My Areas Of Expertise

Robert Ayer MD

Minimally Invasive Spinal Fusion

I have specialized training in minimally invasive fusion techniques such as TLIF, ALIF, OLIF, XLIF, DLIF, PLIF. Allowing patients who need spinal fusion to experience less pain and blood loss.

Degenerative Spine Disease

I perform surgery off all kinds in order to address spinal degeneration, including discectomy, laminectomy, laminotomy. I treat all areas of spinal disease: cervical, thoracic, and lumbar.

Motion Preservation Spinal Surgery

When applicable I look to preserve spinal motion through artificial disc replacements and dynamic stabilization.

Spinal Deformity

Many people develop spinal deformity as a result of spinal degeneration such as scoliosis and saggital imbalance. Unfortunately, poorly performed spinal fusion also contributes to a larger portion of deformities. I know how to properly treat these problems.


I treat both brain and spinal tumors. I have expertise in surgical treatment for glioblastoma, mengiomas, and metastatic tumors of the brain and spine.


I am an expert in the minimally invasive treatment of compression fractures using a technique called kyphoplasty. This procedure is also sometimes performed by other medical specialties such as radiology. However, these other specialties are not properly trained in the comprehensive treatment of spinal fractures.

The Expert in Minimally Invasive Spinal Surgery Techniques

Minimally invasive surgery is an approach to spine surgery that aims to minimize tissue disruption, reduce blood loss, and in some instances reduce surgical pain associated with the procedure.  It has also been associated with shorter hospital stays.  Minimally invasive techniques have been developed for many spine and cranial surgeries, but have mostly been developed for spinal surgery.  It is not applicable for all patients and/or all conditions.  However, I apply these techniques when possible.

Spinal Deformity


Some of the most common surgical procedures I have both open and minimally invasive expertise in are: 


Removal of bone and ligament from the exiting passageway of spinal nerves.

Discectomy or Microdiscectomy

Removal of a herniated intervertebral disc. Therefore, removing pressure from the compressed nerve.​
[Watch Demonstration Video Here]


Removal posterior aspect of the boney spinal canal in order to “decompress” or take pressure of pinched spinal nerves. Laminotomy is a variation of laminectomy that removes less bone. These procedures are used to treat spinal stenosis.
[Watch Demonstration Video Here]


Minimally invasive treatment of compression fractures; most commonly caused by osteoporosis
[Watch Demonstration Video Here]

Spinal Fusion

A process that causes two opposing bony surfaces to grow together, also called arthrodesis. This is done using bone graft that can be taken from the patient during the fusion surgical procedure or taken from a bone bank that contains bone components that were previously harvested from other individuals.​

Spinal Instrumentation

The implantation of titanium, titanium-alloy, stainless steel, or non-metallic devices into the spine. Instrumentation maintains spinal stability while facilitating the fusion.

Spinal Cord Stimulation

Spinal cord stimulators are used to treat chronic pain in either the back or limbs. For more information see the conditions page.
[Watch Demonstration Video Here]

Spinal fusion can be done through a number of techniques and approaches. My practice includes the following techniques and approaches:

Anterior Lumbar Interbody Fusion (ALIF)

Fusion performed through and anterior abdominal incision.
[Watch Demonstration Video Here]

Lateral Interbody Fusion (also known as XLIF, DLIF, OLIF)

Similar to ALIF, but performed through an incision on the side of the patient’s abdomen.
[Watch Demonstration Video Here]

Posterior Lateral Fusion, Transforaminal Lumbar Interbody Fusion (TLIF), Posterior Lumbar Interbody Fusion (PLIF)

Spinal Fusion Techniques performed though and incision(s) in the back. Traditional techniques used larger more disruptive incisions. I use minimally invasive techniques when applicable. Not all surgeons are familiar with these techniques and may not offer or discuss them.
[Traditional TLIF - Open Technique]
[Minimally Invasive TLIF Technique]

