Dr. Gott: Laser procedure for bulging discs

DEAR DR. GOTT: I’m a man in my 60s with two bulging cervical discs. I tried physical therapy and a cervical steroid injection with no relief. The pain radiates from my shoulders down my left arm. The surgeon said I would need surgery to correct the problem. I looked on the Internet, and there is laser done as an outpatient procedure.

Have you heard of this with lasers to correct bulging-disc problems and to eliminate bone spurs? My surgeon said my procedure would include about three days in the hospital.

DEAR READER: Bulging discs can occur anywhere in the spine; however, the cervical (neck) and lumbar (low back) areas are most commonly injured. A bulge occurs when the outer fibers of the disc stretch and weaken, allowing gelatinous material to bulge outward. When this occurs and a pinched nerve compresses against the spinal column, pain and debilitating symptoms occur. There are times, however, when an individual may be completely unaware of having a bulging disc if that bulge doesn’t press on surrounding tissue.

To the best of my knowledge, laser spine surgery, often touted as noninvasive or minimally invasive, has not undergone controlled clinical trials. It is not, in fact, noninvasive, and few neurosurgeons consider it a viable alternative option to traditional back surgery. Incisions are still necessary, but whereas traditional options use electrocautery devices or air drills, laser surgery simply uses a laser to do the cutting.

There is no clear benefit of one over the other; however, the Mayo Clinic has stated that its facilities don’t use or recommend laser spine surgery.

My recommendation to you is to continue to look for nonsurgical options. Get a second opinion from a neurosurgeon or ask for a referral to a pain specialist or clinic. Surgery of any kind is a major decision, especially when the spine and spinal cord are involved. You must consider outcomes that are not favorable, such as permanent nerve damage and paralysis. While not likely to occur if the operation is performed by a highly qualified, experienced surgeon, these are still possibilities.

Based on your letter, you have tried only two therapies. There are several other things for you to try, such as non-steroidal anti-inflammatory drugs, epidural injections, massage, chiropractic manipulation and much, much more. Don’t agree to surgery until you have exhausted your other options.