The Center for Minimally Invasive Spine and Neurosurgery

(Click) Dr. Noel Perin's abbreviated curriculum vitae, publications, and honors and awards.

View a video of Dr. Noel Perin and his staff.

Dr. Perin was previously the Director for Spine and a member of the Faculty at Mount Sinai Medical center until the year 2000 when he moved to the Center's present location. He joined the Faculty at St. Luke’s / Roosevelt Medical center and the Beth-Israel continuum in October 2000.

Along with Dr. Chandranath Sen and Dr. Peter Costantino, (who moved from Mount Sinai during the same period), a very strong Department of Neurosurgery at the Roosevelt site in midtown Manhattan was established.

The Center currently has eight Neurosurgeons, three Pediatric Neurosurgeons from Columbia Presbytarian Hospital, three Interventional Neuroradiologists, four Neurosurgery Residents, ten Physician assistants, six Nurse practioners, and a Fellowship training program in Minimally Invasive Spine Surgery, Base of Skull Surgery and Interventional Neuroradiology.

The Center for Minimally Invasive Spine and Neurosurgery runs four dedicated Neurosurgery rooms daily, with dedicated Neuroanesthesiologists headed by Dr. Jonathan Lesser. We are equipped with the latest state-of-the-art equipment, including Computer Navigation systems (Brain-Lab, Stryker), 3-D Fluoroscopy (Seimans Iso-C), to Stereotactic and minimally Invasive systems.

Dr. Perin's practice is confined entirely to the treatment of disorders of the spine and spinal cord.  The problems he tackles the most involve pain in the lower back and neck. Lower back pain is one of the most common presenting complaints in the Adult population. The causes of lower back pain are numerous. The commonest cause being Lumbar disc herniation or what is commonly referred to as a “slipped disc”. Patients can present with lower back pain and pain radiating down into the legs. The majority of these patients can recover with conservative treatment using Anti-inflammatory medications and rest. However some of these patients can develop intractable pains with numbness and weakness in the legs, which might require surgical treatment. Minimally Invasive endoscopic approaches have significantly improved outcomes and early return to normal activity.  Similarly neck and arm pains are common presenting complaints that could be treated conservatively with a soft cervical collar and Anti-Inflammatories. Most patients will respond to conservative treatment, however patients with weakness in the arms with gait difficulties and evidence for Spinal cord compression on the MRI should be considered for surgery.

Tumors in the spine and spinal cord commonly present with pain. The most common tumors to affect the spine are the tumors (cancers) spreading from other sites via the blood, and destroy the bony elements resulting in a collapse of the bone with Instability and pressure on the nerves.

Spinal cord tumors are rare tumors occurring inside the spinal cord, mostly occurring in the cervico-thoracic region (lower neck to upper chest). Commonly present with pain, may present with weakness and numbness in the arms and legs, difficulty walking loss of balance and urinary difficulty. An MRI with contrast is the test of choice. Two common tumors occur within the spinal cord

• Ependymoma

• Astrocytoma. The ependymoma occurs in the adult patients, is benign and in most cases can be removed totally to afford a cure. The astrocytomas occur more commonly in children; they are more diffuse and are more difficult to remove completely. Both tumors are benign but can grow back locally.

One of Dr. Perin's recent Interests has been in the diagnosis and treatment of a condition called “Spinal Cord Herniation”; we first diagnosed and operated on a patient with spinal cord hernia in 1992. At the time there were only 11 cases that had been reported in the English literature. We recently published an article describing our experience with 7 patients who had presented with this condition (Journal of Neurosurgery – Spine).

In collaboration with Dr. Perin's Cranial base colleagues Drs. Sen and Costantino, he has treated several patients with tumors at the base of the skull and the upper part of the neck. Our group has one of the largest series of patients treated with “Chordomas” (rare tumor arising from remnants of the spinal cord), at the base of the skull.

Tumors at the lower end of the spine and tail bone (Sacrum and Coccyx), common tumors include – Chordomas, Giant cell tumors.
These tumors destroy the bone and involve the nerves for Bladder and Bowel function. In collaboration with Drs. George Todd (vascular surgery), Mitchel Bernstein (colorectal surgery) and Mark Sultan (plastic & reconstructive surgery) we have successfully resected large tumors in these locations.

Dr. Perin developed an interest in Endoscopic surgery of the thoracic spine in the 90s, while working in Cincinnati, Ohio. Pain over the thoracic spine with pains running around the chest with weakness and numbness in the legs can be due to thoracic disc herniations. The standard operation involves opening the chest (thoracotomy) to remove these discs. In collaboration with thoracic surgery (Dr. Cliff Connery) they are able to remove the disc using Endoscopic techniques using 3 to 4 small openings, thereby reducing postoperative pain and getting patients back to normal activities, early. They have used similar techniques to remove tumors of the thoracic spine and tumors that arise adjacent to the spine (Schwannomas, Neurofibromas)

In the Lumbar spine almost all operations are performed using minimally invasive techniques. Using small tubes, endoscopes and the microscope we can remove disc herniations, create more room for the nerves in cases with narrowing of the spinal canal (Stenosis), and perform fusion operations where indicated with tiny openings, thereby reducing un-necessary damage to normal tissues, reducing pain after surgery and returning patients to normal activities sooner.

Dr. Perin's other Interest is the treatment of patients with excessive sweating (Hyperhidrosis). These patients suffer with severe sweating of the hands, armpits and feet. Dr. Perin and his team are able to interrupt the nerves to the sweat glands; the procedure is done endoscopically using two tiny openings in the armpits. The results are immediate and the patients go home in 24hours.