Lase is an acronym for laser assisted spinal endoscopy. It is a minimally invasive surgical
technique most useful for decompression of contained disc herniations in the lumbar spine,
although it can be used in the thoracic spine or cervical spine also. Additionally, LASE may be
used to make diagnosis of pain sources within the spine, although the optics of the scope
preclude fine diagnostic work. Because the laser used in the procedure is used under a
continuous saline solution flush, the penetration is safely controlled to a depth of 0.5 millimeters
(about 1/50 of an inch).
HOW IS LASE PERFORMED?
Patients with disc herniations enter an outpatient surgery center for the procedure. With the
patient lying face down, the back is surgically prepped and draped with sterile drapes. After IV
sedation is given, fluoroscopic guidance (x-ray) is used for placement of a needle into appropriate
disc, and the LASE endoscope wand is advanced through the needle and into the disc. The
endoscope is only 2.4mm wide. A Holmium YAG laser, through the working channel of the
endoscope, is advanced into the disc and the discectomy is performed by using 10-40 watts of
laser energy for a total laser time of approximately 30 minutes. The endoscope is used to assist
in following the progress of the discectomy and to help determine the location of the tip of the
endoscope. The LASE wand is flexible and steerable which makes it possible to target any
region of the disc. After the discectomy is complete, the patient goes home almost immediately.
IS LASE PAINFUL?
With sedation the patient will most likely not remember any of this minimally invasive surgery.
Moreover, the procedure is performed through such a small needle, it is unlikely that there would
be much more than incisional pain afterwards. Since the procedure is performed entirely within
the disc, there is no laser energy imparted to nerve roots.
WHAT IS THE SUCCESS RATE OF LASE?
For a contained disc herniation with primarily leg pain, the usual success rates are between 70
and 80% in significant pain reduction. With central disc bulges and back pain only, the success
rates are lower.
WHAT ARE THE POTENTIAL COMPLICATIONS OF LASE?
Bleeding, infection, muscle soreness from the needle insertion, nerve injury, spinal cord injury
either direct or through infarction of blood vesses., disciitis (disc infection), puncture or laceration
of the dura with prolonged spinal headache, failure to provide sufficient relief. Most of these
complications are very rare except for some mild post operative muscle soreness which resolves
quickly.
DOES LASE PRECLUDE ANY OTHER SURGERIES?
No. A person having LASE can later have other much more invasive surgeries (such as fusion,
microdiscectomy, artificial disc, etc.) if needed.
IS LASE EXPERIMENTAL?
No. The FDA gave 510K approval nearly a decade ago for this specific laser disc procedure and
there have been over 100,000 uses worldwide of endoscopic laser disc surgery. Some insurance
carriers will call this and any other procedure "experimental" in order to save money for their
shareholders. However, LASE and other endoscopic spine surgeries are far from experimental
having moved into the realm of standard patient care many years ago. There are many published
There are also books written on the subject of laser discectomy such as "Percutaneous Laser
Disc Decompression" by Choy.
ARE THERE ALTERNATIVES TO LASE?
Yes, equally minimally invasive options include coblation nucleoplasty and disc dekompressor
(targeting the central portion of the disc) as opposed to LASE which targets the area immediately
under the disc herniation. More invasive options include lumbar microdiscectomy surgery and
still more invasive procedures include artificial discs. Fusion represents the most invasive
surgical spine procedure performed routinely. The more invasive procedures have a much
longer recovery time, are significantly more expensive, and are typically inpatient procedures.
WHAT TRAINING IS REQUIRED FOR LASE AND WHAT TYPE OF DOCTORS ARE THE BEST TO
ADMINISTER LASE TO PATIENTS?
Since LASE is a minimally invasive spine surgery, the best physicians to use this procedure are
advanced pain management physicians since they have the most experience by far in accessing
the disc through needles without injuring nerves. Training is via advanced hands on training
courses and preceptorships with other pain physicians. LASE is not taught in any surgery or pain
management residency program at this time. Doctors performing this surgery need to not only be
competent with endoscopy equipment, but must be laser certified in addition.
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