Vice Chairman & Head - Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi
Part 6 of 10 in Indications for Spine Surgery & Advances for Safer Outcomes
A Fusion Mass at Twenty-Four: Revising a Childhood Scoliosis Correction That Stopped Short
August 27, 2026
Of all the cases in the masterclass, Dr. Puneet Girdhar described this one as staying closest to him personally: a patient he operated on recently, twelve years after her original surgery had stopped short of a real correction.
A correction that stopped at the apex
She was operated on at age 12 in her home country for idiopathic scoliosis. The original surgeon stopped correcting at the apex of the curve, placing only a couple of hooks there rather than extending screw density and correction up to the upper dorsal spine. Because children's tissue fuses quickly once disrupted, the vertebrae set into a single solid mass that Girdhar described as looking like one femur bone, and the shoulder imbalance and hump kept worsening from that point on.
Twelve years spent studying her own condition
By the time she reached Girdhar at 24, she had spent two years reading spine literature to understand which osteotomies could still help her. Their preoperative discussion ran an hour and a half, because in his account she already understood every correction option available and wanted the best one.
Operating on 39 kilograms of thin bone
She weighed only 39 kilograms, with thin pedicles and a limited blood volume that constrained the team's margin for error. Rather than stopping short again, they carried the correction all the way up through multiple osteotomies, achieved a reasonably balanced shoulder line, and had her walking on the first day after surgery.
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. Brian (Zambia)
How should we set up communication so patients from Zambia can reach you with their reports?
Dr. Puneet Girdhar
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.
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Frequently Asked Questions
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.
What is the selection criteria for doctors in our network who want to join your fellowship or observership program?▼
Practically there is no selection criteria for an observer. At best we make you scrub and observe. You cannot participate in performing the procedure, but it is a great experience today, and we can accommodate visitors for one week up to eight to ten weeks. The only credential we can offer is a certificate from our own hospital, signed by myself and our management. The accredited route is a two-year National Board program for postgraduates who clear a super-specialty entrance exam, and the Spine Society of Delhi and Spine Society of India also run fellowships of one to three months, with one running a full year, but none of these are currently available to overseas trainees or visiting surgeons.
What went wrong with the patient's original scoliosis surgery at age 12?▼
The original surgeon stopped correcting at the apex of the curve, placing only a couple of hooks there rather than extending screw density and correction up to the upper dorsal spine.
Why did the incomplete correction turn into a solid fusion mass over time?▼
Because children's tissue fuses quickly once disrupted, so the vertebrae set into a single solid mass that Girdhar described as looking like one femur bone, with the shoulder imbalance and hump worsening from that point on.
How did the patient prepare before her revision surgery?▼
She spent two years reading spine literature to understand which osteotomies could still help her, and their preoperative discussion ran an hour and a half.
What made this particular revision surgery high risk?▼
She weighed only 39 kilograms, with thin pedicles and a limited blood volume that constrained the team's margin for error.
How soon was she walking after the revision surgery?▼
On the first day after surgery, once the team carried the correction all the way up through multiple osteotomies and achieved a reasonably balanced shoulder line.
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