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Israeli surgery removes pain-causing spine tumor with new technique

A minimally invasive procedure at Sourasky Medical Center successfully removes a painful a benign nerve tumor; advanced technique enables patients to resume physical activity within two weeks

Ariela Ayalon|
Last Sukkot, 44-year-old Neta Margalit Auerbach experienced a sudden and severe health crisis. "Out of nowhere, I was struck by intense pain along my entire left side. I couldn’t understand its origin and tried to alleviate it with medication. However, as soon as the medication wore off, the pain returned, forcing me to take more every four hours," recalls Neta, a clinical social worker and psychotherapist, married and a mother of three.
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נטע מרגלית אוירבך כריתת גידול שפיר מעמוד השדרה
נטע מרגלית אוירבך כריתת גידול שפיר מעמוד השדרה
Neta Margalit Auerbach
(Photo: Neta Margalit Auerbach)
"The pain would wake me up at night and persisted during the day, even while I was in my clinic treating patients. Whether sitting, standing, or walking, the pain was unbearable. To me, it felt like labor contractions in my leg," she described.
After the holiday, she consulted an orthopedic specialist who suspected the pain was caused by a benign tumor pressing on a nerve and suggested she adapt to living with chronic pain. "Living with chronic pain wasn’t an option for me," says Neta, "so I sought alternative treatment with a chiropractor. Fortunately, he was more perceptive than the previous doctor and referred me to a neurosurgeon."
Following a CT scan, the neurosurgeon diagnosed her with a schwannoma — a benign nerve tumor — and recommended open surgery with spinal fusion. "I sought a second opinion and was relieved to learn that at Sourasky Medical Center, this type of tumor can be removed using a minimally invasive approach.
"I underwent an MRI scan and, based on the results, was scheduled for surgery last month. While I’m not yet fully recovered, I’ve regained full functionality," she said.
A schwannoma is a benign tumor that develops from Schwann cells, which surround and insulate cranial nerves and other nerves in the body. "These tumors originate from nerve tissue. Although they are benign in most cases, they can cause significant pain and suffering," explains Prof. Zvi Lidar, Director of the Spinal Surgery Unit at the Sourasky Medical Center.
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לכתבה בלבד!  כריתת גידול שפיר מעמוד השדרה (החץ מצביע על הגידול)
לכתבה בלבד!  כריתת גידול שפיר מעמוד השדרה (החץ מצביע על הגידול)
Arrow points to the tumor pressing against the spine
"Schwannomas are soft tissue masses that can sometimes be detected during a physical examination as part of identifying the source of pain. They are highly sensitive — so much so that even a light touch can trigger an electric shock-like sensation along the affected limb," Prof. Lidar elaborates. The most common symptom is pain that follows the nerve’s distribution, which can appear in the arm, leg, back, abdomen, or spine.
"This benign tumor can grow either inside the spinal canal or outside it, near the spine. If left undiagnosed, it can cause paralysis in half of the body. When the schwannoma develops outside the spinal canal, it can lead to partial paralysis along the limb or within the quadriceps muscle," he added.
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In a study published in the scientific journal Surgical Neurology International, Prof. Lidar and Dr. Yuval Shapira, head of the Peripheral Nerve Reconstruction Unit at Sourasky, focused on the diagnosis of schwannomas.
According to their study, the diagnosis is often significantly delayed. On average, patients undergo a year of tests — many of them unnecessary — before being referred to a neurosurgeon, who can then identify the schwannoma. This delay is largely attributed to a lack of awareness among the initial physicians treating these patients.
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(Photo: Shutterstock)
"A patient might complain of heel pain and be treated with painkillers before being referred to physical therapy. When these interventions fail to alleviate the pain, imaging tests are ordered, which may come back normal," explained Prof. Lidar.
"During this time wasted on treating a localized issue that is actually nerve-related, the schwannoma continues to grow, exerting pressure on the nerve. As a result, sensation in the area diminishes, muscle function is impaired, and in severe cases, paralysis can occur. This delay in diagnosis can lead to irreversible nerve damage."
Diagnosis is achieved through MRI scans, and treatment is surgical. The Spine Surgery Unit at the hospital is among the few centers in the world that remove schwannomas using a minimally invasive approach.
Prof. Lidar added: "Traditionally, accessing a schwannoma requires removing the spinal joint, which can cause instability between the vertebrae, necessitating stabilization with screws. The minimally invasive approach eliminates the need for these steps."
פרופ' צבי לידרProf. Zvi LidarPhoto: Yuval Hen
During the procedure, the patient is placed on their stomach under general anesthesia. Using an advanced computer navigation system, the surgeon precisely identifies the cutting point without damaging the spine.
The accuracy of the incision minimizes the surgical area, and the operation is performed directly above the tumor, typically on the side of the spine at an angle that provides a shorter path to remove the tumor without removing the joint. The surgery takes about an hour, and patients are generally allowed to resume physical activity within two weeks.
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