Laser treatment of spinal hernia: full description of the method

The constant development of technology in medicine has also affected surgical intervention for herniated intervertebral discs. The main development priorities are minimally invasive and quick return of the patient to active life. Open discectomy and traumatic operations involving the removal of vertebral arches, such as laminectomy, are gradually becoming a thing of the past. They have been replaced by the next generation of operations: microdiscectomy, which is performed using an operating microscope with a minimal incision.

MRI, hernia.

But there are also methods of surgical treatment that make it possible to do without incisions at all. These include endoscopic discectomy, microendoscopic intervention, and laser treatment of spinal hernia. What is it about? What is the meaning of this method, what are its advantages and disadvantages? To whom is it indicated and contraindicated, how to prepare for the procedure, and how is laser treatment of a herniated disc performed?

The essence of the technique

It must be remembered that laser therapy for the purpose of affecting a hernia is actually part of minimally invasive surgery. And those who think that by using this type of treatment you can do without surgery altogether are wrong. How can we talk about a conservative method of treatment when an intervertebral hernia or its fragments turn into steam, and this steam is released out under high pressure?

Evaporation of a hernia is a real surgical intervention. But laser methods for destroying disc herniations or changing their structure do not require the basic attributes of conventional operations, and proceed without incisions, without blood loss and pain, and therefore do not require endotracheal or intravenous anesthesia. Local anesthesia is quite sufficient.

Next, the treatment of intervertebral hernia using laser radiation will be discussed in detail. But first you should find out what advantages and disadvantages this method has.

Advantages of laser exposure

This technique has a large number of advantages, but all of them will be relevant if the patient has a small and “fresh” disc defect. What are these advantages?

The following indicators and arguments make laser methods of influencing a pathologically changed disc one of the best in our time:

the average duration of the intervention does not exceed 45 minutes, this allows the patient to be hospitalized for only two or three days, and discharged the next day after the procedure;
techniques have a very low number of complications, less than 0.1%;
When performing laser interventions, it is impossible to accidentally damage roots and other structures. The patient is under local anesthesia and can always tell the doctor about unpleasant sensations, for example, that there is a feeling of “pins and needles” in the leg, or muscle twitching. This contact allows the neurosurgeon to take immediate action;
laser methods do not leave scars on the skin, and there is no cosmetic defect;
since there are no incisions or manipulations with the vertebrae, there is no risk of developing instability, as with a classic laminectomy;
on the other hand, there is no risk in obtaining a fixed block, as during spinal fusion operations, which limits the patient’s mobility;
laser methods can be used to treat hernias repeatedly in different parts of the spinal column;
The absence of general anesthesia is very important. As a result, the procedure does not have the high risk inherent in conventional operations in the elderly, as well as with the presence of concomitant pathology;
Laser treatment of hernias is perhaps the safest method. If necessary, it can be used even during pregnancy and breastfeeding, since anesthesia substances that can adversely affect the baby do not enter the woman’s bloodstream.

However, these methods also have certain disadvantages.

Laser therapy for ENT diseases

Laser therapy in otorhinolaryngology can be used as:

main method of treatment
one of a range of treatment methods
prevention.

Laser, taking into account its anti-inflammatory and antiseptic effect, is now a unique tool in the treatment of diseases of the ENT organs. It significantly shortens recovery time, reduces the likelihood of exacerbations of chronic diseases, reduces the number of complications caused by diseases of the ear, nose and throat, and improves the quality of life. When using laser therapy, the following results can be achieved:

radically reduce pain, restore lost or decreased hearing or sense of smell
remove general tissue inflammation and its individual foci
restore metabolic function in diseased tissues.

The maximum effect from the use of laser therapy is achieved in the treatment of the following diseases:

nasal diseases (sinusitis and allergic rhinitis)
chronic adenoiditis
pharyngitis
laryngitis
chronic and acute tonsillitis
chronic and acute otitis media
acute ear diseases.

Under the influence of the laser, tissue heating does not occur, so this procedure, unlike other physiotherapeutic procedures, can be performed at any stage of the disease , including periods of exacerbation. Laser, when used as one of the components of complex treatment, due to its action can significantly increase the effectiveness of the use of other anti-inflammatory, analgesic, and immunostimulating agents.

Since allergies have become widespread, and laser therapy gives remarkable results in the fight against some manifestations of allergic reactions, this procedure in our clinic in St. Petersburg is one of the most popular.

It is possible to achieve maximum results in the treatment of diseases of the ENT organs using laser therapy provided that a full course of treatment is carried out, consisting of 10-15 procedures.

