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Lasers

  • Christopher A. YeungEmail author
  • Anthony T. Yeung
Chapter

Abstract

Lasers are often portrayed as a “miracle cure” for many painful spinal conditions, and many patients seek “laser surgery” to treat their spine problems. The reality is that in most instances the laser is an alternative tool replacing an equally effective mechanical or electrothermal instrument. Lasers are simply one of many tools at the disposal of spine surgeons to cut, shrink, coagulate, or remove tissue including the bone. In minimally invasive spine surgery, especially endoscopic spine surgery, there is a limited working area for tools and lasers that can effectively treat tissue without obscuring the surgeon’s view. Lasers do have the advantage of being very small and precise tools, thus allowing a truly minimally invasive surgical approach/exposure to limit iatrogenic morbidity. The holmium:yttrium-aluminum-garnet (Hol:YAG) laser is the most commonly used laser in spine surgery. It is delivered through small fiber optics and has different probes with both side-firing and steerable straight-firing capabilities to treat even hard-to-reach areas within the surgical view. The treatment area is very precise, and lasers can be safely used in close proximity to sensitive structures such as nerve roots. The surgeon can see exactly where the laser beam is aimed and focused at prior to turning it on. The probe can even be touching the nerve while aiming the beam away from it. This is compared to drills that could jump/bounce off of the bone and radio-frequency probes that cannot control the direction of their thermal energy. In spine surgery, lasers are most useful for endoscopic lumbar discectomies, foraminal decompression (foraminoplasty), facet nerve ablation, and debulking spinal tumors. Potential complications of lasers include neurologic injury, vertebral osteonecrosis, and aseptic discitis.

Keywords

Laser Laser foraminoplasty Endoscopic discectomy Laser disc decompression Dorsal rhizotomy 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Orthopedic Spine SurgeryDesert Institute for Spine CarePhoenixUSA

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