In his office at Brain and Spine Surgeons of New York in Harrison, Dr. Ezriel E. Kornel keeps a model of the human spine. Over a catered luncheon tray and in the hour before his next scheduled surgery at an area hospital, the neurosurgeon wielded it recently to show the new procedure he has pioneered in Westchester.
An assistant clinical professor of neurosurgery at the Columbia University School of Medicine and past president of the New York State Neurological Society, Kornel is an acknowledged expert in minimally invasive spine and brain surgery. About six months ago, he became the first neurosurgeon in Westchester and one of the few in the tristate area to treat degenerative disc disease and its severe back pain through a procedure called percutaneous lumbar interbody fusion.
Using a technology and special instruments developed by Spineology Inc., a state-of-the-art surgical products company based in St. Paul, Minn., Kornel directly removes damaged discs between vertebral bones and injects a bone graft paste inserted in a mesh pouch through a metal tube seven millimeters in diameter. The surgeon”™s precise steps are guided by a fluoroscope, an imaging technique that shows real-time moving images of a patient”™s internal structures.
The tube insertion through the skin requires a much smaller incision than standard disc fusion surgery ”“ two centimeters compared to three inches, said Kornel. Unlike standard spinal surgery, “You”™re not stripping the muscles off and you”™re not cutting the tendons,” he said. “Because you”™re not removing (vertebral) bone, because you”™re not removing muscle, there”™s minimal invasion.” The procedure also enables the surgeon to avoid manipulating nerves to get at the damaged area, thus further reducing a patient”™s pain in recovery.
Kornel said the new fusion technique also takes less time, “generally being completed in under two hours. Consequently, the patient is under anesthesia for less time, there is essentially no blood loss and recovery is much faster.”
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The specialist, a principal at Brain and Spine Surgeons of New York since 1990, said patients undergoing standard fusion surgery have hospital stays of three to five days. With the procedure developed by Spineology, “It”™s been under 24 hours” for patients”™ hospital stays. With less pain, those patients often can return to a normal daily routine within a few weeks.
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With shorter patient stays, “The hospital saves money,” Kornel said. “It”™s better for their profit margin.”
Kornel said the inflatable mesh “stocking” that Spineology has developed to implant bone growth material to fuse vertebrae eventually will allow surgeons to inject a gel into the damaged disc area “that will create what is essentially an artificial disc.” That would spare patients the bone fusion that, while eliminating back pain, also reduces spinal flexibility.
Robert McGann, a tristate sales representative for Spineology who attends surgeries in which his company”™s instruments are used, said Europe is well ahead of the U.S. in implementing such innovative medical devices. The Food and Drug Administration here has been slow in approving new products for specific medical conditions, leaving physicians here to resort to “off-label” uses, he said.
“Once it starts in Europe,” said Kornel, “in my experience it takes about five years before it”™s here.”
Kornel said no neurosurgeons in Manhattan, one of the nation”™s great medical centers, use the new fusion procedure in which he was trained. “I think it”™s because you have to be willing to put in the time and the effort to learn a new technique, and initially it isn”™t too easy,” he said.
In large medical centers with high patient volume and fixed procedures, “You don”™t have the drive to learn new techniques as much,” Kornel said. At the administrative level, “The hospitals become reluctant to try new instrumentation.”
In community hospitals, there are fewer bureaucratic layers for a pioneering physician to pass through, he said.
