Laser spine surgery, a fool and his gold

A patient called me recently asking for a referral letter to travel to Dubai for surgery. Apparently, I had seen the patient a few years ago, offered spine surgery, accepted and then failed to turn up. It seems the fear of spine operations in Nigeria and the need for a second opinion led to an interesting decision. The decision has been made to travel to Dubai for Laser Spine Surgery or as some also call it, ‘bloodless surgery’. Hence the phone calls asking for me to write a referral letter.

What is laser?

A laser is a light beam that can be focused on a very small area. The ‘light’ heats cells in the area being treated until they "burst." There are several types of lasers and each has specific uses. Types of lasers include the carbon dioxide (CO2) laser, the YAG (yttrium aluminum garnet) laser, alexandrite, KTP, and the pulsed dye laser.

A laser (focused beam of light) can be used for cutting soft tissue. In eye surgery, they are definitely useful and have been used to treat glaucoma as reported recently by Professor Femi Babalola. They are also used for treating the lens in our eyes in corrective lens surgery. This helps to avoid wearing glasses in some people with short or long sightedness.

Laser surgery is also useful in treating some cancers, abnormal blood vessels and kidney/bladder stones. Laser surgery is a relatively popular and non-invasive method of haemorrhoidectomy (treatment of piles). Laser surgery may also be used to remove wrinkles, tattoos, birthmarks and to treat some skin diseases.

Laser Spine Surgery

I have sometimes been asked by patients if their spine surgery can be done with a laser. There is a perception by some half educated Nigerians that laser spine surgery is a modern, almost futuristic, high tech, low risk, up and coming technology. The reality is that lasers have been around for a long time and are almost completely useless when it comes to spine surgery.

Spine surgery

In the spine, we use something called electrocautery. This uses electricity to generate heat and we use that to cut. It is much more practical for cutting soft tissue and also stops the bleeding that occurs. Lasers can cut the disc (the shock absorber between bones in the spine). But, it is far easier and more reliable to just simply grab the disc yourself and remove it from where it is compressing the nerve. Also, since discs lie right next to the nerve, one risks the chance of damaging the nerve with the laser. Finally, lasers cannot cut bone so they cannot be used to treat patients with narrowing of the spine.

Just business

It seems that the most practical use for lasers in spine surgery is for marketing. Like most businesses, spine surgery is very competitive, and having an edge in marketing can make a practice standout. Many of the foreign hospitals touting laser spine surgery use it to attract unsuspecting customers. The laser will be of little or no useful function during the surgery.

Hence, at the major spine meetings and in the major spine journals there is a paucity of (if any) articles documenting any use of lasers in spine surgery. Articles on laser spine surgery are few and far between as it is not an accepted spine treatment procedure. Laser cannot be used to treat real spine problems.

Colonial mentality

Lasers are often perceived as an effective treatment for spine diseases because of two reasons: placebo response, and the tendency to always think the second opinion (read: white skin!) sounds more knowledgeable.

I once heard that a Nigerian patient called a hospital in Abuja and asked them, ‘I hope you have white doctors in your hospital?’ Apparently, he did not want to get there and have to see a black (Nigerian) doctor. Sadly, of course, this was before the scandal broke that the hospital had been using junior doctors and others pretending to be fully trained consultants.

A fool and his gold

So, my patients hankering after minimally invasive, bloodless and laser spine surgery do need to be careful they are not used for money. Many unscrupulous doctors especially in private practice abroad use tricks and false promises to ensnare the fool and make him part with his gold. Our colonial mentality helps to facilitate the enslavement.

Designer operations

In conclusion, spine surgery is an individual thing. Operations are designed specifically for each patient and what Joe had may not be suitable for Adamu. Operations are often designed to achieve one of two results: remove pain or to free the nerve from compression. The pain may be coming because of pressure on the nerve or instability of the bones. So, operations may be to free the nerves or to fix the bone or both. More often than not, the surgery will involve cutting of the skin to get to the bones or nerves.

You can do that through a tiny hole (minimally invasive: using a microscope or by using special tubes and cameras) or through a hole wide enough for a surgeon and his assistant to climb into. What do you care, so long as the job is done and you are free of pain!

.