Spine surgery with a laser is not new, nor experimental.
Some people mistakenly believe that this type of surgery is brand-new, or experimental in some way. In actuality, the type of laser used in this technique (a holmium laser) received approval from the FDA more than two decades ago. Even major healthcare providers, like Medicare, cover patients who receive treatment in an outpatient setting. If you know anything about how hard it is to get Medicare to cooperate, you will appreciate that minor bit of trivia!
While laser spine surgery is not in fact an experimental procedure, it is viewed as controversial by plenty of surgeons. For one thing, the holmium laser is expensive to operate and maintain. Certain laser components for example, are disposable. Because new parts are required for each surgery, it is an ongoing expense. Training, or lack thereof, is another controversial topic when it comes to endoscopic spine surgery. Many surgeons are accustomed to operating through large incisions while their patient is under some type of general anesthesia. For surgeons who aren’t used to operating with an endoscope, little thought is given to reducing the size of the incision, or communicating with the patient during surgery.
As far as Dr. Tony Mork is concerned, these issues are irrelevant. In fact, he believes that:
Surgeons have a responsibility to keep their patients comfortable, and to minimize tissue damage whenever possible. If performing a procedure with a smaller incision provides outcomes that rival those seen with more invasive techniques, the less invasive approach should be used. Period.
In summary, laser spine surgery is neither new, nor is it experimental. However, not every surgeon is qualified or up to the task. There are no peer-reviewed/scientific publications comparing procedures done with/without the holmium laser in the treatment of sacroiliac joint syndrome, facet syndrome, or stenosis. Dr. Tony Mork treats these conditions with the laser in his practice.
Something besides a laser is needed to treat spinal stenosis.
While the holmium laser is an ideal piece of equipment to use in the treatment of spinal stenosis, it’s not the only one a surgeon uses to treat conditions like spinal stenosis.
In fact, one of the most important requirements in any type of spine surgery is the surgeon’s ability to see. Of course, this means the surgeon needs a reliable way to control bleeding during the procedure. For the surgeon operating endoscopically, visibility is even more essential. The laser’s primary advantage is that it can be guided through a very small tube and delivers its energy in the form of heat. This heat is ideal when bleeding is encountered. Since soft tissues are comprised mostly of water, the laser easily vaporizes or shrinks the cells, without causing damage to adjacent areas. The small tube, the laser, and the heat characteristics allow for precision and accuracy not found in traditional approaches.
So, the laser is helpful, but it does not work in solitude. You could certainly say that the main tool used to treat spinal stenosis is the bone cutting instrument(s). Bones, unlike soft tissues, are less affected by the laser’s heat. Rather than using these instruments blindly, Dr. Tony Mork uses the endoscope to enhance visualization and keep the incision area small.
The laser has more than one benefit.
A smaller incision means lots of things. Faster healing, less pain, fewer pain medication, etc., etc. However, do not be tempted into believing that the primary benefit of laser spine surgery is a minimally invasive procedure. The real benefit is actually the heat generated by the laser!
Apart from the heat’s ability to control bleeding, it provides a comfortable alternative to electrocauterization (a technique that some patients are sensitive to while under twilight sedation).
Another benefit that wouldn’t be possible without the heat is nerve locationing. Much like echo-locating, this is a clever way of finding something without being able to see it. After the surgeon has directed the laser at an area obscured by scar tissue, a warm sensation is felt by the patient if a nerve is nearby. Incidentally, this another valuable reason why Dr. Tony Mork prefers to administer twilight sedation.
Many patients are empowered by the process of playing an active role in their treatment (not to mention the fact that this real-time feedback makes for a better solution to the patient’s problems!).
The laser isn’t right for every spinal condition.
As you might expect, laser surgery is the preferred method to treat a variety of spinal conditions. That doesn’t mean that every condition qualifies for the procedure, though.
Some disc herniations for example, are particularly challenging to treat with just the laser. These conditions are typically accompanied by bone fragments that can be difficult to locate. If the fragments stay in the same area of the disc herniation, the laser is beneficial. However, when the fragments migrate from this space a laser is of little use. That’s because the beam can’t navigate corners!
The laser doesn’t guarantee results.
It’s easy to forget that the laser is just a specialized instrument. Other factors such as getting an accurate diagnosis, the surgeon’s level of expertise and prior training can play just as much of a role in a patient’s success.