Neurosurgical Spine Service

Overview

Access to Specialized Spine Surgeons

Neurosurgery Spine surgeons at Mass General perform surgeries on the full range of degenerative, traumatic, oncologic, vascular and congenital conditions of the spine. Our spine surgeons are technically versatile in all aspects of decompression surgery as well as reconstruction of the spine.

Each surgeon in our program has an area of specific sub-specialization, focus, and interest within spine surgery. This includes nerve and spinal cord compression syndromes, peripheral nerve entrapment, intradural spine and nerve sheath tumors, tumors affecting the spinal column and scoliotic deformities of the spine.

What to Expect

Send Your Imaging

We ask that you mail us a CD of all of your recent spine scans. This may include MRI, CT and x-ray imaging. Reviewing your scans before your first visit helps us determine the best course of action for your treatment and ensures that you see the most appropriate specialist.Please mail your scans to:

Clinical Access Nurse
Massachusetts General Hospital
Neurosurgical Spine Service
Wang Ambulatory Care Center 745
15 Parkman Street Boston, MA 02114 

Your First Visit

In most cases, your first visit will be a consultation with one of our neurosurgeons to discuss your condition and to review surgical options. We encourage you to bring friends and family to these consultations as a good support system can go a long way in helping manage the psychological, emotional, and physical challenges of going through spine surgery.

Depending on your surgeon, you may also be introduced to a nurse practitioner (NP) who is an integral member of your team The NP will partner with you for the duration of the process, from the consultation all the way through recovery and the post-operative visits.

Post-Operative Visit

When you have spine surgery with one our surgeons at the MGH, we will schedule a series of post-operative appointments with your doctor and NP. During these visits, we will examine your progress and provide guidance for your recovery. Your surgical team will provide you with detailed instructions to help you make the most of your recovery. This includes help with managing your pain and making recommendations for physical therapy.

Conditions and Procedures

We are a collaborative and comprehensive team of spine surgery specialists, including world-renowned surgeons, researchers, and nurse practitioners. Our experts have deep expertise across the vast spectrum of spinal conditions, from common to complex. We personalize our approach for each patient and look forward to working with you.  Below is a select list of conditions our surgeons have expertise in. The field of spine surgery is broad and this list is not meant to include every condition we treat. If you would like more information, please contact our clinical access nurse.

Degenerative and Congenital Spinal Conditions

Our spine surgeons work closely with colleagues in the Departments of Physical Medicine and Rehabilitation and the Pain Center to provide multidisciplinary care for painful, debilitating spinal conditions. We strive to ensure that each patient is seen by the specialist who best meets their needs at the time of consultation.

Our surgeons provide a full range of surgical options to address compression syndromes affecting the spinal cord and nerves. When appropriate, our team may refer you to colleagues in Physical Medicine and Rehabilitation or the Pain Center to ensure that you have maximized medical and physical therapies to treat your condition.

Our neurosurgeons are world-renowned for their microsurgical skill and surgical decision making. We utilize the latest in surgical technology to perform microsurgery for the most difficult spinal cord and nerve compression syndromes.

• Cervical disc disorders
• Cervical myelopathy
• Cervical radiculopathy
• Cervical stenosis
• Chiari malformation
• Thoracic disc disorders
• Thoracic stenosis
• Lumbar disc disorders
• Lumbar radiculopathy
• Lumbar spondylolisthesis
• Lumbar stenosis
• Spinal arteriovenous malformations
• Tethered cord
• Traumatic fractures of the spine
• Ossification of the posterior longitudinal ligament (OPLL)

Spinal Deformity and Scoliosis

Scoliosis and deformities of the spine can cause serious pain and disability affecting the way you stand and walk. Many patients cannot do the activities they wish to do because of their pain and the impact on their quality of life. As such, many patients give up on the hope of returning to their favored activities due to failure to improve despite physical and medical therapies. Common degenerative conditions including disc degeneration, stenosis or spondylolisthesis can make surgery for scoliosis more complicated.

Our neurosurgery spine surgeons take into account all aspects of your health, spine, and function to tailor and present specific individualized treatment options for you. Our team of surgeons and nurse practitioners will help guide you through surgery and recovery.

Our neurosurgeons perform complex spinal reconstructions for the most challenging deformities that affect the spinal column, from the neck to the low back. Patients travel from around the world to seek specialty surgical care with our experts.

