Patients’ Guide To

Laser Spine Surgery

For decades, spine surgeons have used large incisions to treat spinal conditions. Large and invasive incisions necessitate patients be hospitalized and includes extensive rehabilitation and a lengthy and painful recuperation. Since the early 1970s, the arthroscope has been utilized to operate on knees and shoulders. The Laser Spine Institute applies this technology in outpatient surgical treatment of spinal disorders.

Through a tiny incision, the surgeon inserts a small tube followed by a series sequentially larger tubes placed one at a time over the first tube. This technique slowly and gently dilates skin and muscle tissues without tearing or cutting. The final tube is about the diameter of a standard-sized pencil (18 millimeters). Following placement of the final tube, the other tubes are removed. The surgeon operates through the small tube using a fiber optic camera, lasers, irrigation and suction, and other microscopic instruments.

Patient Benefits
This type of minimally invasive surgery is performed on an outpatient basis using a local anesthetic. Since general anesthesia is not used, surgical risks are less. Arthroscopic surgery and use of endoscopic tubes minimizes muscle and other soft tissue damage. Patient benefits include less bleeding during surgery, reduced postoperative discomfort, fewer and smaller incisions, minimal scar tissue formation, and a speedier recovery. In addition, patients can avoid hospitalization and spinal fusion.

Arthroscopic Spine Procedures
Depending on the patient’s diagnosis and surgical needs, sometimes more than one procedure is performed during a single surgery. There are 4 primary arthroscopic spine procedures:

1. Foraminotomy: A foraminotomy helps to relieve symptoms caused by nerve root compression. The foramen are passageways between the vertebrae through which nerve roots exit the spinal canal. A foraminotomy may be performed to treat foraminal stenosis, bulging or herniated discs, pinched nerves, scar tissue formation, bone spurs (osteophytes), spinal arthritis, or sciatica.
   
   During a foraminotomy, the surgeon arthroscopically removes bone and tissue compressing the spinal nerve root. The endoscope is slowly removed to allow muscles and other soft tissues to move back into place. Occasionally, a stitch or two is needed to close the small incision.
   
   
2. Laminotomy: A laminotomy is performed to increase the space around nerve roots and the spinal cord. The procedure helps to remove (decompress) pressure from these neural tissues. The lamina is the bony plate covering each vertebra’s posterior arch, or entryway to the spinal canal and nerve structures.
   
   A laminotomy may also be performed to remove the ligamentum flavum. This is the spine’s largest ligament. Sometimes the ligamentum flavum becomes thick and compresses the spinal cord contributing to spinal stenosis. When the surgeon removes part of the lamina, he can access the ligamentum flavum for removal.
   
   A laminectomy is similar to a laminotomy. The difference between the procedures is a laminectomy is usually performed during a traditional open back surgery to remove the entire lamina. A laminotomy does not remove the entire lamina, but only a portion of the bony plate
   
   A laminotomy is performed to treat bone spurs (osteophytes), bulging and herniated discs, pinched nerves, scar tissue, spinal arthritis, and spinal stenosis.
   
   
3. Percutaneous Arthroscopic Discectomy: Percutaneous means through the skin. A percutaneous arthroscopic discectomy is the surgical removal of bulging or herniated disc material. Bulging and herniated discs are a common cause of nerve root and spinal cord compression.
   
   During this minimally invasive procedure, the surgeon uses a laser to vaporize disc material to reduce pressure on the spinal cord and nerve roots. When the procedure is completed, the endoscopic tube is slowly removed to allow muscles and soft tissues to move back into place. A percutaneous arthroscopic discectomy is a short procedure only taking 30 to 45 minutes.
   
   
4. Facet Thermal Ablation: A facet thermal ablation is performed to treat facet disease, facet joint syndrome, facet hypertrophy (enlargement), facet arthritis, or facet joints affected by degeneration. The facet joints are the spine’s joints. Found at the back of the spine, 2 vertebrae share 1 facet joint.
   
   Thermal ablation refers to disabling or destroying a nerve using a laser. During the procedure, the surgeon uses a laser to clean the facet joint and deaden the nerve that innervates the joint and causes pain.
   
   After a local anesthetic is administered, a small incision is made and the endoscope is inserted. The endoscope (about the size of a straw) helps protect surrounding anatomical structures from damage during thermal ablation. The procedure only takes about 40-minutes.