Spine Health & Spinal Hygiene

For individuals who have exhausted all other treatment options for low back pain and nerve root compression, can laser spine surgery help alleviate nerve compression and provide long-lasting pain relief?

Laser Spine Surgery

Laser spine surgery is a minimally invasive surgical procedure that uses a laser to cut through and remove spinal structures that are compressing nerves and causing intense pain. The minimally invasive procedure often results in less pain, tissue damage, and faster recovery than more extensive surgeries.

How It Works

Minimally invasive procedures result in less scarring and damage to surrounding structures, often reducing pain symptoms and a shorter recovery time. (Stern, J. 2009) Small incisions are made to access spinal column structures. With open-back surgery, a large incision is made down the back to access the spine. The surgery differs from other surgeries in that a laser beam, rather than other surgical instruments, is used to cut structures in the spine. However, the initial incision through the skin is made with a surgical scalpel. Laser is an acronym for Light Amplification Stimulated by Emission of Radiation. A laser can generate intense heat to cut through soft tissues, especially those with a high water content, like spinal column discs. (Stern, J. 2009) For many spine surgeries, the laser cannot be used to cut through bone as it generates instant sparks that can damage surrounding structures. Rather, laser spine surgery is primarily used to perform a discectomy, which is a surgical technique that removes a portion of a bulging or herniated disc that is pushing against the surrounding nerve roots, causing nerve compression and sciatic pain. (Stern, J. 2009)

Surgical Risks

Laser spine surgery may help resolve the cause of nerve root compression, but there is an increased risk of damage to nearby structures. Associated risks include: (Brouwer, P. A. et al., 2015)

• Infection
• Bleeding
• Blood clots
• Remaining symptoms
• Returning symptoms
• Further nerve damage
• Damage to the membrane around the spinal cord.
• Need for additional surgery

A laser beam is not precise like other surgical tools and requires practiced mastery and control to avoid damage to the spinal cord and nerve roots. (Stern, J. 2009) Because lasers cannot cut through bone, other surgical instruments are often used around corners and at different angles because they are more efficient and allow greater accuracy. (Atlantic Brain and Spine, 2022)

Purpose

Laser spine surgery is performed to remove structures that are causing nerve root compression. Nerve root compression is associated with the following conditions (Cleveland Clinic. 2018)

• Bulging discs
• Herniated discs
• Sciatica
• Spinal stenosis
• Spinal cord tumors

Nerve roots that are injured or damaged and constantly send chronic pain signals can be ablated with laser surgery, known as nerve ablation. The laser burns and destroys the nerve fibers. (Stern, J. 2009) Because laser spine surgery is limited in treating certain spinal disorders, most minimally invasive spine procedures do not use a laser. (Atlantic Brain and Spine. 2022)

Preparation

The surgical team will provide more detailed instructions on what to do in the days and hours before surgery. To promote optimal healing and a smooth recovery, it is recommended that the patient stay active, eat a healthy diet, and stop smoking prior to the operation. Individuals may need to stop taking certain medications to prevent excess bleeding or interaction with anesthesia during the operation. Inform the healthcare provider about all prescriptions, over-the-counter drugs, and supplements being taken.

Laser spine surgery is an outpatient procedure at a hospital or outpatient surgical center. The patient will likely go home on the same day of the operation. (Cleveland Clinic. 2018) Patients cannot drive to or from the hospital before or after their surgery, so arrange for family or friends to provide transportation. Minimizing stress and prioritizing healthy mental and emotional well-being is important to lowering inflammation and aiding recovery. The healthier the patient goes into surgery, the easier the recovery and rehabilitation will be.

Expectations

The surgery will be decided by the patient and healthcare provider and scheduled at a hospital or outpatient surgical center. Arrange for a friend or family member to drive to the surgery and home.

Before Surgery

• The patient will be taken to a pre-operative room and asked to change into a gown.
• The patient will undergo a brief physical examination and answer questions about medical history.
• The patient lies on a hospital bed, and a nurse inserts an IV to deliver medication and fluids.
• The surgical team will use the hospital bed to transport the patient in and out of the operating room.
• The surgical team will assist the patient in getting onto the operating table, and the patient will be administered anesthesia.
• The patient may receive general anesthesia, which will cause the patient to sleep for the surgery, or regional anesthesia, injected into the spine to numb the affected area. (Cleveland Clinic. 2018)
• The surgical team will sterilize the skin where the incision will be made.
• An antiseptic solution will be used to kill bacteria and prevent the risk of infection.
• Once sanitized, the body will be covered with sterilized linens to keep the surgical site clean.