Flaws

First of all, there is no large amount of scientific data that allows us to speak confidently about the long-term period, since the technique has been used relatively recently. No one knows how laser treatment will affect the patient's disc structure after 30, 40, or more years. Also:

this type of treatment is not radical.
So, if we talk about disc replacement, which is carried out with great success in Western European countries, for example in the Czech Republic, Germany, then we can assume that a person receives practically a new disc and a return to freedom of movement. After laser manipulation, he is left with an old disk, and often with a changed structure; Disc replacement.
the next disadvantage is the occurrence of relapses, and sometimes there is a need for repeated intervention. But almost always such residual phenomena and the need for re-treatment are associated not with incorrect surgical technology, but with non-compliance with the rules of a healthy lifestyle prescribed by the doctor;
sometimes, when a large volume of the disk is evaporated, the temperature of the surrounding tissues may rise too quickly. If the intervention is carried out too quickly, they can be thermally damaged. Such a burn can worsen the course of the healing period, and even lead to discomfort and pain due to fibrosis and adhesions;
quite high cost of treatment. But in the conditions of the Russian Federation, a drawback is the fact that patients turn to neurosurgeons so late that the hernias already exceed the maximum size and structure allowed for laser correction, which serves as the main contraindication to laser treatment.

Indications for laser treatment methods

In various articles devoted to the treatment of complications of compression-ischemic manifestations of osteochondrosis, that is, protrusions and hernias, you can read that indications for surgical intervention are:

persistent pain that is not relieved by medications;
progression of sensitivity disorders with expansion of zones;
progressive weakness in the muscles, their hypotrophy, that is, the development of paresis, for example, weakness in the foot, flapping or drooping foot, the need to raise the leg high. In a milder version, this is a decrease in tendon reflexes, Achilles and knee, if we are talking about hernias of the lumbosacral spine.

But all these indications are relative. A laser can successfully treat a hernia if and only if the patient “fits” the rule of two sixes. That is:

a hernia older than 6, maximum 7 months, already old, and the amount of water in it is no longer sufficient for vaporization and destruction with a laser;
its size should not exceed 6 mm.

In practice, neurosurgeons in Russia are usually faced with advanced situations and, most often, with old and multiple calcified hernias. In this case, traditional treatments will be indicated, and microdiscectomy and endoscopic hernia removal should be considered among minimally invasive surgical interventions.

OSTEOCHONDROSIS OF THE LUMBAR-SACRAL SPINE

Damage to this part of the spine (Fig. 1) occurs most often, which is due to both the anatomical features of the structure of the spine and the characteristics of human life, because The lumbar region bears the greatest load. The most common pathologies found in this part of the spine are osteochondrosis and complicated forms of osteochondrosis, compression-radicular syndromes, and dysfunction of the nerve root in the form of neuropathies.

The most common syndromes of the lumbar spine are sciatica, lumbago, lumbar radiculitis (lumbar osteochondrosis) and intercostal neuralgia. Each of these syndromes consists not only of pain in the spine, but also secondary inflammatory changes in the muscles near the affected part of the spinal column, as well as symptoms of poor circulation and swelling of internal organs.

Clinic. Manifestations of the disease can be very diverse, depending on the stage of the process. Long-term pain syndrome, foot paresis (“slap foot”), compensatory scoliosis in the lumbar region, tension of the rectus muscles of the back, pain on superficial palpation, hyporeflexia of tendon reflexes, hypotonia of the lower leg muscles with impaired walking function, etc.

The results of clinical observations indicate a pronounced therapeutic effect of laser therapy in patients with osteochondrosis. After the first RT session, the absence of pain was observed in 60-65% of patients, improvement in motor activity was noted in 20-25%, and normalization of sleep in 50% of patients. After the first course of treatment, a positive effect was observed in almost 100% of patients with an early stage of the disease. When the process is started, it is achieved after 2-3 courses of treatment.

Contraindications

There are a number of conditions where laser radiation may cause more harm than good. Laser methods for treating disc herniations are contraindicated if:

in this segment there is an anomaly of the bone structure of the vertebrae, for example, the presence of bilateral Schmorl hernias;
with significant narrowing or stenosis of the spinal canal at the site of the proposed intervention;
According to an X-ray examination, MRI, there are signs of discitis in the intervertebral disc, that is, inflammation, and in the surrounding bone tissue of the vertebrae there are signs of spondylitis.

Finally, laser technology is not used in cases of sequestered hernia. It is highly undesirable to use laser methods, as mentioned above, for large hernias exceeding 6 mm. Of course, no one forbids the patient to insist on this method of treatment, but there is a risk of incomplete removal of the hernia, and especially if the patient is over 50 years old and has tears in the fibrous ring, that is, there is a high risk of repeated protrusions and hernias in this segment.

