Vice Chairman & Head - Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi
Part 5 of 10 in Indications for Spine Surgery & Advances for Safer Outcomes
Minimally Invasive Reduction for Spondylolisthesis: Two Cases From the Same Month
August 27, 2026
Two recent listhesis cases, operated within weeks of each other, gave Dr. Puneet Girdhar's masterclass audience a direct look at how routinely minimally invasive technique now handles a slipped vertebra.
A patient referred from the United States
A man referred from the United States arrived with dysplastic listhesis and tremendous pain from bilateral foraminal stenosis. Girdhar performed a two-level TLIF with bilateral MIS decompression; the patient was walking the day after surgery and being discharged the same day as the masterclass itself.
Six months of radiating pain in a 35-year-old
A 35-year-old woman had grade 3 to 4 listhesis with radiating leg pain for six months, an acute flare for the preceding month, and no response to any other therapy. Her L5 was sacralized, with L4 slipped over it and lysis present. Girdhar performed an MIS reduction and fixation through four small incisions, with no midline incision at all, operating on her in February 2026, weeks before the masterclass.
What stayed consistent across both cases
Girdhar described doing a TLIF as almost always minimally invasive for him now, with open surgery reserved mainly for revisions that need to connect to a previous rod. He avoids posterolateral decompression alone because it can lead to implant failure without anterior, 360-degree support, and restoring lumbar lordosis, the sagittal balance of the spine, is now a standard part of correcting a slip rather than an afterthought.
This guide is based on a live Jivo Masterclass — Dr. Puneet Girdhar taught doctors across Africa on March 15, 2026.
FROM THE LIVE Q&A
Dr. Davis Kenari
How is minimally invasive surgery actually done, since we currently only perform open surgery at our center?
Dr. Puneet Girdhar
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.
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Frequently Asked Questions
How should we set up communication so patients from Zambia can reach you with their reports?▼
My availability is never really an issue. I usually reply the same day, before going to bed, to most of the queries I get, and I hear from 30 to 40 people a day from all over the place. We look forward to working together and helping your patients from Zambia, at the very least by providing an opinion.
Closing thought on the session▼
Thank you for a very impressive, interesting presentation.
Closing thought on the session▼
Today it seems we were not leaving any stone unturned, so detailed.
How will the Jivo Connect Clinic work on an ongoing basis?▼
We are regularizing the Connect Clinic for monthly consultations, and this month's slot is March 23. Doctors should identify relevant patients and share their reports by March 21 so Dr. Girdhar's team has time to review them in advance and we can communicate a consultation slot. The referring doctor should be present so the patient gets a joint consultation from both of them.
What does follow-up look like once a patient returns home after surgery in India?▼
It is a matter of trust for a patient to travel from Africa to India. Being honest and ethical is paramount, as is close follow-up once they return home. It is not just one surgery, it is an entire program of rehabilitation. I talk to my patients before surgery and after, and I do five to six video connects a day with patients all over the world.
How was the US-referred patient's bilateral foraminal stenosis treated?▼
With a two-level TLIF combined with bilateral MIS decompression; the patient was walking the day after surgery.
How many incisions were used to correct the 35-year-old woman's spondylolisthesis?▼
Four small incisions, with no midline incision at all, through an MIS reduction and fixation.
Why does Girdhar avoid posterolateral decompression alone for spondylolisthesis?▼
Because it can lead to implant failure without anterior, 360-degree support.
When does Girdhar still use an open surgical approach for a TLIF?▼
Mainly for revisions that need to connect to a previous rod; otherwise a TLIF is almost always minimally invasive for him now.
What role does restoring lumbar lordosis play in correcting a slipped vertebra?▼
Restoring lumbar lordosis, the sagittal balance of the spine, is now a standard part of correcting a slip rather than an afterthought.
In This Series: Indications for Spine Surgery & Advances for Safer Outcomes
- 1.Indications for Spine Surgery
- 2.The Three-Tier Referral System: When Back and Neck Pain Needs a Spine Surgeon
- 3.Cauda Equina Syndrome and the Spine Emergencies That Cannot Wait
- 4.A Case Worked Through by Phone: Decompression or Fusion for a Kenyan Patient
- 5.Minimally Invasive Reduction for Spondylolisthesis: Two Cases From the Same Month
- 6.A Fusion Mass at Twenty-Four: Revising a Childhood Scoliosis Correction That Stopped Short
- 7.Loose Screws and a Cord That Was Swelling Somewhere Else Entirely
- 8.When Cement Alone Is Not Enough for a Fractured Vertebra
- 9.Training the Next Generation: Inside a Two-Year Spine Fellowship and Its Observership Track
- 10.Cross-Border Spine Care: Inside the Jivo Connect Clinic Model