Taking a Minimally Invasive Approach to Spine Health

Why Choose Sierra Regional?

Although many Americans will suffer from neck or back pain, most can be treated with non-surgical care. At Sierra Regional Spine Institute, it’s our philosophy that every effort should be made to provide non-surgical solutions.

“We use surgery as a treatment only if it is absolutely necessary.”

Our practice has been built around this philosophy. When a patient enters our office, we want to be able to provide them with a full level of options. In addition to our surgeons, we have a team of doctors, physical therapists, athletic trainers, nurses and chiropractors. You can rest assured that we will be able to treat your condition. This is the reason so many doctors in Northern Nevada refer their patients to SRSI. They know that their patients will receive the finest and most appropriate care available.

We accept your insurance provider

*not a complete list, we carry more insurance providers than listed.

Leaders in Spinal Care, Back Health and the Latest Spinal Surgery Technologies

Our surgeons are at the forefront of spine surgery technology. We have a unique reputation for being both conservative as well as being leaders in advanced surgical and non-surgical spine technology.
Our physicians believe the future of spinal health is restoration of anatomy and return of function through motion – using the latest technologies in spinal surgery.
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25 spine practices to know in 2023

Sierra Regional Spine Institute was ranked #14 in Becker's Spine Review 25 spine practices to know in 2023

We accept medical leins from your legal and healthcare team.
US Ski Team Physicians
We’re pleased to have two physicians on staff who have been honored with the role of Official U.S. Ski Team Physician.

Dr. Phelps Kip and Dr. James Rappaport serve with a select group of doctors who continue to volunteer their time to provide professional care to the U.S. Ski Team.

In this role, they have worked with many U.S. Ski Team and Olympic athletes including 3 recent Olympic Gold Medal winners.

With their proximity to the world class ski resorts of Lake Tahoe, both Dr. Kip and Dr. Rappaport have extensive expertise in treating skiing-related spinal and back injuries.
photo of Dr.Rappaport and Dr.Kip
We love our community!
With You Through Every Step
Our compassionate & knowledgeable team helps guide each patient through the whole process from start to finish. From scheduling their appointment, to consultation and surgery. We are there to support during, pre-surgery and post-surgery.

Our team is dedicated to each patient; we want them to feel comfortable knowing that we care and understand their orthopedic needs.
Helping you stay active at any age!
“I had spinal fusion surgery for my lower spine and I went from walking with a cane for over 2 years, to walking out of the hospital.”
Satisfied Patient, Spinal Fusion Surgery

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Artificial Disc Replacement

At Sierra Regional Spine Institute, we believe that the future is restoration of anatomy and function through motion. The artificial disc replacement is the answer to that problem. Sierra Regional Spine Institute continues to be a leader in Nevada when disc replacement surgery is needed.
It is a surgical procedure in which degenerated intervertebral discs in the spinal column are replaced with artificial disc implants in the lumbar or cervical spine.

The procedure is used to treat chronic, severe low back pain and cervical pain resulting from degenerative disc disease.

Artificial disc replacement has been developed as an alternative to spinal fusion, with the goal of pain reduction or elimination, while still allowing motion throughout the spine. Another possible benefit is the prevention of premature breakdown in adjacent levels of the spine, a potential risk in fusion surgeries.

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Revision Spine Surgery

Revision spine surgery is a surgery procedure performed in certain patients to correct the problems of earlier spine surgery. Revision surgery is only when working with patients who experience chronic pain or any worsening symptoms even after the initial surgery.
Other factors that can indicate the need for revision spine surgery include:

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At Sierra Regional Spine Institute we use Decompression in a few ways to treat and make the process of recovery smoother for people with fractures: Microdiscectomy, Microendoscopic Laminectomy, Minimally Invasive Cervical Foraminotomy (MICF), Vertebroplasty and Kyphoplasty.


Microdiscectomy, also called microlumbar discectomy (MLD), is a very common MIS decompression procedure performed in patients with a symptomatic lumbar herniated disc. The operation consists of removing the portion of the intervertebral disc that is herniated and compressing a spinal nerve root.

