Vice Chairman & Head - Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi
Series overview · 18 articles
Advances in Spinal Surgery
August 5, 2026
Spinal surgery in India has moved from large open operations to microscope-guided tubular techniques, biportal endoscopy and robotic-assisted procedures, cutting recovery time from weeks to days for many patients. This guide is based on a Jivo Masterclass on advances in spinal surgery led by Dr. Puneet Girdhar, Chairman of the Max Institute of Robotics and Minimal Invasive Spine Surgery at BLK-Max Super Speciality Hospital, New Delhi, and introduces a series of articles on modern spine treatment.
Who this masterclass series is based on
Dr. Puneet Girdhar has led the spine programme at BLK-Max Super Speciality Hospital, a 650-bed flagship hospital with 24 operation theatres, for 16 years and has performed more than 16,000 spinal surgeries. He now performs around 1,100 spinal surgeries a year, roughly four to six procedures on each of the more than 20 days a month he operates, and trains spine fellows through one of only around 15 accredited Diplomate National Board programmes in India.
How spine surgery has evolved over two decades
Spinal surgery has evolved from fully open procedures, through loupe-assisted surgery and then microscope-guided tubular techniques, to today's biportal endoscopic approaches. Dr. Girdhar trained under Dr. Kevin Foley, the pioneer of microscopic tubular spine surgery, and has used minimally invasive microtubular techniques since 2012. Biportal endoscopy, the most recent addition to spinal surgery in India, can now handle around 90 percent of spinal procedures using a fluid medium similar to knee or shoulder arthroscopy.
Why minimally invasive spine surgery matters for patients
The shift towards minimally invasive and endoscopic spine surgery means smaller cuts, preserved back muscles, less pain and faster recovery. Many patients are walking the day after surgery, and hospital stays for procedures such as decompression or discectomy are often just a day or two. Dr. Girdhar works closely with Jivo to make advanced spinal surgery affordable for patients travelling from Africa, so they can return home sooner rather than later.
This is the first in an 18-part series produced from a Jivo Masterclass on advances in spinal surgery delivered by Dr. Puneet Girdhar at BLK-Max Super Speciality Hospital, New Delhi. Click any article to read:
Minimally Invasive vs Open Spine Surgery: How Techniques Have Evolved | Biportal Endoscopic Spine Surgery: What It Is and How It Works | When to See a Spine Specialist: Warning Signs You Shouldn't Ignore | Minimally Invasive Spinal Fusion: Treating Spinal Instability Without Open Surgery | Navigation and Robotics in Spine Surgery: Why They Improve Accuracy and Safety | Lumbar Canal Stenosis: Symptoms and Modern Minimally Invasive Treatment | Herniated Disc Surgery: Biportal Endoscopic Discectomy Explained | Prolonged Sitting and Disc Degeneration: Why Desk Jobs Are a Spine Risk | Kyphoplasty for Osteoporotic Spinal Fractures: A Same-Day Procedure | Cervical Disc Replacement: Treating Neck Disc Herniation While Preserving Motion | Robotic Spine Surgery for Complex and Revision Cases | Scoliosis and Kyphosis in Children: Types and Warning Signs | Scoliosis Treatment: When Observation, Bracing or Surgery Is Needed | Vertebral Column Resection: Correcting Severe Spinal Deformity From Neglected Tuberculosis | Growth Rods for Early-Onset Scoliosis in Young Children | Hemivertebra: Why Early Surgery Prevents Severe Spinal Deformity | Recovery After Minimally Invasive Spine Surgery: What Patients Can Expect
This article is based on a Jivo Masterclass session conducted by Dr. Puneet Girdhar, Chairman, Max Institute of Robotics and Minimal Invasive Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass — Dr. Puneet Girdhar taught doctors across Africa on August 10, 2025.
Watch the full recording, or read the guide above.
FROM THE LIVE Q&A
Dr. Frank, referring physician, Ghana
I wanted to share how Paulina has been doing since her surgery with you — honestly speaking, I was really impressed by her recovery time. She's come back to Ghana and she's always praising your team, and now I have even more patients lining up who also want to come and have a consultation, and possibly the surgery, after hearing about her experience.
Dr. Puneet Girdhar
We feel privileged to be treating your patient, and I hope we have done justice to you, your practice and of course the patient. I think at the end of the day we all have one common goal — we want to see our patients happy. Otherwise you, me and Jivo would not be here on a Sunday evening, leaving our families aside, if we did not have this goal.
