Chief, Neuro Spine Surgery & Additional Director, Neurosurgery, Artemis Hospitals, Gurgaon, India
Part 6 of 13 in Making Spine Surgery 100% Safe
Keyhole (Minimally Invasive) Spine Surgery Explained
August 6, 2026
Keyhole spine surgery uses incisions of around one inch to relieve pressure on nerves and place screws, without cutting through the muscles that open spine surgery would require. Dr. S. K. Rajan, Chief and Unit Head, Orthopaedics and Spine Neurosurgery at Artemis Hospitals, Gurgaon, uses this technique regularly for spine surgery in India, particularly for conditions like lumbar canal stenosis.
How Keyhole Spine Surgery Differs from Open Surgery
Dr. S. K. Rajan explains that endoscopic and tubular technology avoids cutting through whole muscles, using what he calls an over the top approach to decompress nerve roots on the opposite side of the spine through a single small incision. This significantly reduces tissue trauma compared with traditional open spine surgery.
Real Patient Outcomes with Keyhole Surgery
Dr. S. K. Rajan describes a patient with lumbar canal stenosis who underwent keyhole surgery through approximately one-inch incisions, involving pressure relief and screw fixation, and who was walking the next day. Similarly, an elderly patient with an osteoporotic spinal fracture was treated with a minimally invasive cement injection technique and was also walking the day after surgery.
Why Keyhole Surgery Matters for Spine Surgery in India
Minimally invasive keyhole techniques generally mean less tissue damage, faster recovery and shorter hospital stays compared with traditional open procedures.
← What Is the O-Arm and How Does It Make Spine Surgery Safer? | Series index | Why an Integrated Spine Clinic Matters: Team-Based Spine Care →
This article is based on a Jivo Masterclass session conducted by Dr. S. K. Rajan, Chief and Unit Head, Orthopaedics and Spine Neurosurgery, Artemis Hospitals, Gurgaon, India. 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. S. K. Rajan taught doctors across Africa on September 15, 2024.
FROM THE LIVE Q&A
Dr. Abraa
Do you use intraoperative neuromonitoring?
Dr. S. K. Rajan
Yes, we do use intraoperative neuromonitoring — we are one of the very few centres in the country who have been using this quite regularly. We were focusing on minimally invasive spine surgery and spine navigation in this talk because of limited time, but yes, we do have neuromonitoring available to us as well.
Frequently Asked Questions
Do you have provisions for doing spine surgeries for children with neural tube defects?▼
Yes, we have specialist spine surgeons and pediatric surgeons also, and I myself do a lot of spine surgery in children — whether they have neural tube defects such as meningocele, Chiari malformation, or tethering of the spinal cord which can cause weakness of the legs. In all those patients we do spine surgeries, also in children who've got scoliosis or hemivertebra deformities, or tumours of the spine. All those patients we have been tackling from the age of 6 months to 18 years of age.
What about the cost of treatment, and the duration of treatment, for a spine problem?▼
The cost of surgery in our hospital for spinal problems can range anything from $3,500 for a discectomy and decompression to $5,500 or $6,000 for fixation of the spine at one level, and even up to $10,000 for more complicated cases — that's usually the range of costs patients most commonly have to bear. Most of these patients, who come walking because of pain in the neck, arm, or lower back going into the legs, usually stay in the hospital for about three to four days, and in the country for about two weeks.
Do you use intraoperative neuromonitoring?▼
Yes, we do use intraoperative neuromonitoring — we are one of the very few centres in the country who have been using this quite regularly. We were focusing on minimally invasive spine surgery and spine navigation in this talk because of limited time, but yes, we do have neuromonitoring available to us as well.
How is keyhole spine surgery different from traditional open surgery?▼
Keyhole surgery uses incisions of around one inch to relieve pressure on nerves and place screws, without cutting through the muscles that open surgery would require.
What is the "over the top" approach in keyhole spine surgery?▼
It is an endoscopic and tubular technique that decompresses the nerve root on the opposite side of the spine through a single small incision, avoiding the need to cut through whole muscles.
How quickly can patients recover after keyhole spine surgery?▼
Dr. Rajan describes a lumbar canal stenosis patient walking the day after keyhole surgery, and an elderly patient with an osteoporotic fracture also walking the next day after a minimally invasive cement injection technique.
What are the general benefits of minimally invasive keyhole techniques?▼
They generally mean less tissue damage, faster recovery and shorter hospital stays compared with traditional open procedures.
In This Series: Making Spine Surgery 100% Safe
- 1.Making Spine Surgery 100% Safe
- 2.Cement Augmentation for Osteoporotic Spinal Fractures
- 3.Cost of Spine Surgery in India
- 4.Why an Integrated Spine Clinic Matters: Team-Based Spine Care
- 5.Intraoperative Neuromonitoring in Spine Surgery
- 6.Keyhole (Minimally Invasive) Spine Surgery Explained
- 7.Lumbar Canal Stenosis: Keyhole Surgery and Recovery
- 8.What Is the O-Arm and How Does It Make Spine Surgery Safer?
- 9.Pediatric Spine Surgery in India: Conditions Treated
- 10.Scoliosis Correction Surgery in India
- 11.Treating Spinal Tuberculosis in India
- 12.What Causes Spine Surgery Complications, and How They're Prevented
- 13.When Is Spine Surgery Actually Needed? Signs You Shouldn't Ignore