Does Laser Spine Surgery also sterilise the Disc?
Recent studies have suggested the possibility that low-grade infection may be involved in the generation of disc degeneration and low back pain. Advanced keyhole minimal invasive spine uses laser ablation in the vapourisation of degenerate disc material and the clearance of scar tissue around nerves. The precise and focussed heat directed on these tissues may in addition to removing target material also sterilise the adjacent tissues.
In a randomised controlled clinical study published in the European Spine Journal. Hanne B. Albert PT. from The Back Research Centre, University of Southern Denmark, reported that in a group of 162 volunteers with chronic back pain. This was defined as back pain lasting for more than six months. All of the participants had a disc bulge (protrusion) and fluid leakage in to the underlying vertebrae, this reaction being termed a Modic 1 change.
Earlier studies have shown that nearly half of all the patients with slipped discs tested positive for bacterial infection, with the most common organism being the acne-causing bacterium Propionibacterium acnes. Hanne and Albert randomly allocated patients to antibiotic therapy ((Amoxicillin (amoxicillan) and clavulanate)) for 100 days with the remainder receiving a placebo (dummy) drug.
The antibiotic was associated with significant reductions in disability and pain in 80% of the treated group when evaluated a year later. This study would suggest that 40% of patients with a disc protrusion and short-term back pain without sciatica might benefit from a course of such therapy. However the study is relatively short-term follow up study in spinal terms. Such patients may have a susceptibility to infection so the subsequent re-infection rate needs to be ascertained.
Inappropriate use of antibiotics can contribute to the proliferation of resistant bacteria – a significant anxiety amongst microbiologists at this time where new antibiotic production is significantly lacking. The use of antibiotics should only be considered for chronic lower back pain if a bacterial cause has been identified.
Laser Disc Decompression uses a side firing laser probe to focus ablation upon degenerate disc material primed with indigo-carmine. The technique can be used on a stand-alone basis or as part of the wider reaching intervention of Transforaminal Endoscopic Lumbar Decompression & Foraminoplasty. Led by aware state foraminal palpation the surgeon can determine whether the disc level is causal of the patients predominant presenting symptoms or whether the changes on the MRI scan are innocuous and treatment at that level can be avoided. These techniques have good longterm outcome studies observed for over 10 years. Their use obviates the widespread use of indiscriminate antibiotic therapy and treat patients with long standing and more serious problems than small disc bulges. For instance the laser techniques address, narrowing of the spine, “instability”, slippage of one vertebra over another, degenerative scoliosis, large disc protrusions and Failed Back Surgery which can not be addressed by antibiosis alone.
