This article is from the archives of the UB Reporter.

UB neurosurgeons pioneer technique

Published: February 17, 2005

Contributing Editor

Surgeons at UB have carried out the first minimally invasive spinal surgery in the U.S. using a new technique to stabilize the lumbar spine called axial lumbar interbody fusion, or AxiaLIF™.

The procedure requires only a tiny incision in the back and can have patients up and walking without pain within hours of leaving the operating theater.


Tiny instruments are threaded internally along the spine to the surgery site.

Two hours following surgery, the first U.S. patient to receive the new back surgery said her back and leg pain was totally gone and she was "just a little sore."

"Lumbar spine surgery will never be the same," said a delighted L. Nelson Hopkins, professor and chair of the Department of Neurosurgery, upon hearing of the patient's good results. "This begins a total revolution."

The new technique could be used for 90 percent of all fusion surgeries, Hopkins said.

Elad Levy, associate professor of neurosurgery and radiology, performed the surgery on Jan. 28 in Millard Fillmore Hospital of Kaleida Health on a 31-year-old woman who had long-standing back pain due to an earlier injury. A recent re-injury to her spine had left the patient with debilitating pain in her back and legs, requiring her to take a leave from her bank job and to use a cane to walk.

Levy said the patient was an ideal candidate for the technology's U.S. premiere because she had no arthritis or degeneration of the vertebrae often seen in the mostly older persons who require back surgery.

Typically, spinal-fusion surgery requires a 5-to-6-inch incision in the back, retraction of the back muscles and tissue in order to gain access to the surgery site, cauterization of blood vessels and generalized trauma to the entire spinal region, said Levy. The patient usually spends several days in the hospital and several months in recovery.

Axial lumbar interbody fusion requires a 2-centimeter incision just to the left of the tailbone, he said. Instruments needed to perform the procedure are threaded internally along the spine to the surgery site by following a guide wire. Miniaturized scrapers remove torn and diseased disk material and tiny drills create the spaces to insert screws that stabilize the spine.

For the right patients, the procedure could be done on an out-patient basis, Levy said.

The technique was developed five years ago by an interventional radiologist who founded a company called Axial Med, now Trans1 Inc. The first trials on cadavers took place at UB's Toshiba Stroke Research Center in 2000.

The first surgeries were performed in Brazil, where 35 patients have been operated on since the technique was introduced there in 2003. The Food and Drug Administration (FDA) only recently approved the procedure for use in the U.S.

"Dr. Hopkins has developed the premier model for minimally invasive surgery centers in the U.S., so it's fitting that the first surgery took place in Buffalo," said Rick Randall, president and CEO of Trans1 Inc. "This surgery was the first step in the validation of this unconventional approach to spinal surgery. This is going to be standard practice in the future."