A TIME OF BREAKTHROUGHS

AT MAIMONIDES SPINE CENTER, NEUROSURGICAL SPECIALISTS AND ORTHOPEDIC SURGEONS COLLABORATE ON ADVANCED, MINIMALLY INVASIVE, AND IMAGE GUIDED PROCEDURES

BY JESSICA JONES GORMAN • PHOTOS © AMESSÉ PHOTOGRAPHY

When Dr. John Houten was recruited to Maimonides Medical Center in 2016, he introduced a number of advanced, image guided spinal surgeries to the borough. The hospital’s administration saw the benefits of the advanced technology, and equipped the institution with state of the art neuro diagnostics and imaging tools.

Dr. Houten performed the first artificial cervical disc replacement and minimally invasive pelvic fixation in Brooklyn, as well as other advanced spinal surgical procedures for the first time in the borough.

Today, the Maimonides Comprehensive Spine Center continues to innovate and offers minimally invasive, image guided spine surgery with unprecedented precision.

“The past three and a half years have been the most transformative of my career,” noted Dr. Houten, who serves as the Director of Spinal Neurosurgery and Neurotrauma at Maimonides. “In this short period of time, we’ve been able to deliver a range of highly sophisticated procedures to the people of Brooklyn some of the city’s first applications of very advanced spinal techniques. What we’ve accomplished is nothing short of astonishing.”

“Image guidance provides an internal map and the ability to place spinal screws with great precision,” he explained. “But the robotic arm takes us to a whole new level with precision the human hand simply cannot accomplish.”

Dr. Houten, who specializes in these advanced techniques, completed medical school, a neurosurgical residency, and a spinal surgery fellowship at New York University (NYU) Medical Center before spending more than a decade as Chief of Spinal Neurosurgery at Montefiore Medical Center/Albert Einstein College of Medicine.

“I oversaw a tremendous expansion of the volume and sophistication of spinal neurosurgery procedures,” he said, detailing some of his notable accomplishments: performing the first artificial disc replacement and the first minimally invasive fusion procedures in the Bronx, and performing several complex spinal operations that drew regional and national media coverage.

For Dr. Houten, who is the son of a neurosurgeon, it was a field that captivated him from the start
“I was influenced by some very powerful personalities at NYU while I was a med student,” he noted. “The first neurosurgery I ever saw was performed by Dr. Joseph Ransoh off, who was a pioneer in this field. He was certainly an influencing factor on my career. And I spent a lot of time with a legendary pediatric neurosurgeon, Dr. Fred Epstein, who is credited with the development of several neurosurgical techniques to treat children threatened by brain and spinal cord tumors.”

Dr. Houten wrote a research paper with Dr. Epstein and even considered pursuing pediatric neurosurgery because of him. But it was during residency that he developed an interest in spinal surgery, a passion he’s maintained since.

“There aren’t many subdivisions in neurosurgery where you get such dramatic, immediate results as you do with spine,” he said. “If there’s something pressing on the cervical spinal cord prior to operation, patients might not be able to move their arms or legs or can experience dense numbness in all of their extremities. But once whatever is pressing is removed, even in the recovery room you will see a dramatic difference. It’s those types of immediate results that are extremely gratifying to a surgeon.”

Dr. Houten added that his training came at a pivotal time.

“When I was still in residency, there was a tremendous shift in the use of technology,” he said. “Neurosurgery in general is a much more technologically driven specialty, but in the mid1990s there came something of an explosion of technology.”

Dr. Houten explained that in the decades since, procedures have become even more refined, leading to a variety of breakthroughs in the surgical specialty. And many of those advanced techniques are being offered at Maimonides Comprehensive Spine Center, which opened in 2018.

Located on Bay Parkway, the Center provides treatment for adults and children with neck and back conditions. Its team of nationally recognized orthopedic and neurosurgery spine experts treat routine and complex conditions and injuries with minimally invasive image guided surgery, which speeds recovery time, minimizes scarring, and reduces the need for medication after surgery. There is also a strong focus on multidisciplinary spinal care, with neurosurgeons and orthopedic surgeons working collaboratively.

“There are certain areas of surgery that require such teamwork,” Dr. Houten said. “If a tumor is pressing on the spinal cord and damaging the bony spine, a neurosurgeon is needed to remove that aspect of the spine, but an orthopedic surgeon collaborates, helping to stabilize the tissue that surrounds the spine and correct any deformation that has occurred.”

Dr. Afshin Razi, Vice Chair and Residency Program Director of Orthopedics, whose surgical practice focuses on the diagnosis and treatment of spinal disorders in adults and adolescents, partners with Dr. Houten on such cases.

“Interestingly, past studies have shown that performing procedures with two spine surgeons not only improves the outcome but also decreases complication rates,” Dr. Razi noted. “Dr. Houten and I collaborate on complicated cases when care needs to be addressed from both orthopedic and neurological standpoints.”

Dr. Razi’s specific areas of interest include degenerative diseases of the back and neck (such as disc herniation, degenerative disc disease, and spinal stenosis); pediatric and adult deformities (scoliosis and kyphosis); and fractures of the spine, including compression fractures and those caused by tumors. He has been involved in a wide range of spine related research projects and is the author of several book chapters and scientific articles. Prior to taking on his expanded role at Maimonides, Dr. Razi served for 15 years as faculty and Clinical Assistant Professor in the Department of Orthopedic Surgery at NYU Langone Medical Center (formerly known as the Hospital for Joint Diseases) and as a partner in Madison Avenue Orthopedic Associates.
Born in Iran, Dr. Razi came to America when he was 18 years old and decided to pursue medicine in order to build a secure future.

“I had no money,” he recalled. “And the only way I could survive and grow myself was to study, and studying medicine appealed to me.”

He attended Albert Einstein College of Medicine and completed his residency and fellowship at the Hospital for Joint Diseases. He went into private practice for seven years before working at NYU Langone, and joined the staff at Maimonides in 2008.

“The Orthopedics Department here has a long history of distinction and has gone through a lot of positive changes under the leadership of Dr. Jack Choueka, Chair of the Department,” said Dr. Razi. “He has built a great department; we used to only have four attending surgeons, now we have more than 20. We’ve been able to take on more residents and grow our teaching program exponentially. Our base practice sees over 55,000 patients each year, and we are a major trauma center, taking care of a wide array of serious injuries 24/7.”

Together, Dr. Razi and Dr. Houten perform dozens of minimally invasive treatments. And thanks to the recent introduction of robotic spine surgery at the institution, Dr. Razi said that even more groundbreaking procedures are possible.

Dr. Houten agreed.

“A lot of our attention over the next five years is going to be on the application of this robotic technology,” he said. “But looking beyond that five year time frame, I think we’ll be investigating restorative therapies, such as applying stem cells and other biological methods in an attempt to rejuvenate the spine. It’s a very exciting time for this specialty and for medicine in general.”

Maimonides Comprehensive Spine Center
6010 Bay Parkway, 8th Floor / 888.MMC.DOCS
maimonidesmed.org/spine