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Lasers in Spine Surgery

Radcliff, Kris MD; Vaccaro, Alexander R. MD, PhD, MBA; Hilibrand, Alan MD, MBA; Schroeder, Gregory D. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: September 1, 2019 - Volume 27 - Issue 17 - p 621-632
doi: 10.5435/JAAOS-D-18-00001
Review Article

Laser spine surgery has been a focus of intense interest in the lay press and among patients. On the Internet, a host of purported benefits to laser surgery exists. Lasers have long been used in pain management procedures such as percutaneous diskectomy. However, a few published articles are available on lasers in conventional spine surgery. From our review of the literature, the purported advantages of lasers, such as reduced inflammation and degeneration, are not been supported by preclinical research. The available clinical studies do not show a notable advantage for laser surgery. Moreover, the low enrollment, nonblinded, retrospective studies that are available are heavily subject to bias. The documented advantages of laser spine surgery described in the research studies are not consistent with the public's impression of its purported benefits. Furthermore, laser-specific complications are present about which patients should be informed. On the basis of the current research, we conclude that lasers add distinct potential complications without any corresponding clinical benefit. Because of the public interest, we feel that this is an important topic for the general orthopaedic community.

From the Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA.

Dr. Radcliff or an immediate family member has received IP royalties from Globus Medical, Innovative Spine Devices, and Orthopedic Science; serves as a paid consultant to Globus Medical, Medtronic, and Orthopedic Science; serves as an unpaid consultant to Zimmer Biomet; has stock or stock options held in 4 Web Medical; has received research or institutional support from Orthofix, Pacira Pharmaceuticals, and Simplify Medical; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from CTL Medical, Lilly USA, NEXXT Spine, Paxen, Spinal Elements, Stryker, and Zimmer Biomet; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, Cervical Spine Research Society, ISASS, North American Spine Society, and SMISS. Dr. Vaccaro or an immediate family member has received IP royalties from Aesculap, Atlas Spine, Globus Medical, Medtronic, SpineWave, and Stryker; serves as a paid consultant to Atlas Spine, DePuy, Gerson Lehrman Group, Guidepoint Global, Innovative Surgical Design, Medtronic, Nuvasive, Orthobullets, SpineWave, Stout Medical, and Stryker; and has stock or stock options held in Advanced Spinal Intellectual Properties, Avaz Surgical, Bonovo Orthopaedics, Computational Biodynamics, Cytonics, Dimension Orthotics LLC, Electrocore, Flagship Surgical, FlowPharma, Franklin Bioscience, Gamma Spine, Globus Medical, Innovative Surgical Design, Insight Therapeutics, Nuvasive, Paradigm Spine, Parvizl Surgical Innovations, Prime Surgeons, Progressive Spinal Technologies, Replication Medica, Spine Medica, Spinology, Stout Medical, and Vertiflex. Dr. Hilibrand or an immediate family member has received IP royalties from Amedica and Zimmer Biomet; has stock or stock options held in Lifespine and Paradigm spine; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons. Dr. Schroeder or an immediate family member serves as a paid consultant to Advance Medical, Stryker, and Zimmer Biomet; has received research or institutional support from Medtronic Sofamor Danek; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from AOSpine and Medtronic.

Ethical Board Review statement: This study was approved by the Institutional Review Board at Thomas Jefferson University Hospital. Each author certifies that our institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Copyright 2019 by the American Academy of Orthopaedic Surgeons.
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