Cross-Border Spine Care: Inside the Jivo Connect Clinic Model

Practically there is no selection criteria for an observer. At best we make you scrub and observe. You cannot participate in performing the procedure, but it is a great experience today, and we can accommodate visitors for one week up to eight to ten weeks. The only credential we can offer is a certificate from our own hospital, signed by myself and our management. The accredited route is a two-year National Board program for postgraduates who clear a super-specialty entrance exam, and the Spine Society of Delhi and Spine Society of India also run fellowships of one to three months, with one running a full year, but none of these are currently available to overseas trainees or visiting surgeons.

Anybody can come in. It depends on their interest, whether they are doctors, paramedics, or even technicians who want to learn how the equipment is used more efficiently. Any doctor with an outdoor or clinic practice where spine patients come through is welcome. Until you have seen a technique, it is very difficult to fathom in your head and convince your patient that it will help them. Visitors typically stay for a few weeks to a few months. A fellow from Nepal, already a practicing surgeon at a National Trauma Hospital, recently observed 25 surgeries in a single week, including robotic spinal deformity correction, endoscopic cases, and minimally invasive TLIF for listhesis.

If there is no significant back pain and no instability, we prefer decompression alone, either bipartal endoscopy through two ports of 4 to 5 millimeters to 1 centimeter, or an MIS tubular approach through a single 2.5 centimeter incision, adding a discectomy at the same sitting if the disc is large. If there is significant back pain and the dynamic X-ray shows instability, lysis, or discal collapse with foraminal stenosis, he will need a TLIF with a cage and screws to restore disc height and decompress both foramina. If he is already exhausted by medication and physiotherapy and still suffering, he almost certainly needs surgery; that is exactly why he is still hanging around doctors trying to find another way.

Spinal surgery takes most of the surgical case volume in neurosurgery at my center in Nigeria. We were expecting to see the procedures Dr. Girdhar uses and how they aid recovery, not only the traditional open decompression we already practice, but also how he performs minimally invasive spine surgery, since it is still an emerging area for us.

I would request that we spend time together if you are planning to come to India, please come to Delhi to our center. I tried my best, but that is all you can cover in an hour when it represents twenty years of work with a lot of technology behind it. You need to observe more, and that would let you move on to minimally invasive work. It is not difficult, but everything new you start in your practice is a steep curve at first, though very achievable, looking at how many MIS centers exist in the world today.

By March 21, two days ahead of the March 23 consultation slot, giving Girdhar's team time to review the cases and confirm a slot.

No. Cases that can be managed locally are guided that way, and only those that genuinely need treatment in India are directed to travel.

They consider it a misleading term, framing the model instead as continuity of cross-border care.

Organizing a surgical camp in the referring doctor's own country, which they argued could help many more patients with the same clinical effort as one patient's individual trip.