Complex Spine Cases Treated Minimally Invasively

Multi-level thoracic stenosis and multi-level lumbar disc disease can both be managed with MISS, including fixation at two or three levels, and technology now makes MISS technically feasible at four or even five levels — though each patient has to be assessed individually. As a broad guide: one- or two-level lumbar disease, MISS without question; three to four levels, roughly half our patients proceed with MISS and half need open surgery, mainly for anatomical reasons, not because MISS is inferior. For sequencing combined cervical and lumbar disease: if there's cervical cord compression causing weakness, we operate on the cervical spine first; if the cervical issue is just radiating arm pain without cord compression, we address the lumbar spine first.

A Cobb angle under 10 degrees isn't classified as scoliosis at all. Between 10 and 30 degrees, observation with serial X-rays is appropriate — the curve is largely safe at this stage. The tipping point for a surgical discussion is a Cobb angle approaching 40 degrees; below that, there's generally no urgent surgical indication. Beyond the angle itself, the second key factor is whether the curve stays within the coronal zone of stability — as long as it does, it's relatively safe, but once vertebral segments shift outside that zone, the curve is at high risk of rapid progression and surgery becomes necessary.

The biggest source of confidence for a patient is seeing or hearing from patients who have undergone the procedure — testimonials describing next-day mobilisation are very powerful, and the Artemis Hospitals website carries many of them. Beyond that, as technology spreads to more centres and results accumulate, outcomes will speak for themselves. The current primary limitation is availability of technology, not the evidence.

Safety and success are entirely separate concepts. When we say 99% safe, we mean that out of 100 patients, 99 will not deteriorate — they will not be made worse by the surgery. Success is different: a patient who arrives already paralysed, no technology anywhere in the world can guarantee that patient will walk. Success depends on the patient's pre-operative condition, the stage of disease on MRI, and their own functional expectations — which is why a one-to-one consultation is essential before anyone is given realistic clarity on likely outcomes.

This is a very large grey zone. In general, a patient with acute pain of short duration, no neurological weakness, and quality of life not severely compromised should get a trial of conservative management first. At the other end, a patient who has tried conservative measures without relief, has developed neurological weakness or significantly impaired quality of life, and has imaging confirming nerve compression, needs an honest conversation about surgery as a genuine option. Individual lifestyle demands matter too — the same imaging findings in a sedentary 70-year-old versus someone who needs to travel and stay professionally active can lead to very different recommendations. Treatment has to be individualised.

Yes. Vertebral body tumours are reconstructed via corpectomy and cage placement through a small port, and epidural tumours compressing the cord from outside are also managed this way.

A congenital condition in children that previously required open surgery to divide; it is now managed endoscopically.

It is fixed through small incisions under navigation, with an intraoperative CT taken before the patient is even extubated so any issue can be corrected immediately.

Yes. One documented case involved near-occlusion of the vertebral artery and significant cord compression, managed minimally invasively with complete tumour removal confirmed on postoperative MRI.