By Kristen Gasnick, PT, DPT 

 Medically reviewed by Jennifer Schwartz, MD

Laser spine surgery is a type of minimally invasive spine surgery (MISS) that uses a laser to cut through structures in the spine to reduce nerve compression to help relieve pain. While minimally invasive procedures often result in less pain and tissue damage with a faster recovery time compared with more extensive surgeries, laser spine surgery is limited in its utility in treating spinal disorders and comes with risks.

Verywell / Ellen Lindner

What Is Laser Spine Surgery?

Laser spine surgery is a minimally invasive spine surgery where small incisions less than an inch in length are made to access structures of the spinal column. Compared to open back surgery, where a large incision is made down the back to access the spine, minimally invasive procedures result in less scarring and damage to surrounding structures, and often result in less pain and a shorter recovery time.1

What makes laser spine surgery different from other minimally invasive procedures is that a laser beam, rather than other surgical instruments, is used to cut structures in the spine. The initial incision through the skin, however, is still made with a traditional surgical scalpel.

Laser is an acronym for light amplification by stimulated emission of radiation. A laser is a focused beam of light that can generate intense heat to cut through soft tissues, especially those with a high water content such as the discs of the spinal column.1

When coming in contact with bone, lasers create instant sparks that can damage surrounding structures and cannot be used to cut through bone required for many spine surgeries.

Laser spine surgery is primarily used to perform a discectomy, a surgical technique that removes a portion of a bulging or herniated disc that is pushing against the surrounding nerve roots, causing nerve root compression and resulting pain known as sciatica.1

Potential Risks

Laser spine surgery may help resolve the cause of nerve root compression, but it comes with a greater risk of damaging nearby structures. Associated risks with laser spine surgery include:2

• Possible infection

• Bleeding and blood clots

• Nerve damage

• Damage to the membrane that surrounds the spinal cord

• Need for additional surgery

• Remaining or returning symptoms

A laser beam is an intense, focused source of heat that is less precise than other surgical tools and requires great mastery and control to avoid permanent damage to the spinal cord and nerve roots.1

Is Laser Surgery Better?

There is no scientific evidence suggesting that laser spine surgery is superior to other forms of minimally invasive spine surgery. In many cases, it is more efficient to use other surgical instruments that can be handled at different angles and around corners for greater accuracy. Lasers also cannot cut through bone.3

Always make sure to consult with your healthcare provider about the possible risks of laser spine surgery to determine if it is an appropriate option for you given your age, current health status, and medical history.

Purpose of Laser Spine Surgery

Laser spine surgery is performed to remove structures that are causing nerve root compression in the spine. Nerve root compression is associated with the following conditions:4

• Spinal stenosis

• Bulging or herniated discs

• Sciatica 

• Spinal cord tumors

To confirm any of these conditions, your healthcare provider will order imaging tests of your spine to obtain a clear image of where the nerve root compression is occurring and what the underlying cause is, including:

• X-ray

• CT scans

• MRIs

Laser spine surgery can also be used to perform nerve ablation where the laser burns and destroys nerve fibers that send chronic pain signals to the brain.1

There is a limited role of laser spine surgery in treating spinal disorders like degenerative spine disease, and most of the minimally invasive spine procedures performed in the United States do not use a laser.3

How to Prepare

The surgical team will provide you with more detailed instructions on what you will need to do in the days and hours before surgery. It is recommended that you stay active, eat a healthy diet, and stop smoking prior to any operation to promote optimal healing and a smooth recovery.

You may need to stop taking certain medications to prevent excess bleeding or interaction with anesthesia during the operation. Always consult with your healthcare provider about all prescriptions, over-the-counter medications, and supplements that you are taking for your safety.

Laser spine surgery, like other minimally invasive procedures, is often performed as an outpatient surgical procedure at either a hospital or outpatient surgical center. You will likely go home the same day of your operation and will not have to stay overnight in the hospital.4

You will not be allowed to drive to or from the hospital before or after your surgery, so make sure to arrange for a friend or family member to provide transportation.

Minimizing stress and prioritizing good mental and emotional health are also important to lowering the levels of inflammation in the body to aid in your recovery. The healthier you go into surgery, the easier your recovery and rehabilitation will be.

What to Expect

Laser spine surgery will be decided upon by you and your healthcare provider, and it will be scheduled at a hospital or outpatient surgical center in advance. Make sure to arrive at least an hour before the time of your scheduled surgery to give yourself time to fill out all the necessary paperwork.

Before the Surgery

You will be taken to a pre-operative room where you will be asked to change into a gown. You will undergo a brief physical examination and answer questions about your medical history from the surgical team.

You will then lie down on a hospital bed, and a nurse will place an IV in your arm or hand for delivering fluids and medications. The surgical team will use the hospital bed to transport you in and out of the operating room.