An absolute contraindication to laser treatment of hernias is displacement of the vertebrae and their severe instability, a tumor in this segment, even a benign hemangioma. The patient becomes familiar with the full list of contraindications at the initial appointment with the neurosurgeon, when the type of surgical treatment is selected. How should you prepare for laser treatment?

Sequestrated hernia on MRI.

How does a hernia appear?

The discs between the vertebrae give the spine strength and flexibility. Each is a hard shell (annulus fibrosus) with a semi-liquid “filling” (nucleus pulposus). Careless movement or injury ruptures the annulus fibrosus. Fluid flows out from the core and pinches the nerve endings. In this case, the disc protrudes to the side.

At the Center for Neurosurgery of Dr. Baklanov A.N. successfully treat all types of intervertebral hernia and protrusion. We will answer all your questions by calling +7 (499) 746-99-50. You can also ask a question by filling out the request form below.

Preparation for the procedure

First of all, the cost of one bed-day in countries with a high level of medical development is quite high, and therefore the patient performs all tests and studies on an outpatient basis. These include performing computed tomography and magnetic resonance imaging with the required resolution, ECG, general blood and urine tests, blood glucose testing, and necessary tests for HIV and syphilis.

If necessary, in the presence of concomitant chronic diseases, permission from the relevant specialists may be required. Then the therapist issues an opinion on the possibility of performing intervention on the intervertebral discs (in terms of the absence of contraindications).

The patient comes to the clinic with the appropriate neurosurgical department, and an hour and a half before surgery. Then you will have an appointment with the treating neurosurgeon, as well as an anesthesiologist, despite the absence of general anesthesia. On the eve of admission to the clinic, the patient should not eat or drink in the evening; this is a justified preventive measure. Even in the absence of general anesthesia, there may be an unpredictable reaction to the local anesthetic, such as nausea or even vomiting.

The patient then changes into sterile underwear and is taken to the operating room. About an hour after the end of the laser intervention, he is transported to the observation room, where he remains for 24 hours. You can get up and walk at the end of the first day, that is, on the day of the operation. As a rule, the patient is discharged home the next day.

Position of the patient on the operating table.

Intervention Details

Currently, in all countries with developed medicine, for example, the USA, Israel, Germany, and the Czech Republic, there are three main methods of laser treatment for herniated intervertebral discs. This:

laser vaporization, in which part of the disc that represents a hernia or anatomical defect is evaporated.

When carrying out laser vaporization, the skin, subcutaneous tissue, superficial muscles and ligaments of the spine in the required segment are anesthetized. Then the soft tissue is punctured, and a hollow, semi-rigid needle, covered with a mandrel and capable of bending, is passed through the intervertebral foramen to the required disc.

After the required location is reached under optical control, a thin laser LED is passed along it, at the end of which there is a powerful infrared laser that emits a certain amount of energy. In the same tube there is also a free channel through which the resulting vapors should be discharged back after the boiling of the water entering the disc cartilage. Drawing an analogy with a firearm, this is a channel for the removal of powder gases. It is needed so that the pressure in the area of operation of the high-energy laser does not increase.

As a result, the size of the hernia decreases, intradiscal pressure also decreases, and often right on the operating table the patient reports the complete disappearance of pain.

In simple terms, vaporization is the drying of a hernia with a powerful laser, reducing its volume, while reducing the pressure and level of pain.

The second type of minimally invasive laser surgery is laser reconstruction.

In this case, such high energy radiation is not created, and the hernia does not evaporate, but only changes the structure of the disc. The laser moderately heats the cartilage tissue to approximately 70 degrees Celsius.

Laser reconstruction is a more “humane” method of treatment. If during vaporization there is destruction and evaporation of tissue that is no longer good for anything, then laser reconstruction is used in cases where there are no large protrusions and hernias, but according to tomography there are many cracks in the disc, and they can cause future ruptures of the fibrous ring .

Due to the heating of the intervertebral disc, it receives an additional stimulus to heal these cracks. In simple terms, the disk “sticks together”, and the cause of this phenomenon is considered to be the cavitation effect, or the formation of microbubbles. After this treatment, the cartilage does not improve its structure immediately, but over several months. But the pain and risk of hernia formation decreases after 3 months.

Reconstruction is a therapeutic attempt to restore the disc using low power laser light. Therefore, if the hernia is large, or calcified, or the fibrous ring has already ruptured, then this method will be useless.

Postoperative period

Despite the fact that the patient is discharged the next day, he must adhere as carefully as possible to the recommendations of a neurosurgeon, neurologist, physical therapy specialist, or general practitioner. The main recommendations are as follows:

within 10 days, in the absence of contraindications, it is necessary to prevent the inflammatory process in the laser irradiation area.

