A NEW ERA IN SPINE MEDICINE: PRECISION SURGERY, ADVANCED TECHNOLOGY AND ARTIFICIAL INTELLIGENCE

Dr. Elias Haddad, a senior physician in the Spine Surgery Unit at Rambam Hospital, was called to evaluate a case that left even his experienced medical team uncertain. A patient suffering chronic back pain presented with complex imaging results, raising serious doubts about whether surgery was advisable.
After multidisciplinary discussion, the consensus was that surgery was too complex to be risked. The patient, however, would not accept the decision.

"All my life, I've walked like a duck," she told Dr. Haddad firmly. "Children followed me in the street, mocked me.Still I refused to have a hip replacement surgery that was recommended to me. But this pain is far worse than anything I have experienced, and you have to help me"

Her words moved the team, and reopened the discussion. Among the alternatives, one option stood out: disc ablation, a minimally invasive procedure that Dr. Haddad had initially regarded with skepticism. The team decided to go ahead.

The morning after the procedure, Dr. Haddad walked into his patient's room, "and she got out of bed and ran toward me," he recalls. "She told me it was the first night she'd slept properly in months."

This case demonstrate Dr. Haddad's ability to think beyond conventional protocols and embrace innovative solutions to serve the patient's best interests — a skill honed through years of training, practice and intuition.

A Change in Course to Surgical Innovation
Dr. Haddad never intended to become a spine surgeon. His path changed in his fifth year at the Technion medical school, when he broke his elbow. "That exposed me firsthand to the world of orthopedics, and completely shifted my focus," he says. In 2013, following a clinical fellowship in spine surgery in Toronto, he joined the Rambam Medical Center as a senior physician. In 2018, he went to the UK for further training in scoliosis correction, spinal reconstruction, alignment procedures and advanced spinal endoscopy.

The Art and Precision of Spine Surgery
Spinal surgery drew him, he says, because of its combination of delicate fine motor skills with major structural work. "On one hand, you're an engineer, dealing with the spine's complex mechanics — screws, fixations and biomechanics. On the other, you're working with a microscope on delicate nerve tissue, where the margin for error is nearly zero."

A self-described perfectionist, Dr. Haddad routinely spends hours at the microscope. His surgical approach, whether using a large or small incision, depends entirely on the patient's physiology and clinical need. "Imaging gives me the roadmap, but in the end, it's listening to the patients' needs and the experience, what can I fix with my hands, that guide the surgery and determine the outcome," he says.

He is keenly aware of the stakes. "A tiny mistake — a deviation of a millimeter or unintended nerve damage or a poor decision during surgery — can lead to paralysis or permanent disability. But if we get it right, the transformation can be life-changing."

Many of Dr. Haddad's patients return to work, to driving, even compete in triathlons and cycling events. "They send me photos showing me they're in the best physical shape of their lives," he smiles. "That's what keeps me going."

Fast Recovery, Long-Term Results
Success in spinal surgery begins long before the incision. It starts with choosing the right approach, managing expectations and knowing not just when to operate but also when not to operate. "My commitment is to the process, not just the result," says Dr. Haddad.

When surgery is the appropriate choice, results are often immediate, seen in a patient's first steps after recovery. When it is not, conservative treatments and minimally invasive options offer a cautious, tailored response. Thanks to recent technological advances, these options are increasingly effective and accessible.

"The field is changing and capabilities are improving," says Dr. Haddad. "Today, we can perform complex surgeries through small incisions, minimizing soft tissue damage and accelerating recovery."

Game-Changing Technology
In the operating room, precision technology is key. "Advanced navigation systems show me exactly where I am in relation to vital structures," says Dr. Haddad. "With navigation systems and robotic assistance, we can place screws with high precision and minimize damage to surrounding tissue."

The result: patients who once stayed in bed for days after surgery are now up and moving within hours, and often discharged within a day. It is now known that the sooner a patient gets up and moving, the faster and smoother the recovery process.

Hope in Critical Moments
Dr. Haddad remembers a particularly dire case: a four-year-old boy with a fracture-dislocation of the spine caused by a fall. Unconscious, intubated and immobile, his prognosis was grim.

Dr. Haddad waived a family event that day to perform the complex surgery. "To my amazement, the next morning, the child was moving his legs," he recalls. "Six weeks later, his mother told me he wouldn't stop jumping and climbing. That experience reinforced a key principle for me: "Always give a chance, even when the literature says the odds are low."

Tailored Solutions for Diverse Conditions
Spine surgery addresses six main areas: trauma, oncology, deformities, infections, metabolic diseases and, most common, degenerative spine conditions, such as herniated discs, spinal stenosis and wear and tear.

"In cancer, around 60 percent of patients who develop skeletal metastases, including in the spine," explains Dr. Haddad. "But where life expectancy used to be five years, today it's often much longer. This shift demands a new approach from surgeons: long-term solutions rather than short-term pain relief."

Dr. Haddad also treats spinal deformities (like scoliosis or kyphosis, especially in older adults), full vertebral collapse, and infections or metabolic diseases which sometimes bring fever and chronic pain. What all have in common is the need for accurate diagnosis, clear communication and personalized care, whether surgical or conservative.

Beyond Technique: A Philosophy of Care
In his mentorship of students and residents, Dr. Haddad emphasizes more than just surgical technique. "I teach that the doctor-patient encounter is crucial," he says. "I tell them that if we listen carefully enough, the patient will often tell us the answer."

Sometimes, the solution lies not in another scan but in a return to the basics: listening and observation. "Clinical intuition and empathy come before protocol," he stresses. "Medicine isn't just about following the book. Listening, humility and judgment are as important as technical knowledge."

When Surgery is not the Answer
Surgery is not always the answer. Dr. Haddad often turns to a range of non-surgical and minimally invasive treatments, tailored to the patient's needs. These include epidural injections to reduce nerve root inflammation; PRP (Platelet-Rich Plasma) and Orthokine — biologic therapies derived from the patient's own blood that promote healing and reduce pain; and radiofrequency ablation, a targeted treatment for chronic nerve pain.

"The right solution depends on the individual," he stresses. "There's no one-size-fits-all approach in spinal care."

The Future: Robotics, AI and Personalized Medicine
Looking ahead, Dr. Haddad sees enormous promise in integrating robotics and artificial intelligence into spinal care. "AI is already part of medicine. It helps us make smarter, data-driven decisions," he says. "When combined with robotics, we're able to offer more precise, customized treatments."

This is not, he believes, a distant future. It is already unfolding. Within a decade, he says, such tools will be standard. "This is where medicine should be headed," he concludes. "A blend of expertise, technology and human connection. That's how we give every patient their best chance at a full, healthy life."

Dr. Haddad's Tips for a Healthy Back
Most back problems develop gradually, and many are preventable. Dr. Haddad offers three core principles:

• Maintain a healthy, balanced diet
  Supports weight control and muscle preservation.
• Get consistent, high-quality sleep
  Recovery begins with rest.
• Engage in regular strength training
  Aim for 150 minutes per week.

Why strength training? After age 40, we lose ~1 percent of muscle mass per year. "If you don't do strength training, by age 60 you'll be 20 percent weaker than at 40," warns Dr. Haddad. Sarcopenia (muscle loss) is a major contributor to back pain in older adults. "My practical advice is to focus on strengthening your core, back and leg muscle — they support your spine in daily life," he says. "Those who stay active age with dignity and maintain good quality of life."

In collaboration with Dr. Elias Haddad

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