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, and can go back to work within a week. He can go back to active sports in 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

Because it is by far the best solution science has invented so far. The patients who develop vertebral listhesis are not the majority: I operate on about a thousand patients a year, and listhesis or problems at other levels occur in some patients, not most, and there is a solution for that as well. That a surgery may cause a problem many years later does not mean we should deny the patient its benefit today, when he is in severe pain, unable to walk or becoming paralysed. Some of these patients may need surgery at another level after many years. The same logic applies to liver transplant: it may give the patient 5 to 10 years of life, yet we still perform it, because otherwise the patient is very sick and suffering today.

Question 3

Given that a normal disc height is around 14 to 20 mm, what is the threshold for surgery, for example in a patient with only 7 mm who is still working and has already had two surgeries with L4 to S1 arthrodesis?

Dr. Puneet Girdhar · Accepted Answer

Do not measure the millimetres; measure the patient's symptoms. Surgery depends on the patient's symptoms and the treatment taken so far, not on the measurement. The 7 mm is not the problem; pain in the leg is. If the patient is not getting relief with medicines and physiotherapy, he will require surgery to extend the fusion. For questions about specific patients, the referring doctor should share the patient's reports so that a complete written reply can be sent.

Question 4

What are the new advances in managing cervical spine conditions that lead to quadriplegia?

Dr. Puneet Girdhar · Accepted Answer

With a patient who has quadriplegia, you first have to find out why the quadriplegia happened. If we know the cause, we can remove the cause. Because this question concerns a specific patient, the referring doctor should share the patient's reports for a detailed written reply.

Question 5

What is the motivation for organising this webinar?

Accepted Answer

Healthcare should be handled by doctors, not by agents or corporates. Jivo is building a platform for direct communication between specialists in India and colleagues in Africa: it starts with dialogue, and solutions follow. The aim over five to ten years is that agents are out of the business and doctors in Africa, the Middle East or elsewhere know the relevant specialists directly. These sessions let doctors get to know specialists and their day-to-day advances, and for complex cases Jivo is the formal channel to approach them for solutions, whether in the home country or in India.

Question 6

What are the possible obstacles to performing minimally invasive spine surgery in tropical areas?

Dr. Puneet Girdhar · Accepted Answer

There is no obstacle; the obstacle is in the mind. If Congo finds it challenging to perform minimally invasive spine surgery routinely, Nigeria faced the same challenge. In the last two months we performed three minimally invasive spine surgeries in Abuja, two of them revisions in patients who had already undergone laminectomy, and all three patients started walking the next day. I am now getting calls from ten different hospitals wanting to start minimally invasive surgery there. It is a matter of time before someone takes the initiative, and it happens through collaboration with local doctors who are keen to take it forward. In Nigeria we are bringing local doctors to India for training, as part of a programme for local doctors to perform minimally invasive spine surgery in future, and we would love to do the same in Congo. If we can do it here, you can do it there.

Question 7

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.

Question 8

What would someone need to do to become your assistant?

Dr. Puneet Girdhar · Accepted Answer

We have training programmes in India that bring fellows from Africa. You do not have to be my assistant; you can be my colleague.

Question 9

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

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 10

At what point can we say that scoliosis bracing has failed and surgery is indicated? And for the interbody cage, can long plates (Roy-Camille type) not be used instead?

Dr. Puneet Girdhar · Accepted Answer

If the curve goes beyond 40 to 45 degrees despite bracing, then surgery. Nowadays nobody uses Steffee plating or similar long plates: for the last 15 to 20 years we have been using transpedicular screws with a titanium or PEEK cage.

Live Discussion with Dr. Puneet Girdhar