A Unique Surgery Performed at Ichilov, Removing Vertebrae Through the Nasal Passages

In the Israeli hospital Ichilov, a man suffering from severe neurological disorders caused by spinal stenosis was saved from disability by performing a unique and complex intervention. Using an innovative technique, Israeli specialists removed the damaged cervical vertebrae through the nasal passages. The new approach not only reduced the volume of traumatized tissues but also avoided the risk of postoperative complications and prolonged recovery.

A 60-year-old employee of the Nigerian embassy in Tel Aviv had lived for many years with a diagnosis of "spinal canal narrowing," which caused him constant severe pain. The stenosis led to compression of the spinal cord and its nerve roots, responsible for the ability to move and control the functions of the pelvic organs. Several years ago, the man underwent surgery to widen the spinal canal, but it did not provide significant relief. Doctors insisted on a repeat intervention, but the patient, disheartened by the first failure, was reluctant to agree for a long time. "Only when my condition noticeably worsened, the pain became unbearable, sensitivity decreased, and the prospect of remaining disabled for life loomed on the horizon, did I decide," says the man.

By that time, he already exhibited severe neurological symptoms affecting both arms and legs. "He could barely move his arms, had difficulty walking, and also began to have problems controlling the functions of the urinary and anal sphincters," says Tzvi Lider, head of the spinal surgery department at Ichilov Hospital. The patient was promptly sent for examination, which confirmed the presence of severe compression of the spinal cord in the area of the cervical vertebrae located near the skull. "We could not wait; irreversible changes could occur at any moment, and he would be paralyzed," admits Dr. Lider. Urgent preparations for surgery began.

At the council, it was decided to perform the intervention using a new technique, removing the damaged vertebrae through the nostrils. As a backup option, doctors considered the possibility of performing the necessary manipulations through the oral cavity. This is a well-established method; however, it has several drawbacks, including greater trauma, the risk of disrupting the swallowing mechanism, damaging major arteries, causing changes in the functioning of the speech apparatus, and many others.

Since the intervention was ultimately decided to be performed through the nose, one of the best ENT surgeons in Israel, Avraham Abardzhil, was invited to participate. "After the anesthesia took effect, I inserted a flexible endoscope with a tiny camera at the end into the right nostril, which transmits images to a large screen. Then I carefully shifted the back ends of the inferior nasal concha, thus preparing the surgical field," says the doctor. After that, he performed the same actions through the left nostril. According to him, this approach simplifies the removal of vertebrae and provides greater mobility for microsurgical instruments in the nasal cavity.

Next, Dr. Abardzhil removed a fragment of muscle tissue from the back of the throat, exposing the necessary vertebrae, and handed over to his colleague, Professor Lider. The neurosurgeon carefully inserted instruments into the patient's nasal cavity, using them to remove the destroyed vertebrae, which took about three hours. After that, the surgeons closed the resulting cavity with a living flap of muscle tissue taken from the man's leg to prevent cerebrospinal fluid leakage into the oral cavity.

At the final stage, they introduced a special sealing substance into the patient's nasal cavity, thus creating a protective shell that completely closed the empty space. By connecting all the tissues and arteries, the doctors literally reformed a new nasal cavity. Such a complex surgery was performed in Israel for the first time, and it was successful.

After the intervention, the patient, still under anesthesia, was transported to the intensive care unit. For some time, he was not awakened from anesthesia, as it was dangerous – any movement could have negative consequences. However, a day later, the man was transferred to the postoperative ward. At that time, he tried to drink and eat independently – the doctors wanted to ensure that the swallowing function was not impaired after the intervention.

The surgeons acknowledge that although the operation was successful, it is still too early to introduce such a complex surgical technique into standard practice. But they hope that this can be done in the near future.

The patient is currently recovering from the intervention, and the doctors note a significant improvement in his condition and are pleased that they were able to prevent the risk of paralysis. At the same time, they note that the man delayed the surgery significantly, so restoring motor functions will take a long time and he is unlikely to be able to do so completely.