Training the Next Generation: Inside a Two-Year Spine Fellowship and Its Observership Track

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.

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.

Anybody can come in. It depends on their interest, whether they are doctors, paramedics, or even technicians who want to learn how the equipment is used more efficiently. Any doctor with an outdoor or clinic practice where spine patients come through is welcome. Until you have seen a technique, it is very difficult to fathom in your head and convince your patient that it will help them. Visitors typically stay for a few weeks to a few months. A fellow from Nepal, already a practicing surgeon at a National Trauma Hospital, recently observed 25 surgeries in a single week, including robotic spinal deformity correction, endoscopic cases, and minimally invasive TLIF for listhesis.

If there is no significant back pain and no instability, we prefer decompression alone, either bipartal endoscopy through two ports of 4 to 5 millimeters to 1 centimeter, or an MIS tubular approach through a single 2.5 centimeter incision, adding a discectomy at the same sitting if the disc is large. If there is significant back pain and the dynamic X-ray shows instability, lysis, or discal collapse with foraminal stenosis, he will need a TLIF with a cage and screws to restore disc height and decompress both foramina. If he is already exhausted by medication and physiotherapy and still suffering, he almost certainly needs surgery; that is exactly why he is still hanging around doctors trying to find another way.

Spinal surgery takes most of the surgical case volume in neurosurgery at my center in Nigeria. We were expecting to see the procedures Dr. Girdhar uses and how they aid recovery, not only the traditional open decompression we already practice, but also how he performs minimally invasive spine surgery, since it is still an emerging area for us.

A National Board diploma in spine surgery, entered by Indian postgraduates after clearing a national board entrance exam.

The Spine Society of Delhi and the Spine Society of India run fellowships lasting one to three months, with one program running a full year.

No, none of the accredited tracks are currently open to overseas trainees or visiting surgeons.

Only a certificate from the hospital and its management, not a board qualification.

25 surgeries in a single week, spanning robotic deformity correction, endoscopic cases, and minimally invasive TLIF for listhesis reduction.