When Cement Alone Is Not Enough for a Fractured Vertebra

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.

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.

15 to 20 a month, most for osteoporotic collapse or fractures secondary to malignancy or myeloma.

Local anesthesia, as a daycare procedure; patients can walk out of the hospital the same day once the cement stabilizes the fracture.

Because the vertebra's edges are broken on all sides, leaving nothing intact for the cement to brace against.

Fixation, typically minimally invasive, combined with cementing rather than cementing on its own.

It would relieve pain temporarily while leaving the underlying instability, and any eventual deformity or cord compression, unaddressed.