Minimally Invasive Cervical Foraminotomy

This is a MIS cervical foraminotomy decompression procedure that enlarges the space in which a spinal nerve root exits the cervical spinal canal (intervertebral foramen). This narrowing can be caused by a herniated disc, bone spurs, thickened ligaments or joints, which may result in pinched nerves.


Vertebroplasty for the treatment of vertebral compression fractures (VCFs) was introduced in the United States in the early 1990s. The procedure is usually done on an outpatient basis, although some patients stay in the hospital overnight. The procedure may be performed with a local anesthetic and intravenous sedation or general anesthesia.

Using x-ray guidance, a small needle containing specially formulated acrylic bone cement is injected into the collapsed vertebra. The cement hardens within minutes, strengthening and stabilizing the fractured vertebra. Most experts believe that pain relief is achieved through mechanical support and stability provided by the bone cement.
Kyphoplasty involves an added procedure performed before the cement is injected into the vertebra. First, two small incisions are made and a probe is placed into the vertebral space where the fracture is located.

The bone is drilled and one balloon (called a bone tamp) is inserted on each side. The two balloons are then inflated with contrast medium (which are visualized using image guidance x-rays) until they expand to the desired height and removed. The spaces created by the balloons are then filled with the cement. Kyphoplasty has the added benefit of restoring height to the spine.

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Cervical Fusion

Cervical Fusion is an operation that creates a solid union between two or more vertebrae in the upper spine (neck) area. This procedure may assist in strengthening and stabilizing the spine and may thereby help to alleviate severe and chronic back pain.
The best clinical results are generally achieved in single-level fusion, although fusion at two levels may be performed in properly selected patients.

Bone grafts may be taken from the hip or from another bone in the same patient (autograft) or from a bone bank (allograft). Bone graft extenders and bone morphogenetic proteins (hormones that cause bone to grow inside the body) can also be used to reduce or eliminate the need for bone grafts.

Fusion sometimes involves the use of supplemental hardware (instrumentation) such as plates, screws, and cages. This fusing of the bone graft with the bones of the spine will provide a permanent union between those bones. Once that occurs, the hardware is no longer needed, but most patients prefer to leave the hardware in place rather than go through another surgery to remove it.

Fusion can sometimes be performed via smaller incisions through MIS techniques. The use of advanced fluoroscopy and endoscopy has improved the accuracy of incisions and hardware placement, minimizing tissue trauma while enabling an MIS approach.

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Lumbar Fusion

This is a MIS technique that is performed in patients with refractory mechanical low back and radicular pain associated with spondylolisthesis, degenerative disc disease, and recurrent disc herniation. The procedure is performed from the back (posterior) with the patient on his or her stomach.

Using x-ray guidance, two 2.5-cm incisions are made on either side of the lower back. The muscles are gradually dilated and tubular retractors inserted to allow access to the affected area of the lumbar spine.

The lamina is removed to allow visualization of the nerve roots. The disc material is removed from the spine and replaced with a bone graft and structural support from a cage made of bone, titanium, carbon-fiber, or a polymer, followed by rod and screw placement.

The tubular retractors are removed, allowing the dilated muscles to come back together, and the incisions are closed. This procedure typically takes about 3 to 3 1/2 hours to perform.

Outcome & Benefits

Pioneers of both surgical and non-surgical techniques


Minimally Invasive Spine Surgery

MIS was first performed in the 80s but has recently seen rapid advances. Technological advances have enabled surgeons to expand patient selection and treat an array of spinal disorders, such as degenerative disc disease, herniated disc, fractures, tumors, infections, instability, and deformity.
This can result in quicker recovery, decreased operative blood loss, and speedier patient return to normal function. In some MIS approaches, also called, “keyhole surgeries,” surgeons use a tiny endoscope with a camera on the end, which is inserted through a small incision in the skin. The camera provides surgeons with an inside view, enabling surgical access to the affected area of the spine.

Benefits of Minimally Invasive Surgery

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