We use the latest technologies and surgical techniques to offer patients innovative and advanced solutions to their spinal deformities. This includes using sophisticated surgical planning computer software, predictive analytics, intra-operative CT imaging and computer-based spinal navigation. Our surgeons offer both minimally invasive and open reconstruction options.

In certain complex cases, our surgeons may lead and assemble a team of surgeons to ensure the best possible outcome for you. Depending on the situation, the team may include either orthopedic, plastic, vascular, or thoracic surgical specialists. The need for a multidisciplinary team-based approach depends on each case and will be discussed with you in great detail. Below is a list of the most common spinal deformities we treat:

• Kyphosis
• Chin-on-chest deformity
• High-grade spondylolisthesis
• Flat back deformity
• Post-laminectomy syndrome
• Revision lumbar fusion surgery
• Adult degenerative scoliosis
• Neuromuscular scoliosis
• Spine deformities related to Marfan syndrome and related conditions
• Basilar Invagination
• Craniocervical instability
• Spinal instrumentation failure
• Post-traumatic deformity
• Post-infectious deformity
• Ankylosing spondylitis

Spinal Cord and Spinal Column Tumors

In the Department of Neurosurgery at Mass General, our spine neurosurgeons treat the full spectrum of tumors that affect the nervous system and the bones that make up the spinal column. Whether you have a spinal cord ependymoma or a chordoma, our neurosurgeons have the experience to guide you through treatment. Each of our spine neurosurgeons has specific expertise with the various tumors and we will help connect you with one of our world class surgeons.

There are many different types of tumors that involve the spinal cord, nerves, and vertebrae and each requires a different diagnostic workup and evaluation. We understand the anxiety and uncertainty with having a tumor in the spine and will work with you to expedite the consultation, workup, and treatment.

Our spine neurosurgeons are international thought leaders in the treatment and management of spinal tumors and offer highly specialized treatments for resection. Depending on the tumor type, this may involve surgery, radiation, medical therapy, or a combination of each.

Intradural Spine Tumors

Our neurosurgeons have expertise in surgery for intradural tumors such as meningioma, schwannoma, astrocytoma, hemangioblastoma. Our spine neurosurgeons have some of the largest surgical series and experience with the treatment of these tumors over the last several decades.

These are tumors that grow within the spinal cord, around the spinal cord, or from a nerve within the spinal column. These tumors may cause pain, weakness, numbness, and in severe cases affect the ability to stand, walk, or use the arms or legs.

While the cause of spinal tumors is something we do not know at this time, certain immune disorders and genetic conditions can increase one’s likeliness of developing a spinal tumor. In these situations, our spine neurosurgeons collaborate with specialists in Neuro-Oncology and Medical Oncology to provide multi-disciplinary care.

Some of the most common intradural spinal tumors we treat are:

• Astrocytoma

• Ependymoma

• Hemangioblastoma

• Meningioma

• Schwannoma

• Neurofibroma

• Neurofibromatosis

• Malignant peripheral nerve sheath tumors

Metastatic Spinal Tumors

Metastatic spinal tumors are tumors that spread to the spine from cancer that has affected other organs in the body, such as breast, lung, and prostate.

The management and treatment of metastatic spinal column tumors is complex and benefits from multidisciplinary communication and collaboration with experts in medical oncology, radiation oncology, interventional radiology, and palliative care. Each tumor that involves the spinal column presents unique surgical and oncologic challenges. With advances in medical and radiation oncology, patients are living longer but may struggle with pain and disability related to spinal cord or nerve compression. In some cases, this can lead to weakness, paralysis, and the inability to stand or walk. Because of the way that cancer affects the bone in the spinal column, this may also lead to painful fractures.

At Mass General, our spine neurosurgeons are leaders in the multidisciplinary management of metastatic spine tumors. Each case is discussed with experts in a team-based approach, ensuring that all specialists communicate their recommendations and review treatment options in a coordinated manner. When cancer affects the spine, surgery alone is usually not the only intervention required and the timing of treatments like radiation, chemotherapy, and immunotherapy need to be planned and coordinated.

Here at Mass General, our spine neurosurgeons offer a wide range of therapeutic interventions for metastatic spine tumors including open and minimally invasive spine surgery, spine stabilization surgery, cement augmentation, and stereotactic radiosurgery. Our surgeons are also international leaders in clinical and basic science research, advancing the field through molecular research as well as clinical trials, biobanking, and registry studies. We are dedicated to improving pain and quality of life for those affected by cancer.

Whether you are being treated by medical cancer specialists at the Mass General Cancer Center or another hospital, our team will work with yours to ensure continuity of your care.