The surgical team will assist you onto the operating table, and you will be given anesthesia medication. You may receive general anesthesia, which will put you to sleep for the surgery, or regional anesthesia, which will be injected into the spine and numb the affected area so that you do not feel anything during the procedure.4

The surgical team will sterilize the skin around the area of your spine where an incision will be made. Antiseptic solution will be used to kill bacteria and prevent the risk of infection. Once sanitized, your body will be covered with sterilized linens to keep the surgical site clean.

During the Surgery

For a discectomy, your surgeon will make a small incision less than one inch in length with a scalpel along your spine to access the problematic nerve roots. An endoscope, a surgical tool equipped with a camera, will be inserted into the incision to view your spine from the inside.2

Once the problematic disc portion is located, a small laser will be inserted into the incision site and used to cut through the disc area that is causing the compression. The cut disc portion will then be removed, and the incision site will be sutured closed.

After the Surgery

After your laser spine surgery, you will be brought to a recovery room where your vital signs will be monitored as the effects of the anesthesia begin to wear off. You will typically be able to go home one or two hours after the operation once you are stabilized.

Make sure to arrange for a friend or family member to drive you home. Your surgeon will determine when you will have clearance to safely resume driving.

Recovery

Following a discectomy, you can generally go back to work within a few days to a few weeks, although it may take up to three months to return to normal activities. Length of recovery can vary from two to four weeks or less to resume a sedentary job, or up to eight to 12 weeks for more physically demanding roles that require heavy lifting.5

During the first two weeks of recovery, you will likely have several restrictions in place to facilitate healing of the spine until it becomes more stable. These restriction include:5

• No bending, lifting, or twisting

• No lifting anything that weighs more than 5 pounds

• No strenuous physical activity, including exercising, housework, yardwork, and sexual activity

• No driving or operating a vehicle of any kind until discussed with your surgeon

• No drinking alcohol in the initial stage of recovery or while taking narcotic pain medication

Your healthcare provider may refer you to physical therapy to help with your recovery. Physical therapy generally begins at a frequency of two to three times a week for four to six weeks. Your physical therapist will communicate and coordinate care with your practitioner and determine if you need more visits after the initial frequency is close to completion.

 Coping with Recovery

It is important to follow all instructions from your surgeon and physical therapist to promote optimal healing and recovery for the best possible outcome.

Recommendations for optimal recovery include:

• Prioritizing getting enough sleep at night, at least seven to eight hours, to promote healing

• Staying hydrated

• Maintaining a positive attitude and learning how to cope with and manage stress

• Following your exercise program as prescribed by your physical therapist

• Staying active and limiting the amount of time you spend sitting each day

• Maintaining proper posture with sitting, standing, walking, and sleeping to decrease strain on your low back

• Learning proper lifting techniques to utilize your core and leg muscles to prevent increased pressure on your spine

Long-term Care

Possible Future Surgeries

Laser spine surgery has a limited role in treating conditions of the spine. Because it is primarily used to perform a discectomy to remove a portion of a damaged disc, your symptoms may still be present after surgery if there are other issues causing nerve root compression.1 In that case, you will need another surgery.

Lasers cannot cut through bone and cannot be used to remove bone spurs, perform laminectomies, foraminotomies, or spinal fusion procedures. Future surgery may be required if a discectomy is not effective in reducing nerve root compression.

Lifestyle Adjustments

While certain activities should be avoided, it is also very important that you limit how much time you spend sitting or laying in bed each day. Staying active is crucial for recovery and preventing deconditioning from a sedentary lifestyle, especially after having surgery.

Remember to:

• Avoid staying in one position for too long, which includes lying down, sitting, or standing

• Try to get up and walk every one to two hours during the day to stay active and prevent blood clots. You can gradually increase the amount of time or distance you walk as you progress with recovery

• Do not push yourself to do too much too soon. Overexerting yourself can increase your pain and delay your recovery

• Attend all of your regularly scheduled physical therapy sessions as recommended by your healthcare provider and follow up with a home exercise program prescribed by your physical therapist.

Sources

Stern, J. Lasers in Spine Surgery: A Review. SpineLine. Sep/Oct 2009;17-23

Brouwer, PA et al. Percutaneous laser disc decompression versus conventional microdiscectomy in sciatica: a randomized controlled trial. Spine J. 2015;15(5):857-65. doi: 10.1016/j.spinee.2015.01.020

Atlantic Brain and Spine. The Truth About Laser Spine Surgery [2019 Update].

Cleveland Clinic. Can Laser Spine Surgery Fix Your Back Pain?

University of Wisconsin School of Medicine and Public Health. Home Care Instructions after Lumbar Laminectomy, Decompression or Discectomy Surgery.

By Kristen Gasnick, PT, DPT
Dr. Gasnick, PT, DPT, is a medical writer and physical therapist at Holy Name Medical Center in New Jersey.