News and Events

Front-to-Back: Novel Surgical Procedure Implemented at Rambam

Publication Date: 8/25/2022

A novel, minimally invasive, surgery for the lower back, developed in Australia, was recently implemented at Rambam Health Care Campus (Rambam), Haifa, Israel. Dr. Ory Keynan, Head, of the Spine Surgery Unit at Rambam, together with specialists from the unit, are now using this procedure.

L-R) Dr. Shai Menachem and Dr. Ory Keynan performing novel lower back surgery. Photography:  Rambam HCCL-R) Dr. Shai Menachem and Dr. Ory Keynan performing novel lower back surgery. Photography: Rambam HCC

Lower back surgery may be necessary for multiple reasons: back injuries, tumors, infection, degenerative disease, and other conditions. For patients being treated for persistent pain by non-surgical means, the elderly, or those with serious medical conditions affecting the back, lower back surgery may be the only answer.

Standard lower back surgery calls for a back-to-front incision. On the other hand, the new procedure, referred to as Anterior to Psoas (ATP), calls for making a front-to-back incision at the waist, using state-of-the-art surgical instruments.

Dr. Shai Menachem, an attending physician in Rambam’s Spine Surgery Unit, specialized in the procedure during his fellowship at Prince of Wales Hospital, Sydney, Australia. Regarding the advantages of ATP, he shares: “This surgical approach minimizes damage to the surrounding tissues, making recovery-time faster. Using ATP, we can correct common, degenerative conditions in the lower back, as well as less common spine conditions in a more efficient and less traumatic way.

The ATP technique has marked differences from standard back surgery, which involves repeat procedures. “An incision is made through the back, but this also involves opening old scars. Surgical work can add to the tissue damage. As a result, there is a higher chance of complications among patients. However, using the ATP provides a different access to the area requiring surgical repair,” explains Dr. Menachem.

Two years ago, the first patient in Israel, underwent ATP surgery at Rambam. An 80-year-old woman suffering from chronic back pain, she had already undergone two lumbar spine operations. She subsequently developed a curvature of the spine – lumbar scoliosis – a degenerative condition causing leg and lower-back pain.

Dr. Menachem shares a few details regarding the procedure. “We used the ATP minimally invasive technique on our patient. We made a small side-to-front incision in the abdominal wall using specialized instruments developed in Australia. We were able to repair the patient's degenerative scoliosis and released the pressure on the nerves, which had caused her leg pain. We also realigned, immobilized, and stabilized her spinal segments, using minimally invasive keyhole surgery.”

“ATP has many clear advantages in first or repeat surgeries. If this technique is suited to a patient, we prefer to use it; recovery is faster and easier,” Dr. Menachem concludes.