Vice Chairman & Head - Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi
Part 9 of 18 in Spinal Surgery: Advances in Techniques & Technology for Excellent Patient Outcomes
Minimally Invasive Spinal Fusion: Treating Spinal Instability Without Open Surgery
August 5, 2026
Minimally invasive spinal fusion treats spinal instability by increasing disc height with a cage, decompressing the affected nerve and placing screws through two small cuts, without opening the back. This approach allows most patients to walk the day after surgery and go home within two days.
How the procedure is performed
The procedure increases the height of the collapsed disc space using a cage, performs a thorough decompression of the nerve on the affected side, and places screws percutaneously through two small cuts of around one and a half to two inches on the lower back. The midline muscles of the back, the multifidus and erector spinae, which are the major stabilisers of the spine, are left undisturbed.
Outcomes and recovery
The surgery takes one to one and a half hours and does not require a blood transfusion. Patients are up and about the day after surgery and are typically ready to leave hospital within two days, with sciatica and numbness largely resolved. Some residual back stiffness is common but usually resolves by 70 to 80 percent within two weeks.
Treating more severe instability
Even patients with grade two or grade three spinal listhesis, a more severe slip of one vertebra over another, or significant deformity, can often be managed with minimally invasive spinal fusion rather than open surgery. Some cases can also be treated with biportal endoscopic decompression and stabilisation. Dr. Puneet Girdhar of BLK-Max Super Speciality Hospital now uses open procedures only rarely for one- or two-level spinal instability, reserving them for the most complex deformities.
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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.
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.
What does minimally invasive spinal fusion involve?▼
It increases the height of the collapsed disc space using a cage, decompresses the affected nerve, and places screws percutaneously through two small cuts on the lower back, without opening the back.
Are the back muscles damaged during minimally invasive spinal fusion?▼
No. The midline muscles of the back, the multifidus and erector spinae, which are the major stabilisers of the spine, are left undisturbed.
How long does minimally invasive spinal fusion take and what is recovery like?▼
The surgery takes one to one and a half hours and does not require a blood transfusion. Patients are up and about the day after surgery and typically ready to leave hospital within two days.
Can minimally invasive fusion treat severe spinal slips?▼
Yes. Even grade two or grade three spinal listhesis, or significant deformity, can often be managed with minimally invasive spinal fusion rather than open surgery.
Is open spine surgery still used for spinal instability?▼
It is now used only rarely, reserved mainly for the most complex deformities rather than for typical one- or two-level instability.
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