The term “renowned leader” gets thrown around a lot, but neurosurgeon Ernest Braxton has an abundance of experience, expertise and proven innovation to solidly back that claim. Braxton, a neurosurgeon at Vail-Summit Orthopaedics & Neurosurgery, was the first surgeon in the nation to perform minimally invasive spinal surgery; in 2018, he inserted an artificial disc into a patient’s spine through the belly button.

In 2016, he was the first surgeon in Colorado — and one of the first in the U.S. — to successfully perform an awake surgery. Traditional neurosurgery knowledge maintained that spinal fusions were too long, painful or complex to undertake awake, but Braxton proved that idea fictitious.

Minimally invasive surgery

Braxton’s experience as a neurosurgeon in the military helped shape his commitment to performing the most minimally invasive surgeries possible, in order to promptly return soldiers back to duty. He served as a neurosurgeon during the war in Afghanistan, as well as the chief of neurosurgery at San Antonio Military Medical Center — the Department of Defense’s largest medical treatment facility with the highest acuity and volume of any military hospital. While the war raged in Afghanistan, he contributed to a 96% survivability rate for incoming wounded, including severe traumatic brain injuries and complex spinal fractures from explosions.

“I’m passionate about minimally invasive spine surgery because patients return to performance faster,” Braxton said.

He transferred his surgical experiences within the military to serving civilians in the Vail Valley and beyond, so they can return to the sports and activities they love.

He views minimally invasive surgery not as a procedure, but rather, a philosophy. He customizes his surgical approach to each patient, isolating the problem that prevents the patient from fully enjoying life and finding a surgical intervention that returns the person to an active life, whether that’s through inserting an artificial disc, thinning away a bone or a disc to free up a nerve or fusing a painful spine.

He often utilizes computer assisted systems, which he likens to GPS navigation or x-ray vision. The computerized systems allow him to make smaller incisions; they employ microscopes to show areas he needs to trim, like bone or discs, or possibly fuse. While some surgeons face a barrier in transitioning to performing surgery with these computerized systems and microscopes, Braxton’s training stems from working on the brain — arguably the most complicated and intricate organ in the body.

“I’ve had many years working under a microscope and being comfortable working in a very small area rather than just (opening up) and exposing things,” he said.

In routine spinal fusion surgeries, Braxton prevents core muscle from dying and the associated higher risk of infection by cutting small incisions on the side of the spine and spreading the muscles, rather than completely slicing through muscles. Other, more invasive, surgeons cut closer to the spine and strip the muscles off the bones to fuse vertebrae. This traditional, invasive method stops blood flow to the muscles, which causes muscles to die, making them impossible to rehabilitate and prone to infection, Braxton said.

Awake surgeries

Braxton advocates awake surgery, without the use of heavy anesthetics, for three main reasons. First, it results in faster recovery and avoids risks; patients older than 60 and those in high elevations like Vail have a higher percentage of anesthesia-related post-operative cognitive dysfunction, including memory and executive function problems, which can last weeks and up to a year. While traditional spine fusion surgeries require patients to remain hospitalized for three to four days, awake patients leave the hospital the same or next day.

Second, awake surgeries allow doctors to talk to patients, who literally feel the relief while still on the table, after the problem is surgically repaired. Surgeons can test a motion, such as a leg movement that previously caused pain, and ensure the pain is gone. Braxton likens such tests to a mechanic fixing engine problems; starting up the car confirms it works.

Finally, awake surgeries promote a patient-centered environment, right down to the type of music played during surgery.

“It allows me to be more delicate with neurological structures and creates a more professional atmosphere that is centered on patient care, and patients seem to recover better because of more gentle handling of the tissue,” he says. “If it doesn’t hurt during surgery, usually it doesn’t hurt after surgery.”

Though an awake spinal fusion may sound painful, Vail Valley residents like Tom Kleinhardt, who underwent a fusion June 20, 2019, don’t experience pain.

“Your body feels some motion, and you feel pressure and a little jerking, but nothing to be concerned about,” Kleinhardt said. “I highly recommend it.”

With former Lt. Col. Braxton’s military experience — and as the current team physician for the US Ski and Snowboard teams and the USA Nordic Team — he’s a trusted leader in minimally invasive spinal surgeries; he specializes in returning people to the activities they love.