Neurosurgeon Ori Barzilai specializes in minimally invasive spine surgery.
The specialists at our Minimally Invasive Spine Surgery Center are highly skilled at stabilizing the spine and removing tumors while reducing pain and damage to surrounding tissue.
Our doctors use image guidance and advanced devices to operate with high precision. These minimally invasive techniques reduce surgical risk, decrease pain, and prevent complications so patients can recover more quickly.
Our doctors primarily perform minimally invasive spine surgery for two purposes:
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Stabilization: Stabilizing surgery can remove stress and relive pain caused by spine fractures. For this procedure, we use advanced instruments and special bone cement.
- Decompression and tumor removal: As a spine tumor grows, it can compress the spinal cord and nerves, which causes pain and may result in weakness and loss of sensation. We use minimally invasive surgery to decompress the spinal cord and nerves, preserving or improving their function and reducing pain. This may also be a crucial step in allowing the use of radiation therapy to prevent the tumor from growing. Our doctors also use minimally invasive methods, including very small incisions, to remove the tumor.
Our Experts
Director of Minimally Invasive Spine Oncology
Director, Neuroradiology IR
Benefits of Minimally Invasive Spine Surgery
Some of the most important advantages of minimally invasive spine surgery compared with traditional open methods include:
Minimizing interruption or delay of cancer therapy
Traditional spine surgery usually requires three to four weeks of healing time, which can delay radiation therapy or systemic treatments — such as chemotherapy — for the primary cancer. Minimally invasive spine surgery shortens the healing period, often without interruption of these treatments, enabling patients to resume or start therapies sooner.
Preserving muscle function
Traditional spine surgeries typically require the surgeon to make a long incision and move the back muscles to the side in order to see and access the spine. Our doctors use specialized techniques to gain entry to the spine through small incisions, which minimizes damage to these muscles. In most cases, this results in less pain after surgery and a faster recovery.
Reduced skin damage
The smaller incisions we use enable the skin to heal faster and reduce scarring.
Less pain
Minimally invasive techniques reduce the amount of pain felt by patients after surgery.
Faster recovery
Patients receiving minimally invasive spine surgery usually regain their mobility more quickly and are able to leave the hospital sooner following the operation.
Decreased risk of wound complications
Wound complications such as infection may occur after conventional spinal surgeries. The smaller incisions used in minimally invasive spine surgery virtually eliminate these risks.
Minimally Invasive Techniques
Our surgeons use highly advanced technology and sophisticated approaches to perform minimally invasive procedures including:
Microsurgery
Microsurgery is performed through very small incisions using a specialized operating microscope or an endoscope (a flexible tube with an attached camera). The microscope allows our surgeons to perform delicate operations with specially designed instruments through a small incision of one or one-and-a-half inches. Conventional surgical methods for these operations require incisions of six to ten inches.
Use of tubular retractors
A tubular retractor is a tool that can be inserted through a small incision to act as a narrow tunnel to the part of the spine that needs repair. The device holds the muscles open and the surgeon accesses the spine using small instruments that fit through this tunnel. Tumor, bone, or disk material can be removed through the retractor, and screws or rods can be inserted through it.
Minimal access decompression and tumor removal
Our experts use tubular or expandable retractors (which pull back tissue to increase access without making a large incision) to take out bone and soft tissues that are compressing nerves, as well as remove tumors when needed.
Intraoperative imaging and neuronavigation
Our surgeons are guided by real-time medical imaging to enable the precise placement of instruments. Neuronavigation employs intraoperative and preoperative imaging in order to provide a real-time, computer-assisted, three-dimensional road map of the operation. It improves our surgeons’ ability to confine the tumor while keeping the surrounding organs safe.
Our neuronavigation is guided by several imaging techniques:
- fluoroscopy, which shows a continuous x-ray image on a monitor, much like an x-ray movie
- intraoperative CT scans, which provide three-dimensional imaging during surgery in order to confirm tumor location and the positioning of rods, screws, or other objects
- intraoperative ultrasound that allows us to ensure decompression of the neural structures
Percutaneous stabilization
Our surgeons may insert rods and screws to stabilize your spine or keep it immobile so vertebrae can fuse together. Traditional approaches require extensive removal of muscle and other tissues from the spine surface. Our surgeons use fluoroscopy and neuronavigation to perform percutaneous (“through the skin”) placement of the rods and screws through small incisions without cutting or dissecting the underlying muscle.
Other percutaneous procedures to stabilize the spine include vertebroplasty and kyphoplasty, which can be done on an outpatient basis.
- Vertebroplasty is the injection of special bone cement into a collapsed vertebra. The cement may also serve as a marker in patients who are treated with image-guided radiation therapy.
- Kyphoplasty is a procedure in which a special balloon called a tamp is inserted into the vertebra and inflated, creating a space into which bone cement can be injected.
Robotic surgery
Robot-assisted surgery may decrease the invasiveness of certain operations while making them safer. MSK has a strong tradition of pioneering robotic surgery to operate on tumors. In fact, we perform the highest number of robot-assisted surgeries in the United States. We have used currently available robotic technology to remove tumors in and around the spine, and we are designing and developing new robotic devices and techniques to make this procedure even more effective and less invasive.