Revolutionising spine care through precise diagnostics and technological innovations

Understanding spine health has become increasingly important in today’s fast-paced and physically demanding world. The spine is one of the most critical components of the human body, providing structural support, facilitating movement, and protecting the spinal cord—a vital part of the central nervous system. As spinal disorders become more prevalent due to ageing, sedentary lifestyles, trauma, or genetic conditions, the evolution of surgical care in this domain has taken significant strides.

Minimally invasive and endoscopic spine surgery

Minimally invasive spine surgery (MISS) has transformed the landscape of spinal care. Unlike traditional open spine surgery, which involves large incisions and considerable soft tissue disruption, MISS relies on small incisions, specialised instruments, and advanced imaging technology to achieve similar, if not better, surgical outcomes. The advantages are numerous: reduced post-operative pain, shorter hospital stays, faster recovery, and a lower risk of infections.

Endoscopic spine surgery is one of the key techniques in MISS. It involves using a thin, flexible tube with a camera (endoscope) to visualise and access spinal pathology. Most commonly employed for disc herniations and spinal stenosis, endoscopic procedures are performed under local or general anesthesia and often on a day-care basis. Patients can expect minimal blood loss and a relatively quick return to daily activities.

Endoscopic discectomy is a game-changing procedure. Unlike traditional discectomy, it is performed through a small ‘keyhole’ incision using an endoscope that provides high-definition, magnified visualisation of the operative field. This allows the surgeon to remove the offending disc fragment with extreme precision while sparing the surrounding muscles and ligaments. Significantly, endoscopic discectomy is offered as a day-care procedure under local anaesthesia, eliminating the risks associated with general anaesthesia, especially in elderly or patients with co-morbidities. Most patients will be able to walk within a few hours and return home the same day. Pain relief is often immediate, and return to normal activity is dramatically faster compared to conventional surgery.

Conditions treated with minimally invasive approaches

Several spinal conditions can now be effectively managed using minimally invasive techniques. These include: lumbar and cervical disc herniation causing radiculopathy; lumbar spinal stenosis with neurogenic claudication; vertebral compression fractures due to osteoporosis; spinal instability from trauma, infections or tumours; spondylolisthesis and degenerative disc disease.

In these cases, procedures such as microdiscectomy, endoscopic discectomy, minimally invasive decompression, and minimally invasive percutaneous pedicle screw fixation, provide excellent clinical outcomes with minimal physiological burdens.

Technological integration: navigation

One of the most significant advancements in spine surgery has been the integration of navigation systems and robotic assistance. Image-guided navigation allows surgeons to place screws and perform complex procedures with exceptional precision, even in anatomically challenging situations and complex spinal deformities.

These technologies reduce radiation exposure to the surgical team, enhance confidence during instrumentation, and improve alignment in spinal reconstruction. The result is better clinical outcomes and fewer complications.

Surgical management of spinal deformities

Spinal deformities such as scoliosis, kyphosis, and flat-back syndrome affect not just the physical appearance of an individual, but also lung function, gait, and self-esteem. In children and adolescents, early detection is crucial. Bracing may suffice in mild curves, but surgery becomes necessary for progressive or severe deformities.

Spinal fusion with segmental instrumentation is the standard technique in scoliosis surgery. For adult deformities, osteotomies and long segment fixation are employed to restore sagittal alignment. In both age groups, neuromonitoring during surgery helps ensure spinal cord safety. Advances in implants and techniques now allow for more corrections with lower risks.

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Trauma and fragility fracture management

Spinal trauma, particularly in the thoracic and lumbar regions, demands urgent evaluation and stabilisation. Unstable fractures can lead to neurological deficits and chronic pain. Minimally invasive percutaneous screw fixation helps stabilise such injuries quickly and safely, allowing for early mobilisation.

In elderly individuals with osteoporotic fractures, cement augmentation procedures like vertebroplasty and kyphoplasty can provide dramatic pain relief and structural support. Early mobilisation in these patients reduces the risk of bed-bound complications such as pneumonia, pressure sores, and thromboembolisms.

Infective and tumour-related spine conditions

Infective spondylodiscitis, often caused by tuberculosis or bacterial infections, leads to pain, instability, and potential neurological compression. Surgical intervention in such cases involves debridement of the infected tissue, spinal stabilisation, and a biopsy for diagnosis. Minimally invasive approaches help achieve these goals while preserving healthy tissue.

Spinal tumours—whether primary or metastatic—require multidisciplinary care. Stabilisation, decompression, and tumour excision are performed when necessary. The goal is to preserve or restore neurological function and spinal stability, thereby improving the patient’s quality of life and tolerance to adjuvant therapies.

Beyond surgery: comprehensive spine care

Optimal spine care goes beyond the operating room. Multidisciplinary evaluation ensures that surgery is only offered to those who truly need it. These multidisciplinary teams often includes spine surgeons, pain specialists, physiatrists, neurologists, radiologists, and physiotherapists.

Non-operative care includes structured physiotherapy programmes, ergonomic training, and pain interventions such as epidural injections or radiofrequency ablation. Prehabilitation—physical and nutritional optimisation before surgery—is especially valuable in elderly or high-risk patients to improve recovery outcomes.

Rehabilitation post-surgery is equally crucial. A tailored rehabilitation programme enhances function, strengthens spinal musculature, and reduces the chance of recurrent injuries or degeneration. Psychological support and patient education form an important part of holistic recovery.

Spine surgery today is no longer a last resort. With precise diagnostics, technological innovations, and skilled execution, it offers hope and healing for many patients who once had limited options.

(Dr. G. Sudhir and Dr. K. Karthik Kailash are senior consultant orthopaedic spine surgeons at the Centre of Excellence for Endoscopy and Minimally Invasive Spine Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai. The former is available at sudhiraxon@gmail.com and the latter can be reached on kkspinedoc@gmail.com)

Published – June 23, 2025 07:00 am IST