One of the first questions I hear from patients diagnosed with a need for surgery, “What are my options for back surgery?”

In the United States, the lumbar discectomy is the most common back surgery ^[1] performed. This procedure allows the surgeon to remove the disc and other tissue that is causing pressure on surrounding nerves. The operation is often used to alleviate the symptoms of sciatica. Traditionally, the procedure was open surgery that entailed an increased risk of complications and an extended recovery period.

Over the years, new techniques have been perfected to reduce the trauma to the operative area. Minimally invasive surgical techniques employ microscopes, endoscopes and miniature instruments to visualize the spine and make the necessary repairs. The scopes and instruments are passed through one or more tiny incisions. Images are transmitted to a monitor that the surgeon uses to guide his movements. Recovery rates are faster, post-operative pain is less and the risk of complications is reduced. Many patients require only a local anesthetic and may return home the same or following day.

Laser surgery of the spine began several decades ago and has been increasing in popularity. However, many hospitals do not approve of the procedure even though a large number of these operations have been performed with few complications. The procedure is performed under a local anesthesia and the patient may be allowed up within minutes of the surgery. Patients whose occupations do not require heavy physical activity can often return to work in as little as two weeks

.

The basic technique for laser surgery utilizes the same principles as other minimally invasive procedures. A small incision is used to insert a camera and a laser. With the camera to guide him, the surgeon uses the laser to vaporize the portion of the disc causing the problem. However, the lasers are incapable of cutting through bone. This means that they can only be used on the discs.

Despite advances in microsurgery, many patients still require open surgery for back problems. One example is spinal fusion, which has an overall high failure rate when performed as a minimally invasive technique. However, some individual surgeons find their patients’ success rates are excellent. The choice of a technique is one that the patient should discuss with his surgeon and should be based on not only the patient’s preference but also the surgeon’s experience with a particular technique.

Until next time,

Stuart