Spinal Deformity

I implement the principles of sagittal balance in all of my spinal fusions. I also correct sagittal deformities through the use of minimally invasive (MIS) techniques and the use of osteotomies when required. I frequently treat flat-back syndrome as well as degenerative scoliosis. A large number of surgeons are not familiar with these principles.
[Link To: SpineUniverse]

SI Joint Fusion

I diagnosis and treat painful sacroiliac joint disease both surgically and non-surgically. I frequently use the SI-bone iFuse system.
[Watch Demonstration Video Here]

Cervical Fusion

Cervical Fusion Techniques are used for a variety or pathologies. These can be done through anterior or posterior approaches
[Anterior Cervical Discectomy Fusion Demonstration (ACDF)]

[Posterior Cervical Laminectomy and Fusion Demonstration ]

What Is Unique About Dr. Ayer?

Throughout his education and training, the over-arching concept behind every procedure can be defined by two words- minimally invasive

Next, our patients have access to something few other private practices have access to- a tumor board. This is a monthly meeting with oncology specialists from all around the state where cases are reviewed for treatment protocols. This defines treatment excellence.  

Brain Surgery

I spent an additional year of training to gain experience in complex brain tumor surgery.  I also spearheaded the organization of a Multidisciplinary Brain Tumor Board at Gwinnett Medical Center, the only one of its kind in Gwinnett County.  This is where physicians from different specialties (Neurosurgery, Radiation Oncology, Oncology, and Radiology) meet on a regular basis to discuss brain tumor patients.  This allows for comprehensive care in an organized manner and allows for access to clinical trials.  I have experience in the treatment meningiomas, gliomas, and skull base tumors.

Cerebrospinal Fluid Shunting:  I have experteise in shunting patients for obstructive hydrocephalus, normal pressure hydrocephalus (NPH) and pseudotumor cerebri.

Chiari Decompression:  I provide Chiari decompression surgery to patients with symptomatic Chiari malformations.


Motion Preservation Spinal Surgery

I employ motion preservation techniques when applicable.  These techniques inlcude:

Cervical Disc Arthroplasty and Lumbar Disc Arthroplasty:  The removal of a degenerated disc and its replacement with an artificial disc that preserves motion and simulates the motion of the natural disc.  This technology is relatively new with 10-15 years’ worth of data showing advantages over fusion surgery when applied to the correct patients.

Links for extra info:

Coflex: The coflex® device is a titanium metal implant that helps keep your spine stable after surgical decompression and helps maintain the normal foraminal height and motion in your spine.  It provides and alternative to spinal fusion for some patients.

Links for extra info:



Orthospine Surgeon

Neurosurgeons spend 7 years training in brain and spinal disorders with about half of their time focused on the treatment of spinal disorders. When a Neurosurgeon completes their training they are able to treat a majority of spinal disorders, except for those that may require specialty centers. Orthopedic Surgeons complete training in the treatment of bones and joints that exclude the head and spine, and require at least one year additional training if they wish to treat spinal disorders.

Neurosurgeons and Orthopedic Spinal Surgeons have the ability to treat disorders of the bones, joints, and discs of the spine. However, Neurosurgeons are trained to operate on the nervous system itself, and are able to treat disorders of the spinal cord and nerves themselves. If these types of disorders are encountered by an Orthopedic Spine Surgeon they must seek the assistance of a Neurosurgeon. Today, most spinal surgeries are performed by Neurosurgeons.

As part of my Neurosurgery residency, I chose to pursue additional experience in complicated spinal disorders.  During this time I had the unique opportunity to operate with ORTHOPEDIC SPINE SURGEONS specializing in degenerative deformity. This experience provides me the perspective of both specialties.

I Use Advance Imaging Technologies During Spine Surgery

Computer-assisted image guidance allows surgeons to view operative targets with far greater detail and accuracy than traditional visualization techniques. These techniques have been shown to be more accurate placement of hardware into the spine.

* Mason A1, Paulsen R, Babuska JM, Rajpal S, Burneikiene S, Nelson EL, Villavicencio AT. The accuracy of pedicle screw placement using intraoperative image guidance systems.J Neurosurg Spine. 2014 Feb;20(2):196-203.