New to Israel: Back surgery via the waist, using advanced keyhole method

An 80-year-old woman becomes the first Israeli to receive a spinal fusion operation — which normally involves opening up the back — via a tiny incision in the waist instead

Nathan Jeffay is The Times of Israel's health and science correspondent

Rambam Health Care Campus physicians Dr. Shai Menachem, left, and Dr. Ory Keynan, perform back surgery using the anterior-to-psoas method for the first time in Israel. (Courtesy of Rambam Health Care Campus)
Rambam Health Care Campus physicians Dr. Shai Menachem, left, and Dr. Ory Keynan, perform back surgery using the anterior-to-psoas method for the first time in Israel. (Courtesy of Rambam Health Care Campus)

Doctors in Haifa have started performing back operations via a small incision in the waist, a method that is less invasive and quicker to heal than previous techniques.

Rambam Health Care Campus is the first Israeli hospital to introduce the method, called anterior-to-psoas. It is used in the US, Australia and some other countries, but only in a minority of institutions.

It takes advantage of an “anatomical corridor” — i.e., free passage for surgery — that runs from the waist to the back. Doctors make a small incision in the waist, and insert a tube through which they can operate.

They then perform spinal fusion, an operation that connects two or more vertebrae in the spine, which is normally done to reduce pain, correct a deformity, or improve stability.

“This is a surgical technique that can be used both in simple cases and in the most complex ones,” Dr. Shai Menachem, who performed the operation together Rambam’s spine surgery division head Dr. Ory Keynan, told The Times of Israel.

“It allows us to perform spinal fusions through a small incision in the waist, and as a result achieve faster and easier recovery from the surgery compared to the common technique.

“Normally you would open up the back and disconnect the muscles from the spine, but using this method we don’t. The way we’re going in, we disrupt less tissue, and there is less bleeding and less post-operative pain.”

Illustrative image: A doctor holding a model of the spine front of an MRI scan on a computer screen (iStock via Getty Images)

The first patient, just treated at Rambam, is an 80-year-old woman who underwent two back surgeries years ago due to pain when standing and walking, but has since developed new pain along the right leg as well as lower back pain.

Instead of having further incisions on the back, which would have caused scarring of her delicate back tissue, she underwent the operation via the waist.

Menachem was performing the operation for the first time in Israel, but he had carried it out multiple times in Sydney, Australia, where he recently spent a stint working and mastering the technique.

“The surgery was performed by making a small side-front incision in the abdominal wall,” he said. “With the help of medical equipment designated for this surgical approach, specially imported from Australia, the patient’s degenerative scoliosis — curvature of the spine — was repaired, and the stressed nerves that caused pain along the leg were released.”

Menachem said he expects to start using the procedure widely. “Among patients suffering from medical conditions that are suitable for correction with the method, we will definitely prefer to operate with this approach in order to reduce invasiveness and speed up recovery.”

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