Spine Surgery · Minimally Invasive · Cardiff & Beyond

Spine Procedures

Expert spine surgery with a focus on getting you better faster. Where possible, the preferred approach is minimally invasive or endoscopic — smaller incisions, less disruption, quicker recovery.

Endoscopic Spine Minimally Invasive (MIS) Cervical Spine Thoracic Spine Lumbar Spine Pain Management

The Approach

Surgery Should Be the Smallest Intervention Needed

Every patient is different. The goal is always to restore function and relieve pain using the least invasive approach that delivers the best long-term result.

Dr. Agrawal's practice is built on a simple principle: a well-planned, precisely executed spine procedure causes the least harm to surrounding tissue, heals faster, and gets patients back to living their lives sooner. This is not just a philosophy — it is backed by the published research he actively contributes to.

With formal training in endoscopic spine techniques and minimally invasive surgery across India, the UK, and the USA, Dr. Agrawal brings an internationally informed perspective to every clinical decision. Where open surgery is necessary, it is performed with the same meticulous precision.

Patients receive a thorough explanation of their diagnosis, their options, and what to realistically expect — before any decision is made. The operating room is only ever the destination when it is truly the right one.

Guiding Principles

Smallest effective incision — preserving muscle, bone, and function
Evidence-based decisions drawn from published research
International training in endoscopic and robotic-assisted techniques
Non-surgical options always explored first
Clear, jargon-free explanation of every step
Post-operative rehabilitation planned from day one
Long-term outcomes prioritised over short-term convenience

Specialist Area

Endoscopic Spine Surgery

The most advanced minimally invasive approach available. Performed through a small working channel roughly the diameter of a pen, guided by a high-definition camera, with real-time visualisation of the spine.

Lumbar · Keyhole

Interlaminar Endoscopic Lumbar Discectomy

Removal of a herniated disc fragment compressing a spinal nerve, performed through a small incision between the vertebrae. No bone removal is typically required. Patients often mobilise the same day.

Treats sciatica and leg pain from disc herniation
Preserves surrounding muscles and ligaments entirely
High-definition endoscopic visualisation throughout
Typically day-case or overnight stay

Day Case No Bone Removal Walk Same Day Local / GA

Lumbar · Keyhole

Transforaminal Endoscopic Discectomy

Access is achieved through the natural foramen (opening) of the spine, avoiding any disruption to the back muscles. Ideal for far-lateral disc herniations and foraminal stenosis causing nerve compression.

Access through natural spine opening — no muscle cutting
Suitable under local anaesthesia for appropriate patients
Excellent for recurrent disc herniations
Immediate nerve decompression

No Muscle Cutting Local Anaesthetic Option Recurrent Disc

Lumbar · Decompression

Endoscopic Lumbar Decompression for Spinal Stenosis

Narrowing of the spinal canal (stenosis) compresses nerves and causes leg pain, numbness, and difficulty walking. Endoscopic decompression widens the canal through a minimal incision, with full preservation of spinal stability.

Treats neurogenic claudication (walking-related leg pain)
Bilateral decompression possible through single incision
Preserves facet joints and spinal stability
Significantly faster recovery than open laminectomy

Stability Preserved Single Incision Fast Recovery

Cervical · Keyhole

Endoscopic Cervical Discectomy

A pinhole approach to the cervical spine to remove a herniated disc or bone spur pressing on a nerve. Avoids the need for fusion in many cases, preserving natural neck movement.

Treats neck pain, arm pain, and upper limb weakness
Motion-preserving — often no fusion required
Posterior approach avoids risks associated with front-of-neck surgery
Shorter hospital stay than conventional approaches

Motion Preserving No Fusion Posterior Approach

Minimally Invasive

Minimally Invasive Spine Surgery (MIS)

When a condition requires more than pure decompression — such as instability, deformity, or fracture — MIS techniques achieve the same surgical goals as open surgery with significantly less collateral damage.

Stabilisation

Percutaneous Pedicle Screw & Rod Fixation

Screws and rods are inserted through small stab incisions using fluoroscopic guidance rather than a long open incision. This preserves the back muscles, dramatically reducing post-operative pain and allowing faster recovery.

Used for spinal instability, fractures, and spondylolisthesis
Multiple levels can be stabilised through tiny incisions
Navigation or robotic assistance available for accuracy
Published research: complications and bailout strategies

Stab Incisions Image Guided Multi-Level

Fusion · Lumbar

MIS Transforaminal Lumbar Interbody Fusion (TLIF)

Fusion of two or more vertebrae to eliminate painful movement at a degenerate or unstable segment. Performed through small tubes rather than a wide open incision, preserving the surrounding musculature.

