Laser back surgery: Breakthrough or marketing bonanza?

January 19, 1993|By McClatchy News Service

SACRAMENTO, CALIF. — To cover the incision from Dale Borgman's recent bac surgery, his doctor needed only a Band-Aid. That's because the incision consisted of a single needle puncture.

Yet that needle -- as skinny as a plastic coffee-stirrer -- contained a miniature laser and fiber optic lens that made it possible for Sacramento orthopedic surgeon Paul Lim to operate on the ruptured disk that had plagued Mr. Borgman for several months. The procedure was done in a half hour.

Dr. Lim and other doctors believe the laser surgery, which has been used on a small scale around the country, may revolutionize back surgery, allowing those who suffer from debilitating back and leg pain to be cured relatively easily.

"It's simple, quick, safe and effective," Dr. Lim said. "It's revolutionary."

But other doctors say the laser back surgery is not a

breakthrough -- just an easy product to market. They contend that the procedure is effective for only a select group of patients, and that many people could be lured into unnecessary back surgery by the popular image of lasers as cure-alls.

"My objection to the laser disk decompression is that if there was not a company making money on the equipment, and if it was not such a sexy thing, you wouldn't hear anything about it as revolutionary," said Dr. Barry French of Sacramento, a neurosurgeon and medical director of the Sutter Spine Institute at Sutter General Hospital.

"There are doctors in Northern California who are marketing this," Dr. French said. "It's sort of very sexy and attractive to the lay person."

But after his surgery, Mr. Borgman, a 49-year-old sheet metal worker, believed the quick procedure would be the key to his recovery. Since he suffered a herniated disk in May, the Shingle Springs, Calif., man has sometimes been unable to even get out of his recliner. And other times, the pain was so bad he couldn't sleep without taking pills.

"The most amazing part of this is I'll be going home pretty soon," said Mr. Borgman, as he was wheeled out of the operating room at the Greater Sacramento Surgery Center.

"I think it's fantastic," said his wife, Mary, standing by his side and smiling. The couple left the center having been there just a few hours for the procedure. And Mr. Borgman, who felt only a little soreness, expects to return to his heavy-lifting job in a few weeks.

That kind of result has Dr. Lim excited. He says he's posted a 70 percent success rate -- meaning that the patient is healed -- in 18 operations during the past six months.

But equally important is the speed and ease with which it is done.

"The surgery is done with the patient awake. They go home the same day, and they can go out and walk and drive a car the next day," said Dr. Lim, who used to see his patients endure three-hour operations, stay in the hospital several days, and then take two to three months to recover. He still performs that operation in certain cases.

The procedure is done on herniated disks, an often-painful problem suffered by about 2 percent of the population. A disk ruptures when the outside wall -- made of tough, fibrous tissue -- tears or weakens, ballooning out and putting pressure on nearby nerves.

With 85 percent of Americans facing back trouble at some point during their lives and $24 billion being spent last year on spine care in the United States, the option of laser surgery appeals to many.

But some doctors remain unconvinced that the procedure should be used on a wide scale -- or even that laser back surgery is effective.

"The bottom line with it in my mind is that most people who would benefit from this procedure do not need surgery in the first place," said Dr. Gary Schneiderman, a Sacramento orthopedic surgeon.

"It's not some sudden, miracle cure for back pain, it's not a miracle cure for disk herniations," he said. "The patients have to fit a very strict criteria, and many of the patients in my practice who have that get better without the surgery."

Only 2 percent of all people with spine problems ever need surgery, according to Sutter's Dr. French. And he, Dr. Schneiderman and other physicians expressed concern that patients with all types of back problems may undergo the procedure unnecessarily by doctors who want to make money.

"This is very, very big business. It's probably the most frequent complaint in a physician's office -- the complaint of back pain," said Dr. James Boggan, an associate professor of neurological surgery at U.C. Davis Medical Center in Sacramento. "I honestly don't have any intention of doing it, and the real reason is my skepticism as to whether it really makes for a significant 'N advance."

But those who support the procedure counter that studies have shown if used correctly, the new technique -- which has been approved by the FDA -- can produce miraculous results.

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