Primary Spinal Column Tumors

Tumors that come from the bone can cause pain and symptoms of nerve or spinal cord compression if the tumor has grown outside the spinal vertebrae. Sometimes, these bone tumors are found incidentally during a workup for another medical condition. Most of the time, these are detected on MRI or CT imaging because of ongoing pain, numbness or weakness.

Tumors that come from the bone in the spinal column can be benign or malignant. Some benign tumors like chordoma may behave aggressively and be difficult to resect or control with surgery alone. The diagnosis of the tumor will ultimately help determine the appropriate management as this may entail surgery, radiation, medical therapy, or a combination of each.

At Mass General, the care for patients with primary spinal column tumors such as chordoma and sarcomas is multidisciplinary and emphasizes a team-based approach, drawing upon the vast expertise of specialists in bone and spine oncology. Challenging cases are reviewed in a weekly conference and our team utilizes all the advanced resources Mass General has to offer to treat these tumors, including reconstructive surgery and proton beam radiation therapy.

Our spine neurosurgeons have expertise in complex spinal tumor resection and reconstruction surgery from the base of the skull to the sacrum and are leaders in the field.

We work together as a team with experts in orthopedic oncology, plastic surgery, thoracic surgery, vascular surgery, and surgical oncology to name a few, to provide exceptional state-of-the-art care for patients. For an individual case, several different surgical specialists may work together to ensure the best possible outcome.

• Chondrosarcoma
• Chordoma
• Giant cell tumor
• Osteosarcoma
• Sarcoma
• Hemangioma
• Aneurysmal bone cyst

Minimally Invasive Spine Surgery (MISS)

Minimally Invasive Surgery is a technique designed to decrease the amount of disruption to the tissues of the body while still accomplishing the treatment goals. Minimally invasive spine surgery involves using small openings with less muscle dissection, such as a small tube (<2 cm), to perform decompression and image guidance with small incisions to perform fusion surgeries.

Benefits

The benefits of minimally invasive spine surgery are less post-operative pain, less blood loss, and shorter length of stay in the hospital. Some patients find they can also return to normal activities more quickly. For patients with other medical problems (such as cancer or heart problems), these procedures can lead to a faster return to their medications and other treatments.

Procedures and Techniques

Many MISS procedures are done through a tube or a small incision with limited muscle dissection. Procedures to decompress the nerves and/or fuse the spine can be performed using MISS techniques. Advanced imaging techniques and navigation are used to perform these procedures.

Decompression Procedures

• Laminectomy
• Discectomy
• Resection of mass

Fusion Procedures

• Transforaminal Interbody Fusion (TLIF)
• Extreme Lateral Interbody Fusion (XLIF)
• Anterior Lumbar Interbody Fusion (ALIF)
• Percutaneous Pedicle Screw Fixation

Motion-Sparing Surgery

• Cervical Arthroplasty

Pain Management Procedures

• Spinal Cord Stimulators

Patient Information

Patients with degenerative spine disease, traumatic injuries to the spine, tumors or cancer in the spine, and pain are possible candidates for minimally invasive spine surgery. While treating patients with a minimally invasive technique is always our goal, sometimes these techniques are not best for patients because of their disease. A spine surgeon can help guide you through this decision to find the best treatment for you.

Meet Our Team

Spine Deformity/Oncology/Complex Reconstruction

Ganesh Shankar, MD, PhD

Neurosurgical Spine

Intradural Tumors, Nerve Tumors, and Degenerative Spinal Disorders

Lawrence Francis Borges, MD

Neurosurgical Spine

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Jean V. Coumans, MD

Neurosurgical Spine

Degenerative Spine and Peripheral Nerve Disorders

Ziv Williams, MD

Functional Neurosurgery
Peripheral Nerve Surgery

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Justin M. Brown, MD

Peripheral Nerve Surgery

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Jeffrey S. Schweitzer, MD, PhD

Functional Neurosurgery
Community Neurosurgery

Degenerative Spinal Disorders, Minimally Invasive Spinal Surgery

Theresa Williamson, MD

Complex Spine Surgery
Neurotrauma

Conservative Treatment Team

Jennifer Kurz, MD

Physical Medicine & Rehabilitation

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Edward Wei, MD

Physical Medicine & Rehabilitation

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Herbert Cares, MD

Neurosurgery

Advanced Practice Practitioners

Julia Bireley, PA-C

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Kathleen Lavoie, NP

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Kristina Shultz, NP