Question 1

How long will it take with rehabilitation for a patient to regain full mobility after spinal arthrodesis (fusion)?

Dr. Puneet Girdhar · Accepted Answer

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.

Question 2

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?

Dr. Puneet Girdhar · Accepted Answer

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.

Question 3

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?

Dr. Puneet Girdhar · Accepted Answer

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.

Question 4

What are the new advancements for conditions like quadriplegia in the cervical spine?

Dr. Puneet Girdhar · Accepted Answer

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.

Question 5

What would someone need to do to become your assistant?

Dr. Puneet Girdhar · Accepted Answer

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.

Question 6

Does nutrition play any role in spine health, and is a nutritional deficiency a risk factor for developing spine problems?

Dr. Puneet Girdhar · Accepted Answer

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.

Question 7

At what point can we say scoliosis bracing has failed and surgery is indicated? Also, for the interbody cage, can long plates not be used instead?

Dr. Puneet Girdhar · Accepted Answer

For idiopathic scoliosis, once the curve goes beyond 40 to 45 degrees, bracing has failed and surgery is indicated. On plates: long plates such as Steffee plating are no longer used - for the last 15 to 20 years, the standard has been transpedicular screws with a titanium or PEEK cage instead.

Question 8

What are the possible obstacles to performing minimally invasive spine surgery in tropical, resource-limited areas?

Dr. Puneet Girdhar · Accepted Answer

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.

Question 9

What would be the medical method for the management and support of individuals with discopathy (disc disease)?

Dr. Puneet Girdhar · Accepted Answer

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.

Advances in Spinal Surgery Technology

Questions Doctors Asked Dr. Puneet Girdhar