Vice Chairman & Head - Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi
Part 8 of 8 in Advances in Spinal Surgery Technology
Spinal Fusion, Symptom-Based Surgery Decisions, and Spine Nutrition
May 26, 2024
Whether spinal fusion (arthrodesis) is really the right call, and how nutrition supports a healthy spine, are two of the most practical questions patients and referring doctors raise.
Why spinal fusion remains the standard, even knowing its limits
Spinal fusion (arthrodesis) is, by far, the best solution currently available in spine surgery, and only a minority of patients who undergo it go on to develop problems at adjacent spinal levels years later - most who operate roughly a thousand cases a year see this in only a small subset. The reasoning is similar to why a liver transplant is offered even knowing it may only extend life by five to ten years: a real, immediate problem today is treated with the best available solution, rather than being withheld because of a possible issue much further down the line, which itself typically has its own solution when it arises.
Symptoms decide surgery, not measurements
A narrow disc space on imaging (for example 7mm against a normal range of 14-20mm) does not by itself mean surgery is needed - what matters is the patient's actual symptoms and how much prior treatment has already been tried. If medicine and physiotherapy haven't relieved the symptoms, surgery to extend the fusion may be needed regardless of the exact millimetre measurement.
Nutrition for a healthy spine
The spine depends on three tissue types, each with its own nutritional needs: bones need calcium, vitamin D and sunlight; muscles and soft tissue need exercise and adequate protein; nerves need exercise and vitamin B12. A good overall lifestyle, diet and regular exercise together are what keep the spine healthy.
This article is based on a Jivo Masterclass session conducted by Dr. Puneet Girdhar, Principal Director & Head, Ortho Spine, MIS & Robotic 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
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This guide is based on a live Jivo Masterclass: Dr. Puneet Girdhar taught doctors across Africa on May 26, 2024.
FROM THE LIVE Q&A
Moderator
What are the possible obstacles to performing minimally invasive spine surgery in tropical, resource-limited areas?
Dr. Puneet Girdhar
There is no real obstacle - the obstacle is in the mind. As an example, three minimally invasive spine surgeries (two of them revisions of prior laminectomies) were performed in Abuja, Nigeria over the last two months, and all three patients were walking the next day; this has already led to inquiries from ten different hospitals wanting to start similar programmes. It is a matter of local doctors taking the initiative, supported by training and partnership.
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Frequently Asked Questions
What would be the medical method for the management and support of individuals with discopathy (disc disease)?▼
The first line is medicine and physiotherapy. If that doesn't help, a nerve block injection is the next step. If that also fails, endoscopic surgery is used.
How long will it take with rehabilitation for a patient to regain full mobility after spinal arthrodesis (fusion)?▼
With minimal invasive and robotic techniques, the patient walks the same day, is discharged in one to two days, can return to work within a week, and can return to active sports within three weeks.
Why is spinal arthrodesis still the technique of choice when a majority of patients who benefit from it develop vertebral listhesis (adjacent-level problems) after years?▼
It is by far the best solution science has invented so far. Vertebral listhesis develops in some patients, not the majority - of around a thousand operations a year, only a small subset develop problems at another level. Just because a surgery might cause a problem many years down the line doesn't mean a patient in pain and unable to walk today should be denied its benefit now - the same reasoning applies to a liver transplant, which is offered even knowing it may extend life by only five to ten years.
Given that a normal disc diameter is around 14-20mm, what is the limit at which surgery is needed - for example, for someone with only 7mm who is still working?▼
Don't measure the millimetres, measure the patient's symptoms. Surgery depends on the patient's symptoms and what treatment has already been tried, not on the measurement alone. If medicine and physiotherapy haven't relieved symptoms, surgery to extend the fusion may be needed regardless of the exact disc height.
What are the new advancements for conditions like quadriplegia in the cervical spine?▼
The first step with quadriplegia is always to find out the underlying cause. Once the cause is identified, it can potentially be addressed and removed.
Does spinal fusion cause problems at other spine levels later?▼
In a minority of patients, yes, but it remains the best available solution today, similar to how a liver transplant is offered despite a limited extension of life - a real problem now is treated rather than withheld over a possible future issue.
What determines whether a narrow disc space needs surgery?▼
The patient's symptoms and response to prior treatment, not the millimetre measurement of disc height on imaging.
In This Series: Advances in Spinal Surgery Technology
- 1.Advances in Spinal Surgery Technology
- 2.The Technology Behind Modern Spine Surgery
- 3.Robotic Spine Surgery: Accuracy and Outcomes
- 4.Minimally Invasive Surgery for Disc Herniation and Spinal Stenosis
- 5.Scoliosis: Warning Signs and When to Brace or Operate
- 6.Complex Spine Reconstruction: TB Spine, Revisions and Delayed Referral
- 7.Bringing Minimally Invasive Spine Surgery to Resource-Limited Settings
- 8.Spinal Fusion, Symptom-Based Surgery Decisions, and Spine Nutrition