During Surgery

• For a discectomy, the surgeon will make a small incision less than one inch in length with a scalpel along the spine to access the nerve roots.
• A surgical tool called an endoscope is a camera inserted into the incision to view the spine. (Brouwer, P. A. et al., 2015)
• Once the problematic disc portion causing the compression is located, the laser is inserted to cut through it.
• The cut disc portion is removed, and the incision site is sutured.

After Surgery

• After surgery, the patient is brought to a recovery room, where vital signs are monitored as the effects of the anesthesia wear off.
• Once stabilized, the patient can usually go home one or two hours after the operation.
• The surgeon will determine when the individual is clear to resume driving.

Recovery

Following a discectomy, the individual can return to work within a few days to a few weeks, depending on the severity, but it can take up to three months to return to normal activities. Length of recovery can range from two to four weeks or less to resume a sedentary job or eight to 12 weeks for a more physically demanding job that requires heavy lifting. (University of Wisconsin School of Medicine and Public Health, 2021) During the first two weeks, the patient will be given restrictions to facilitate the spine's healing until it becomes more stable. Restrictions can  include: (University of Wisconsin School of Medicine and Public Health, 2021)

• No bending, twisting, or lifting.
• No strenuous physical activity, including exercise, housework, yard work, and sex.
• No alcohol in the initial stage of recovery or while taking narcotic pain medications.
• No driving or operating a motor vehicle until discussed with the surgeon.

The healthcare provider may recommend physical therapy to relax, strengthen, and maintain musculoskeletal health. Physical therapy may be two to three times weekly for four to six weeks.

Process

Optimal recovery recommendations include:

• Getting enough sleep, at least seven to eight hours.
• Maintaining a positive attitude and learning how to cope and manage stress.
• Maintaining body hydration.
• Following the exercise program as prescribed by the physical therapist.
• Practicing healthy posture with sitting, standing, walking, and sleeping.
• Staying active and limiting the amount of time spent sitting. Try to get up and walk every one to two hours during the day to stay active and prevent blood clots. Gradually increase the amount of time or distance as recovery progresses.
• Do not push to do too much too soon. Overexertion can increase pain and delay recovery.
• Learning correct lifting techniques to utilize the core and leg muscles to prevent increased pressure on the spine.

Discuss treatment options for managing symptoms with a healthcare provider or specialist to determine if laser spine surgery is appropriate. Injury Medical Chiropractic and Functional Medicine Clinic care plans and clinical services are specialized and focused on injuries and the complete recovery process. Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers, therapists, trainers, and premiere rehabilitation providers. We focus on restoring normal body functions after trauma and soft tissue injuries using Specialized Chiropractic Protocols, Wellness Programs, Functional and integrative Nutrition, Agility and mobility Fitness Training, and Rehabilitation Systems for all ages. Our areas of practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols.

The Non-Surgical Approach

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, don't hesitate to contact Dr. Alex Jimenez or us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Stern, J. SpineLine. (2009). Lasers in Spine Surgery: A Review. Current Concepts, 17-23. https://www.spine.org/Portals/0/assets/downloads/KnowYourBack/LaserSurgery.pdf

Brouwer, P. A., Brand, R., van den Akker-van Marle, M. E., Jacobs, W. C., Schenk, B., van den Berg-Huijsmans, A. A., Koes, B. W., van Buchem, M. A., Arts, M. P., & Peul, W. C. (2015). Percutaneous laser disc decompression versus conventional microdiscectomy in sciatica: a randomized controlled trial. The spine journal: official journal of the North American Spine Society, 15(5), 857–865. https://doi.org/10.1016/j.spinee.2015.01.020

Atlantic Brain and Spine. (2022). The Truth About Laser Spine Surgery [2022 Update]. Atlantic Brain and Spine Blog. https://www.brainspinesurgery.com/blog/the-truth-about-laser-spine-surgery-2022-update?rq=Laser%20Spine%20Surgery

