for Pain Relief Remains Unproven

June 26, 2009
Dear Mayo Clinic:
Can you shed any light on the reliability of laser spine surgery as a successful treatment for chronic neck and back pain? Do these treatments work?

Answer:
Spine surgery can be performed using several different tools, including a laser. Laser spine surgery has been around since the 1980s, but it has never been studied in a controlled clinical trial to determine its effectiveness. Most neurosurgeons don’t use lasers for spine surgery because there are no clear benefits to laser surgery over more well-established spine surgery techniques that have proven to be effective.

The purpose of spine surgery typically is to relieve pain and other symptoms by decreasing pressure on a compressed spinal nerve or by stabilizing the spine. Surgery may involve removing a herniated or damaged portion of a disk in the spine (discectomy); removing the back part of the bone that covers the spinal canal (laminectomy); removing bone spurs or other spinal growths; or connecting two or more of the vertebral bones in the spine (spinal fusion).

Traditionally, a small, high-speed air drill or a surgical instrument that’s heated with an electric current (electrocautery) is used to cut away the tissue and bone. During laser spine surgery, a focused beam of light (laser) is used to cut away tissue. Laser spine surgery is often promoted as being noninvasive and risk-free. However, these procedures require incisions and can result in serious complications.

Before deciding on the type of spine surgery to have, first, you should thoroughly investigate the need for surgery. Chronic neck and back pain has many possible causes. I’d strongly recommend that you do not proceed with any type of treatment until you see a medical spine specialist such as a neurologist to evaluate your symptoms and diagnose what’s causing them.

In some cases, a precise diagnosis can be difficult to determine. If you have pain that’s confined to your spine ? it doesn’t radiate to your hands, arms, feet or legs ? and magnetic resonance imaging or another imaging test doesn’t reveal a specific diagnosis, you may want to consult a specialist in a pain clinic.

Pain specialists can use diagnostic injections to pinpoint the problem area. One difficulty in diagnosing spine problems is that the spine has many moving parts that are potential pain generators ? for example, disks, facet joints, nerve roots, the spinal cord and muscles. By systematically injecting these structures one by one with anesthetic agents, the anatomic source of the pain often can usually be determined.

Even when you know what is causing neck and back pain, surgery shouldn’t be the first line of treatment, unless you’re having severe pain or muscle weakness that results in difficulty walking or performing daily activities. Medications and physical medicine that combines exercise, lifestyle changes and treatment modalities such as acupuncture or therapeutic massage can often effectively reduce pain.

If your symptoms persist, a reasonable next step would be injection therapy. Your doctor may inject medication such as cortisone into the space around the spinal cord (epidural space) to decrease inflammation around the nerve roots. Or your doctor may inject numbing medication into or near the structures that are causing back pain. Often both substances are injected simultaneously.

If more conservative treatments fail to reduce back pain, then surgery may be necessary, depending on your diagnosis. For example, if you have a herniated disk with leg or arm pain as a major symptom that hasn’t been relieved with other treatments, discectomy may be appropriate. If your doctor recommends surgery, don’t move forward until you have a clear understanding of your diagnosis and how the surgery will help relieve your symptoms.

Traditional spine surgery has been tested in numerous clinical trials and proven to be effective. Studies have shown that discectomy reduces pain and other symptoms in approximately 85 percent of people who have a herniated disk. In elderly patients who have radiating pain due to spinal stenosis, laminectomy effectively reduces symptoms in about 80 percent of patients. Very few neurosurgeons regard laser spine surgery as a viable alternative to conventional spine surgery techniques. At Mayo Clinic, we don’t use or recommend laser spine surgery.

– H. Gordon Deen, M.D., Neurosurgery, Mayo Clinic, Jacksonville, Fla.