Vice Chairman & Head - Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi
Series overview · 8 articles
Advances in Spinal Surgery Technology
May 26, 2024
Spine surgery has been transformed by two decades of steady technological advancement, to the point where minimally invasive and robotic techniques now handle most cases that once required large open operations. Dr. Puneet Girdhar, Principal Director & Head, Ortho Spine, MIS & Robotic Spine Surgery at BLK-Max Super Speciality Hospital, New Delhi, used his Jivo Masterclass to walk through the technology behind modern spine surgery, how common conditions like disc herniation and spinal stenosis are treated with keyhole precision, how scoliosis is corrected, and how minimally invasive spine surgery can be brought to resource-limited settings.
What this series covers
This series works through the imaging, neuromonitoring, microscope and robotic technology now used in spine surgery, how robotic assistance improves accuracy and reduces blood loss compared to manual surgery, how endoscopic and minimally invasive techniques treat common conditions like disc herniation and canal stenosis, how scoliosis is diagnosed and corrected, complex reconstructive cases including tuberculosis of the spine and revision surgery, the real obstacles (and lack of them) to bringing minimally invasive spine surgery to low-resource settings, and the role of nutrition and non-surgical care in spine health.
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
Dr. Kavele
How long will it take with rehabilitation for a patient to regain full mobility after spinal arthrodesis (fusion)?
Dr. Puneet Girdhar
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.
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Frequently Asked Questions
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.
What would someone need to do to become your assistant?▼
Rather than becoming an assistant, doctors can partner through Jivo's training programmes, which bring fellows from Africa to train directly - the framing is colleague and partner, not assistant.
Does nutrition play any role in spine health, and is a nutritional deficiency a risk factor for developing spine problems?▼
The spine is made up of three main components, each with its own nutritional needs: bones need calcium, vitamin D and sunlight; muscles and tissues need exercise and good protein in the diet; nerves need exercise and vitamin B12. Altogether, a good lifestyle, diet and exercise are what keep the spine healthy.
What does this masterclass series cover?▼
Spine surgery technology (robotics, navigation, neuromonitoring), minimally invasive and endoscopic techniques, scoliosis correction, complex reconstructive cases, bringing MIS spine surgery to resource-limited settings, and spine health nutrition.
Who is Dr. Puneet Girdhar?▼
Principal Director & Head, Ortho Spine, MIS & Robotic Spine Surgery at BLK-Max Super Speciality Hospital, New Delhi.
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