For this purpose, drugs from the NSAID group are used, preferably from the group of selective cyclooxygenase type 2 inhibitors. Usually these are (according to the INN) ketoprofen, meloxicam, nimesulide. But when taking it, you should remember about contraindications in the presence of exacerbation of erosive gastritis and peptic ulcer of the stomach and duodenum, since these drugs increase the risk of erosion and bleeding;

within a month after the operation, any physical procedures are completely prohibited, only absorbable techniques are performed, for example, magnetic therapy;
physical exercises can be used only after a month and a half, you should also avoid visiting the pool for at least 4 weeks after surgery;
Intense loads on the operated spine, such as carrying heavy things, car repairs, and gardening are prohibited;
normal loads in the form of housework are possible, but it is very advisable to wear a semi-rigid corset for a month after surgery (for operations on thoracic and lumbar hernias). Its role is not to limit the normal range of motion, but to prevent accidental sharp and rapid bending and turning, which can worsen the process of tissue restoration after laser intervention.

Scars after back surgery.

As clinical practice shows, it is the failure to comply with these rules and feel completely healthy that leads to the patient requiring repeated surgical intervention on the operated segment.

A routine visit to a neurosurgeon or neurologist is usually scheduled after 2 months, as well as subsequent imaging tests. This is due to the fact that about 8 weeks after the operation the process of organization of the fibrous ring takes place, and physiological pressure inside the disc normalizes. As for the recommendations for following the rules of a healthy lifestyle, they are very simple. This means normalizing body weight, strengthening the back and abdominal muscles, that is, doing therapeutic exercises and swimming, and regularly taking courses of physiotherapeutic procedures and massage.

Back corset.

If the patient wants to take extra care, then wearing a semi-rigid corset or Shants collar in case of cervical hernias will be indicated when planning significant loads, for example, while washing windows or doing household work. These simple devices will protect the back or neck from excessive movements, which can lead to the development of secondary, recurrent protrusions and hernias.

Causes and risk factors

constant physical activity
osteochondrosis
congenital or acquired spinal deformities (scoliosis, kyphosis, lordosis)
sedentary lifestyle and lack of physical activity
excess weight
back and spine injuries
stress and nervous tension
infectious diseases
hereditary factor
age from 20 to 50 years
height above 170 cm
working at the computer
constant driving
incorrect posture
hypothermia

Cost of laser treatment

What is the cost of this modern spinal surgery? Of course, many factors play a role in pricing. They are influenced by the qualifications and experience of the doctor, the complexity of the case and the presence of additional risk factors, the need to use certain imported devices, as well as the number of days spent in hospital treatment.

The prices in the capitals, Moscow and St. Petersburg, are much higher, but we can say that percutaneous vaporization of the affected intervertebral disc averages from 150 to 250 thousand rubles, depending on the complexity of the case and the chosen clinic.

If we take the prices of prestigious world clinics, they will be many times more expensive. Thus, a 5-day stay at the Top Ichilov clinic in Israel and removal surgery costs $28,000, an MRI costs $1,500, and related consultations cost from $500 per one. Accordingly, this all-inclusive package will cost about 30 thousand dollars. In Europe, prices for laser treatment of intervertebral discs range from 10 to 20 thousand euros, in Turkey and India - from 3 to 4 thousand US dollars. Of course, this is the most general data.

In conclusion, a little should be said about patient reviews. Reading reviews from other patients before undergoing surgery, even such a minimally invasive one, is a very harmful practice. Each person represents a separate and unique clinical case, and any negative review will never be accompanied by a story about how the patient violated the doctor’s instructions. Perhaps he did not realize that in the early postoperative period he was not behaving as he should. As a result, the review will be negative, although the treatment was carried out correctly and according to indications.

On the other hand, positive reviews may encourage the patient to choose this particular clinic and this doctor, but his personal situation will initially differ from those patients who are not at risk of relapse. Therefore, it is possible to draw conclusions based on reviews only if everyone is offered exactly the same product, and this method is unlikely to be useful in medicine.

Laser therapy in urology

Due to its properties, laser therapy takes a well-deserved place in the treatment of various urological diseases. The use of a laser can achieve a significant improvement in the patient’s condition, while negative side effects and allergic reactions are completely eliminated. Laser therapy has an anti-inflammatory, restorative, analgesic effect on organs that are exposed to radiation. Laser therapy in urology is most often used for:

chronic prostatitis
acute and chronic cystitis
chronic cystitis and pyeloniphritis
chronic urethritis
male infertility.

Most often, this procedure is used in conjunction with restorative and antibacterial therapy.

The key to successful treatment using laser therapy in our clinic in St. Petersburg is highly qualified personnel and the most modern medical equipment.