Ortho or neuro

[wilron]

I have had a L4-L5 disc rupture and surgery.  I have no back pain, but a lot of lower leg pain.  Many neurosurgeons have told me that you do not do "back fusion" if you have only leg pain.  However, my surgeons tell me that the only alternative left for me is to have a fusion.  Here is an except from my last MRI analysis:  L4-L5 demonstrates post surgical changes involving a right laminotomy.  There is intermediate signal intensity tissue seen extending into the epidural space just lateral to the thecal sac on the right.  ...this tissue does apear to compress the L% nerve root in the lateral recess."
I have located an orthopedic surgeon who says he can remove the scar tissue with a laser during orthopedic surgery.  Will this removal of scar tissue by laser, impede the regrowth of scar tissue that occurs when the neurosergeon cuts away the scar tissue; and is the operation safe?

[CCF-Neuro-M.D.-JT]

Laser surgery for disk problems have been increasing in the U.S. as it is minimally invasive and has been shown to be about 70-89% effective with a 1% or less complication rate reported in the medical literature.  Complications that are being recognized are bone marrow changes in the spine such as osteonecrosis (which is unhealthy bone) due to the heat from the laser.  I'm not sure that anyone can accurately predict if it will impede any further scar tissue after potential reoperation by your neurosurgeon.  But in one series of cases in which laser surgery was used in relieving pressure from a nerve by herniated discs, there was a 17-18% recurrence rate.  I haven't seen anything in the literature specifically about the recurrence rate in the removal of scar tissue.

You should talk to your neurosurgeon about this procedure and if it will affect re-operation for fusion. Also, talk to the orthopedist and ask about his/her own personal complication and success rate. Good luck.