So that is a very, very basic breakdown of typically what's associated with a laser type procedure. Now, also keep in mind there are some crossover in terms of terminology with some pain management groups that talk about laser type procedures and they may actually be doing facet ablations or RFAs with a laser type device, simply ablating the nerves within the facet jo and not necessarily going all the way to a decompression type procedure. So again with all of this, there is a lot of variation. So you have to be able to ask informed questions. What is the exact procedure that they are doing? A laser spine procedure is not a procedure type. That's a marketing term designed to get somebody to pick up the phone to call in. But the second question always has to revolve around what's the pathology they're attempting to treat and what is the type of procedure that they are trying to do? Is it a laminotomy, Is it a laminectomy? Is it a foraminotomy? Are they going all the way towards a disc replacement or perhaps even an outpatient minimally invasive fusion? Those are all things that are on the table. And again, quite often many groups utilize the laser word to as a marketing technique. There are many groups that utilize the laser that very advocate for it quite heavily, that utilize it only in a minority of the procedures they perform. And that's not a bad thing necessarily. There are many groups out there doing fantastic minimally invasive work with the spine. For those patients that are unable to get well, conservatively and or have some sort of red flags, hey, there's a time and a place for it. And the laser doesn't need to be used every time. Again, if somebody has big osteophytes obstructing a lateral recess or a foraminal canal, a laser ain't gonna do squat for it. You need to be able to have a rongeur, a bur. You need to be able to take those bony protuberances down. And there's only a couple ways to do that. A rongeur and a bur are two of the best ways to do it. A laser ain't gonna cut it. So when you again, when patients ask you about laser based procedures, are they good? Are they not good? Really? Hopefully this gives you a nice foundation and really it's about asking further questions. What's the pathology? What's the exact procedure type that they are looking to do? Is it outpatient or inpatient? And is their insurance covering this or not covering it? These are good questions to ask and to get good answers because this will help you help your patient, guide them to the best place to go for their care. And again, any group that these individuals, your patients, your community, perhaps even a friend or neighbor are asking you about. With all of this, in the absence of red flags, these people need to be in your practice first undergoing chiropractic care. And any practice worth their salt is going to encourage their patients to certainly go through an extensive amount of conservative care before even entertaining the idea of doing a surgical procedure. Laser or not. Minimally invasive or not, conservative care absolutely needs to come first. But keep in mind as your patients ask you questions, hopefully this will give you a good opportunity to answer them in maybe a little bit better way than before you listen to this podcast. I certainly hope. If you have any additional questions, feel free to hit me up Jeff at the Evidence Based Chiropractor. I'll be happy to answer them. And that is all for this week. I hope you have a fantastic week in practice.

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