Cleveland Clinic. (2018). Can Laser Spine Surgery Fix Your Back Pain? https://health.clevelandclinic.org/can-laser-spine-surgery-fix-your-back-pain/

University of Wisconsin School of Medicine and Public Health. (2021). Home Care Instructions after Lumbar Laminectomy, Decompression or Discectomy Surgery. https://patient.uwhealth.org/healthfacts/4466

Radiofrequency ablation, also known as RFA is a minimally invasive procedure performed in an outpatient clinic to treat neck, back, facet joints, and sacroiliac joint pain. It involves the use of radio waves pulsing at a high frequency that temporarily disable the nerves from transmitting pain signals to the brain. Relief can last three to six months. Radiofrequency ablation treatment could be an option to manage chronic back and neck pain. There are other names, but the radio frequency concept is the same. They are:

• Pulsed radiofrequency ablation
• RF ablation
• Radiofrequency lesioning
• Radiofrequency neurotomy
• Radiofrequency rhizotomy

Chronic neck, back, and hip pain take a significant toll on the body. Finding the right treatment can make all the difference. However, it does not work for everyone. For those that might have tried other non-surgical treatments to manage the pain, including physical therapy and steroid injections, that did not bring relief then radiofrequency ablation could be another treatment option.

Radiofrequency Ablation Benefits

• Pain relief compared to steroid injections lasts longer
• Relief exceeds that of injections
• It is a non-surgical procedure
• Complication risks are low
• Opioid or other analgesic medication is reduced
• Quick recovery
• Improved quality of life
• Relief can last six months to a year, and longer

Pain Reduction

Before undergoing radiofrequency ablation, a doctor must pinpoint the nerves causing the neck, back, or sacroiliac joint pain. They will perform a nerve block injection to determine if there is temporary relief from the pain. If there is temporary relief it means that the origin of the pain was found. This could qualify to become a candidate for radiofrequency ablation.

• A Medial branch block is performed to diagnose the facet joint/s that are causing the pain.
• A sacroiliac joint block is performed to determine if and which sacroiliac joint is causing the pain.

Preparation

The doctor will give instructions on how to prepare for the procedure. Instructions can vary from those listed, as every patient's case is unique.

• Do not eat 6 hours prior to your procedure
• Wear loose, comfortable clothing
• Easy to put on shoes
• Have a designated driver for after the procedure
• Make sure the doctor knows about all medications, vitamins, supplements, and herbs being taken
• Follow the doctor’s instructions when taking prescribed and over-the-counter medications. This includes vitamins, supplements, and herbs
• Bring all medications on the day of the procedure to be taken with minimal interruption

Radiofrequency ablation usually takes an hour or longer depending on the extent of the treatment. One example could be the number of facet joints being treated.

The Procedure

The patient will be positioned face down on the treatment table. Pillows are offered and positioned for optimal comfort. The area where the treatment will be administered is sterilized. The areas of the body not undergoing the treatment are covered with a sterile covering. Sedation could be utilized but not heavy sedation. More than likely it will be what is known as twilight sedation.

A local anesthetic is injected into and around the area/s being treated. Because radiofrequency ablation involves electricity a grounding pad is attached to the calf of one of the legs. The treatment table is adjusted for the precise placement of the needles and electrodes. The doctor will use fluoroscopy or a real-time x-ray as a guide.

Once the needle/s and electrode/s placement is confirmed, a low electrical current is sent through the electrodes. This creates waves of pulsating energy that stimulate and change the nerve/s sensory tissue so it does not send pain signals. Some individuals report a warm or mild pulsing sensation. When finished, the electrodes and needles are removed. The treated area is cleaned up, sterilized and bandages are applied.

After the Procedure

After the procedure, the patient is sent home with a set of recovery instructions. An example could be:

• Keep the bandages in place
• Don't take a bath or shower
• A shower can be taken the following day and the bandages removed
• Do not perform any strenuous activity for up to two days

When the anesthetic wears off, the individual will have soreness and some mild pain around the treatment area. As long as everything is fine individuals can return to work and normal routine within three days. Full recovery can take up to two weeks for the treated/ablated nerves to stop sending pain signals. Although the nerves no longer conduct pain, it is temporary and not a permanent fix. This is because the nerves grow back. If the cycle starts over, talk with the doctor about another session.

Peripheral Neuropathy Relief and Treatment

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*