Expanding Minimally Invasive Options

Kauvery Hospital, Alwarpet has advanced its spine care programme with the successful introduction of endoscopic fusion surgery, a first-of-its-kind procedure in Chennai. The technique offers a minimally invasive alternative for selected patients who require spinal fusion but may benefit from a smaller surgical footprint than traditional open surgery or standard minimally invasive surgery (MIS). Endoscopic fusion is spinal fusion performed through a working channel and high-definition camera inserted via an incision of about 8 mm. The surgeon decompresses the affected nerves, prepares the disc space and places an interbody implant with fixation under continuous visualisation, while aiming to preserve surrounding muscle, bone and ligaments. Unlike traditional open spine surgery, which involves larger incisions and extensive muscle dissection, and standard MIS, which still requires some tissue handling with an incision of around 20 mm, the endoscopic approach is designed to reduce tissue damage, blood loss and postoperative pain, and to support faster recovery. The treatment is more suitable for Degenerative lumbar conditions such as disc disease, spinal stenosis and selected low-grade instability, persistent nerve-root compression causing leg pain after adequate conservative care, revision or re-do spine surgery, where previous open surgery has left scar tissue that would be riskier to operate through again. It is also recommended for selected elderly patients for whom a long open fusion would be a heavier surgical burden. “Endoscopic procedures are also used for disc herniation and nerve compression. In certain cases, they may help avoid the need for extensive fusion by preserving the spine’s natural stability. However, the suitability is decided after clinical evaluation, imaging and assessment of overall health. The technique is not suitable for all patients. High-grade slips, some complex deformities and cases that require wide open reconstruction may still need conventional surgery,” said Dr Keerthivasan P, Senior Consultant Spine and Orthopaedic Surgeon, Kauvery Hospital Alwarpet Chennai. In appropriately selected cases, intended benefits include a smaller wound, less muscle injury, lower blood loss, less postoperative pain, earlier walking and a shorter hospital stay. In a recent complex case, a 56-year-old woman who had previously undergone L4–L5 open spine surgery later developed problems at the L3–L4 and L4–L5 levels. The team used an endoscopic approach to avoid operating through scarred tissue. Blood loss was less than 50 ml. The patient walked within two hours and was discharged within two days. In another case, an elderly patient with severe leg pain due to a disc problem was treated endoscopically, avoiding a major open operation that would have required long-segment fusion. The patient recovered quickly and returned to normal activity sooner than expected. Dr Balamurali, Head of Department – Spine and Neurosurgery, Kauvery Hospital, Alwarpet, Chennai, added, “This advancement strengthens our comprehensive spine care programme, where patient selection, precision planning and multidisciplinary coordination play a crucial role in outcomes. Endoscopic fusion is not just about smaller incisions, but about choosing the right approach for the right patient. With this technique, we are able to expand our treatment spectrum and offer personalized solutions, especially in complex and revision spine cases.” Speaking on the technology , Dr Aravindan Selvaraj, Co Founder and Executive Director Kauvery Hospitals said, "Our focus is to combine clinical expertise with advanced technology to deliver effective treatment while reducing the overall burden of surgery. The introduction of endoscopic fusion surgery reflects our commitment to offering less invasive options wherever appropriate."