Sometimes during my patient consultations, I receive the question “What about Laser Spine?” Having practiced in Phoenix and currently living in New Mexico, I have encountered many patients before and after their experience with the Laser Spine Institute (LSI). My impression of LSI has more to do with a focus on promoting Minimally Invasive Surgery (MIS) than with a focus on using a laser.
Starting approximately 10 years ago, outpatient (MIS) surgery has grown extensively. Some authorities estimate that by 2025, fifty percent of spine surgeries will be performed in an outpatient setting. Currently, in my practice, cases that are performed at the Las Cruces Surgical Center (LCSC) include healthy patients in need of Posterior Lumbar Disc Surgery, Sacroiliac fusion or single level Anterior Cervical Fusions (ACD&F).
The key with successful outpatient surgery is patient selection. One size does not fit all. Healthy patients with minimal medical issues fit the profile better for successful outpatient surgery than older patients with medical issues such as obesity, heart or lung issues, and chronic pain. Minimizing risk is important because Ambulatory Surgical Centers (ASC’s) do not have access to all of the specialties (Cardiologist, Urologist, Internal Medicine) that a hospital may have to offer. Patient selection and surgical procedures have to be chosen carefully.
Oftentimes, patients ask whether I can perform the surgery we are discussing using “one 1 inch incision” (per the Laser Spine Institute commercial). I routinely chuckle because the size of the incision is the least of my pre surgical concerns. I only know of three spine surgeries that could realistically be done with one 1 inch incision: MIS Lumbar Microdiscectomy, Posterior Cervical Foraminotomy, and perhaps a one level ACD&F. In my practice, this accounts for < 10% of the surgical cases. Interestingly, the patients asking for the smaller incisions have the most extensive findings (multi-level arthritic changes with Scoliosis or stenosis). Can you perform theses surgeries with “one 1 inch incision”; the answer is NO.
Ultimately, surgery should be tailored to the disease of the spine. If the goal of surgery is to decrease leg or back pain, then the incision size should match the spine disease…not vice versa. A mentor of mine taught me “Do what you do best”. If a specific surgery requires a larger incision, then a larger incision is needed. Patients want to feel better, the incision size is secondary. What good is a small incision if the patient still has symptoms?
To conclude, MIS/ Laser Surgery/ Outpatient spine surgery is here to stay. Additional precautions have to be taken in performing these surgeries from patient selection, ability to achieve a surgical goal with a smaller incision, emergency and pain management protocols, as well as investment in expensive equipment. Every patient is different and safety has to be a priority. Las Cruces Surgical Center has been performing outpatient spine surgery since 2008. The important point is not whether I am using a Laser, Endoscope or a Tube system (MIS); what matters is whether the goal of surgery is attained. A successful outcome with a larger incision is always better than a small incision with continued pain.