Laser Spine Surgery for Herniated Discs and/or Nerve Root Entrapment: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines

Key Message

In general, findings from non-randomized and observational research report that laser spine surgery is effective in reducing pain in patients with herniated disc and/or nerve root entrapment. Two randomized controlled trials (RCTs) concluded that there were no significant differences in short-term post-operative back pain or functional disability between patients who underwent surgery using laser versus conventional techniques. However, the authors of one RCT reported significantly higher levels of lumbar back pain at one-year follow up in patients who underwent laser spine surgery as compared to those who underwent conventional, open surgery, and; significantly higher levels of radicular pain were observed at 14 days, 2 months and one-year post-surgery in patients who underwent the laser surgical procedure. Authors of a second RCT reported no difference in functional disability between patients who underwent laser versus conventional surgical procedures; however, at one-year follow up, a significantly higher proportion of patients in the laser spine surgery group had required re-operation with conventional, open surgery.No relevant economic studies regarding the cost effectiveness of laser spine surgery in patients with herniated disc and/or nerve root entrapment were identified. One eligible guideline from the United States did not state any recommendation with regard to percutaneous lumbar laser disc decompression due to a lack of high-quality evidence.