Question 1

What is the selection criteria for doctors in our network who want to join your fellowship or observership program?

Dr. Puneet Girdhar · Accepted Answer

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.

Question 2

Does an observership need to be limited to specialists, or can general practitioners take part, and who benefits most?

Dr. Puneet Girdhar · Accepted Answer

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.

Question 3

A 32-year-old male has a diffuse L4-L5 disc bulge compressing both traversing nerve roots, a left paracentral L5-S1 disc protrusion narrowing the left lateral recess, and canal stenosis measured at 9.5 millimeters. He is exhausted by medication and physiotherapy but afraid of surgery. What would you recommend?

Dr. Puneet Girdhar · Accepted Answer

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.

Question 4

What were you and your colleagues hoping to take away from this session?

Dr. Puneet Girdhar · Accepted Answer

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.

Question 5

How is minimally invasive surgery actually done, since we currently only perform open surgery at our center?

Dr. Puneet Girdhar · Accepted Answer

I would request that we spend time together if you are planning to come to India, please come to Delhi to our center. I tried my best, but that is all you can cover in an hour when it represents twenty years of work with a lot of technology behind it. You need to observe more, and that would let you move on to minimally invasive work. It is not difficult, but everything new you start in your practice is a steep curve at first, though very achievable, looking at how many MIS centers exist in the world today.

Question 6

How should we set up communication so patients from Zambia can reach you with their reports?

Dr. Puneet Girdhar · Accepted Answer

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.

Question 7

Closing thought on the session

Dr. Puneet Girdhar · Accepted Answer

Thank you for a very impressive, interesting presentation.

Question 8

Closing thought on the session

Dr. Puneet Girdhar · Accepted Answer

Today it seems we were not leaving any stone unturned, so detailed.

Question 9

How will the Jivo Connect Clinic work on an ongoing basis?

Dr. Puneet Girdhar · Accepted Answer

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.

Question 10

What does follow-up look like once a patient returns home after surgery in India?

Dr. Puneet Girdhar · Accepted Answer

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.

Indications for Spine Surgery & Advances for Safer Outcomes

Questions Doctors Asked Dr. Puneet Girdhar

What is the selection criteria for doctors in our network who want to join your fellowship or observership program?

Does an observership need to be limited to specialists, or can general practitioners take part, and who benefits most?

What were you and your colleagues hoping to take away from this session?

How is minimally invasive surgery actually done, since we currently only perform open surgery at our center?

How should we set up communication so patients from Zambia can reach you with their reports?

Closing thought on the session

Closing thought on the session

How will the Jivo Connect Clinic work on an ongoing basis?

What does follow-up look like once a patient returns home after surgery in India?

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