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Frequently Asked Questions
I'm also trying to go into orthopedic surgery myself, and I'm really happy learning more about it and seeing the advances in the surgery you're doing. Out of curiosity — how many of your own fellows go on to specialize in spine surgery after training under you?▼
I always joke about this with my orthopedic fellows. I've had an orthopedic training program for the last 13 or 14 years, and not even one of them has opted for spine surgery as a career — they're very happy doing a knee replacement, arthroscopy, or a fracture nail instead. Spine surgery has evolved so much that the moment they look into the scope, everything is very tiny, and that can be discouraging — it looks very uphill. It takes a little while to enter the system and understand what's going on through keyholes; one has to be patient, because it has a steep learning curve and the margin of error is not there. So for the last four years I've run a dedicated fellowship national training program for spine fellows — once they're selected and come to me, they don't have the option to go to any other theatre, because they're now committed to spine surgery for the rest of their life.
I wanted to share how Paulina has been doing since her surgery with you — honestly speaking, I was really impressed by her recovery time. She's come back to Ghana and she's always praising your team, and now I have even more patients lining up who also want to come and have a consultation, and possibly the surgery, after hearing about her experience.▼
We feel privileged to be treating your patient, and I hope we have done justice to you, your practice and of course the patient. I think at the end of the day we all have one common goal — we want to see our patients happy. Otherwise you, me and Jivo would not be here on a Sunday evening, leaving our families aside, if we did not have this goal.
How many spinal surgeries has Dr. Puneet Girdhar performed?▼
More than 16,000 over 16 years leading the spine programme at BLK-Max Super Speciality Hospital, where he now performs around 1,100 procedures a year, typically four to six surgeries on each of the more than 20 days a month he operates.
What is the difference between microscope-guided and biportal endoscopic spine surgery?▼
Microscope-guided tubular surgery, which Dr. Girdhar has used since 2012 after training under its pioneer Dr. Kevin Foley, gives magnified, illuminated access through a narrow tube. Biportal endoscopy is the more recent addition, using two ports in a fluid medium similar to knee or shoulder arthroscopy, and can now handle around 90 percent of spinal procedures.
How long is the hospital stay after minimally invasive spine surgery?▼
Many patients are walking the day after surgery, and hospital stays for procedures such as decompression or discectomy are often just a day or two.
Is spine surgery in India accessible for patients from Africa?▼
Dr. Girdhar works closely with Jivo to make advanced spinal surgery affordable for patients travelling from Africa, with the aim of helping them return home sooner rather than later.
What accreditation supports Dr. Girdhar's spine fellowship training programme?▼
He trains spine fellows through one of only around 15 hospitals in India accredited to run a Diplomate National Board programme, one of the highest recognitions available for post-graduate super-specialty training.
In This Series: Spinal Surgery: Advances in Techniques & Technology for Excellent Patient Outcomes
- 1.Advances in Spinal Surgery
- 2.Biportal Endoscopic Spine Surgery: What It Is and How It Works
- 3.Cervical Disc Replacement: Treating Neck Disc Herniation While Preserving Motion
- 4.Growth Rods for Early-Onset Scoliosis in Young Children
- 5.Hemivertebra: Why Early Surgery Prevents Severe Spinal Deformity
- 6.Herniated Disc Surgery: Biportal Endoscopic Discectomy Explained
- 7.Kyphoplasty for Osteoporotic Spinal Fractures: A Same-Day Procedure
- 8.Lumbar Canal Stenosis: Symptoms and Modern Minimally Invasive Treatment
- 9.Minimally Invasive Spinal Fusion: Treating Spinal Instability Without Open Surgery
- 10.Minimally Invasive vs Open Spine Surgery: How Techniques Have Evolved
- 11.Navigation and Robotics in Spine Surgery: Why They Improve Accuracy and Safety
- 12.Prolonged Sitting and Disc Degeneration: Why Desk Jobs Are a Spine Risk
- 13.Recovery After Minimally Invasive Spine Surgery: What Patients Can Expect
- 14.Robotic Spine Surgery for Complex and Revision Cases
- 15.Scoliosis and Kyphosis in Children: Types and Warning Signs
- 16.Scoliosis Treatment: When Observation, Bracing or Surgery Is Needed
- 17.Vertebral Column Resection: Correcting Severe Spinal Deformity From Neglected Tuberculosis
- 18.When to See a Spine Specialist: Warning Signs You Shouldn't Ignore