According to Dr. Kaixuan Liu, When Traditional Back Surgery Fails, Endoscopic Spine Laser Treatments Offer Relief for Persistent Back Pain

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Kaixuan Liu MD, PhD, spine expert: a relatively simple procedure may make persisten back pain go away, even if it’s the result of a botched or misguided surgery.

As many as 80,000 Americans face the nightmare of a failed back surgery syndrome every year: After undergoing a complicated and painful operation, they find that their pain remains—and might even be worse than before. They’re told that they can look forward to a lifetime of discomfort, with several less-than-attractive options for pain management, including perpetual doses of nonsteroidal anti-inflammatory medications (NSAIDs), spinal cord stimulator, or even implanted morphine pumps.

But a relatively simple procedure may make the pain go away, even if it’s the result of a botched or misguided surgery, says Kaixuan Liu MD, PhD, spine expert and chief surgeon at Atlantic Spinal Care in Edison, N.J.

The problems of persistent pain in the back and/or legs following spinal surgery are often lumped together under a single name: failed back surgery syndrome, or FBSS. It can be caused by residual pressure on a spinal nerve (caused by remaining bone spurs or spinal disc fragments), leftover or recurring disc herniation (a condition in which the soft part of one or more of the discs in the spine protrudes through the hard outer layer), the development of excessive scar tissue, the body’s rejection of implanted hardware (such as plates or screws), or nerve damage. People with FBSS typically experience dull, aching pain in their back and/or legs, along with sharp, burning, or stabbing pain in the extremities.

Surgery by the Numbers
Although Americans don’t appear to be more susceptible to back pain than people in other countries, the United States leads the world in spinal surgeries: more than 1.2 million every year, including as many as 200,000 spinal fusions, a procedure in which the surgeon will surgically fuse two or more vertebrae together. In fact, says Dr. Liu, the U.S. rate of spinal surgery is at least 40 percent higher than any other country’s—and five times higher that England’s.

Traditional back surgery, also known as “open” back surgery, is a complicated procedure, in which the surgeon cuts through the skin and muscles surrounding the spinal column in order to reach the spine. There, he or she may remove portions of bone to widen an area that’s become too narrow (a condition called stenosis) or cut away part or all of a disk that’s herniated or ruptured.

While open back surgery can be successful, it’s often not: as many as 40 percent of open spine surgeries go awry—and create FBSS. “Unfortunately, many FBSS cases are entirely preventable, because the patient should not have had surgery in the first place,” Dr. Liu says.

Better Options
But endoscopic laser spine surgery offers relief, Dr. Liu says. The procedure can treat many of the common causes of failed back surgery syndrome without subjecting the patient to another major operation.

According to Dr. Liu, trained spine experts can treat FBSS with two types of laser surgery: endoscopic facet rhizotomy, in which the surgeon uses laser light to deaden the affected nerves, and endoscopic lumbar spinal decompression, in which the laser and other micro instruments are used to remove the tissue—scars, bone spurs, artificial bone graft, or ligaments—that is causing the patient’s pain. (Endoscopic procedures use a long tube, inserted into the body through a small incision, that carries a light, a small camera, and a tool—in this case, a laser.)

In these endoscopic laser spine procedures, the surgeon makes a tiny incision—less than an inch long—and gently eases apart the muscles surrounding the spine. He then inserts the laser through a tiny tube, about the size of a pencil, which allows him to make exactly the repairs required while leaving the surrounding tissue unharmed, Dr. Liu explains. This simple procedure provides a much lower risk of infection and other complications, plus much less pain and much shorter recovery times (most people leave the hospital the same day, and are back to their regular activities in about six weeks).

About Dr. Liu: Kaixuan Liu, M.D., Ph.D. is a nationally recognized leader in endoscopic spinal surgery. Dr. Liu is certified by The American Board of Pain Medicine and The American Board of Anesthesiology, and is a member of The International Society for Advancement of Spine Surgery, The American Society of Interventional Pain Physicians (ASIPP), The American Academy of Pain Medicine (AAPM), The International Intradiscal Therapy Society (IITS), and The American Society of Anesthesiologists (ASA). He also serves as an international surgeon for The Spinal Foundations in England. Dr. Liu is the founder of Atlantic Spinal Care, LLC, in Edison, New Jersey,


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