Minimally Invasive Spine Surgery Comes to University Hospitals St. John Medical Center

Surgeon Richard Rhiew, MD, PhD, with the new
Neuronavigation technology now in place at

Minimally invasive spine surgery has come to University Hospitals St. John Medical Center in Westlake.

Bringing state of the-art neurosurgical approaches to the care of spine – and brain – patients is one of the ways UH SJMC is revolutionizing community medicine.

These services mean shorter hospital stays, less pain and incisions the size of a quarter. They all add up to making life easier for patients.

“This is all part of $1.7 million in upgrades we have brought to the community,” says UH SJMC President and CEO Robert G. David. “The goal of this hospital is to be a regional hub.”

Traditionally, spine surgeons have taken an ‘open’ approach to spine and neck surgeries. These traditional surgeries include a large incision and typically mean a hospital stay of 2-3 days.

The team at the UH SJMC Neurological Institute is specializing in minimally invasive approaches. Surgery is mapped out by sophisticated imaging equipment before an incision is even made. Oftentimes, the patient can go home the next day or even an hour or two after the procedure.

“I tell patients it is basically like GPS,” says Board Certified neurosurgeon Richard Rhiew, MD, PhD, of the Neuronavigation technology. “In the old days, if you drove to someone’s house you would flip out your map. Today, you would use a GPS. That’s what this Neuronavigation CAT technology is to a piece of paper. Do you want me to drive there with a map? Or do you want me to use GPS? It is totally technology driven.”

How It’s Done

Laminectomy, discectomy and even fusion patients can be candidates for minimally invasive surgery.

Laminectomy (a procedure which corrects narrowing of the spinal canal due to arthritic changes) is a common corrective surgery for spinal patients.

The surgeon relies on an x-ray first, to localize the precise area of the pathology. Then, an incision that is typically about three-quarters of an inch is made to come right down to the site of the disc herniation.

Guided by a microscope and working through a set of tubes about the size of a quarter, the operative channel is just enough for the small surgical instruments that are utilized.

The surgeon is able to identify the disc and the exiting nerve root and remove the disc without having to do any significant muscular retraction. The approach means less patient stress and easier recovery.

An Example

Margaret Hess of North Royalton is a patient of Dr. Rhiew who experienced success through minimally invasive spine surgery. Because of her risk factors related to a heart condition, her need for a laminectomy had been denied.

“I couldn’t be on the table for more than 4 hours because of my heart condition. So they did the minimally invasive approach. I was very grateful,” reports the 61-year old.

She could not stand for more than 8 minutes prior to surgery because of her back pain. “Now I can get back to cleaning and cooking,” she laughs. “It used to take me days to get ready for a dinner party. I would have to sit for 10 minutes and then stand for 10.”

Her stenosis was relieved via a 1 ½ inch incision and she was back on her feet in 24 hours. An open procedure would have meant a 4-5 day hospital stay.


Neuronavigation is the set of computer-assisted technologies used by neurosurgeons to guide or “navigate” within the confines of the skull or vertebral column during surgery.

The Navigation system allows the team at UH SJMC to reconstruct a patient’s spine in three dimensions visually.

They start with a Volume CT scan, which is very detailed. The computer in the operating room reconstructs the spine in three dimensions. Surgeons can plan out an exact strategy before an incision is even made.

“My goal as a surgeon is to make sure the first time around we are getting an adequate decompression,” says Dr. Rhiew. “This is where, in real time, I can see on the Navigation that I am, in fact, drilling wide enough. Without the Navigation, you are just going by what you can see visually. Then, if you do a CAT scan post-op you might wish it was wider. But with the Navigation you know right where your cut line is supposed to be.”

All the variances that once would make it impossible to perform minimally invasive surgery go away with Navigation.

A Brain Injury

Alia Hdeib, MD, is double-board certified as a neurological oncology surgeon and also a neurological spine surgeon. She shares Dr. Rhiew’s enthusiasm for the Neuronavigation equipment now at UH SJMC.

“It helps us in both brain and spine surgery because we can map right where we need to go in the spine and we can have accurate imaging for the brain as well,” she says.

Its presence on the UH SJMC campus means lives will be saved.

“We have the team, the experts, the facilities and the infrastructure to provide these services locally to everyone here on the west side,” she says. “We are very fortunate to be able to bring these services to the community and be present in the community when there is a need in an emergency or emergent setting.”

Recently, Dr. Hdeib received a patient who had experienced a serious cranial trauma with a subdural hematoma.

“To perform her surgery locally and not somewhere else saved her life,” said Dr. Hdeib. “Now, she is doing very well and was here for just a few days. It was because the facility here at UH SJMC had this process in place that allowed us to do it here and save her life in an emergent setting.”

The Neurological Institute at UH SJMC

The Neurological Institute at University Hospitals St. John Medical Center means world class care is uniquely delivered within a community setting.

UH SJMC Neurological Institute team members include Richard Rhiew, MD, Alia Hdeib, MD, and Tanvir Syed, MD.

“The UH Neurological Institute set on a grand plan a couple years ago with the focus on bringing the latest high tech advancements in neurological and surgical care to the community,” reports Nicholas Bambakidis, MD, Director, Neurological Institute, University Hospitals.

“This is one of these big core elements that brings to UH St. John Medical Center real advances in neurosurgical care. It also has many applications in addition to spine and spine surgery for cranial and trauma cases. UH St. John Medical Center is a Level 3 Trauma Center.”

“There are 72 physicians in the entire University Hospitals Neurological Institute,” reports Richard C. Hundorfean, Administrative Director, Neurological Institute at University Hospitals.

A wide range of neurologic conditions can be referred to the appropriate specialist within the Institute, including stroke patients, or aneurysm and more.

Now that UH SJMC has Neuronavigation equipment, Hundorfean expects other hospitals that lack its sophistication will be sending their emergency patients to UH SJMC.

“This speaks volumes to what we are able to do. This equipment is top of the line, state of the art,” he says. “You now have access to all of these great physicians, these surgeons and all of this new technology at a community location instead of having to travel long distances to get to a complex surgical site.

“Your complex care is no longer just downtown at the Cleveland Medical Center. This ensures that the complex and minimally invasive procedures that the Neurological Institute is doing here spreads from the West Side all the way to the East Side so patients can stay local, have it convenient and close to home. It truly is a team approach.”

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