Treats degenerative disc disease, spondylolisthesis, failed disc surgery
Tubular retractor system — no muscle stripping
Combined with percutaneous screw fixation
Significantly reduced blood loss vs. open TLIF

Tube Approach Less Blood Loss Stable Fusion

Fusion · Lateral

Pre-Psoas / Oblique Lateral Interbody Fusion (OLIF)

A lateral approach to the lumbar spine that avoids the back muscles entirely, accessing the disc space from the side through a small incision. Allows placement of a large fusion cage, restoring disc height and indirectly decompressing nerves.

Suitable for multiple disc levels in a single procedure
Excellent for sagittal correction and deformity
Avoids neural structures entirely
Active research: facet degeneration & canal volume outcomes

Lateral Approach Deformity Correction Multi-Level

Deformity

Circumferential MIS (cMIS) for Adult Spinal Deformity

Correction of scoliosis or sagittal imbalance in adults using a combination of lateral interbody fusion and posterior percutaneous fixation — all without a large open incision. Research-proven outcomes over long-term follow-up.

Treats adult scoliosis and flat-back deformity
Combined anterior & posterior correction through small incisions
Published long-term outcomes (2–13 year follow-up)
Significant reduction in blood loss, ICU stay, and recovery time

Scoliosis Long-Term Data Combined Approach

Procedures by Region

Cervical, Thoracic & Lumbar Spine

Beyond endoscopic and MIS surgery, a full range of spine procedures across all three regions of the spine are offered — tailored to the patient's specific anatomy, age, and condition.

Cervical Spine (Neck)

The cervical spine supports the head and protects the nerves running to the arms and hands. Conditions here can cause neck pain, arm pain, numbness, weakness, or in severe cases, problems with balance and hand coordination (myelopathy). Treatment ranges from targeted injections to fusion or motion-preserving disc replacement.

7 Vertebrae in the cervical spine, each protecting critical nerve pathways

C3–C7 Most common levels affected by disc disease and stenosis

Anterior Cervical Discectomy & Fusion (ACDF)

The disc is removed through a small incision at the front of the neck and the vertebrae are fused together. Highly effective for nerve compression causing arm pain or weakness.

Cervical Disc Replacement (Arthroplasty)

An artificial disc is inserted to replace the damaged one, preserving normal neck movement. Preferred in younger patients to avoid adjacent segment stress.

Posterior Cervical Foraminotomy

A keyhole approach from the back of the neck to widen the nerve exit (foramen). Nerve decompression without fusion, often performed endoscopically.

Cervical Laminoplasty

The lamina is hinged open like a door to enlarge the spinal canal. Used for multilevel cervical myelopathy where cord compression spans several levels.

Posterior Cervical Fusion & Instrumentation

Screws and rods placed from the back of the neck to stabilise the cervical spine in cases of instability, fracture, or failed previous surgery.

Occipito-Cervical Fusion

Stabilisation at the junction of the skull and cervical spine. Indicated for craniovertebral junction instability, rheumatoid arthritis involvement, or trauma.

Thoracic Spine (Mid-Back)

The thoracic spine is the most complex region surgically because it is closely adjacent to the lungs, heart, and spinal cord. Thoracic problems often present with band-like chest or back pain, and in severe cases, leg weakness or paralysis. Dr. Agrawal is a primary author of a chapter on thoracic spine approaches in Gray's Surgical Anatomy.

12 Thoracic vertebrae, each attached to a rib pair, making surgical access uniquely challenging

T4–T9 Zone of greatest surgical complexity due to vascular and cord proximity

Thoracic Discectomy

Removal of a herniated thoracic disc. Approach varies based on level and disc position — costotransversectomy, transpedicular, or video-assisted thoracoscopic (VATS) techniques are used.

Thoracic Decompression for Myelopathy

Enlargement of the thoracic spinal canal to relieve cord compression causing progressive weakness or sensory changes in the legs.

Thoracic Pedicle Screw Fixation

Stabilisation of the thoracic spine using pedicle screws, often percutaneously. Used for fractures, tumours, or deformity requiring posterior column support.

Vertebral Augmentation (Kyphoplasty / Vertebroplasty)

Injection of bone cement into a fractured vertebral body to restore height and relieve pain from osteoporotic or pathological compression fractures.

Thoracic Corpectomy & Reconstruction

Removal of an entire thoracic vertebral body affected by tumour, severe fracture, or infection, followed by structural reconstruction with a cage and fixation.

Thoracolumbar Deformity Correction

Correction of kyphotic or scoliotic deformity at the thoracolumbar junction, combining posterior instrumentation with interbody fusion for optimal sagittal balance.

Lumbar Spine (Lower Back)

The lumbar spine bears the body's weight and is the most commonly operated region. Conditions include disc herniation causing sciatica, spinal stenosis causing leg pain on walking, spondylolisthesis (slippage), and degenerative disc disease. Minimally invasive and endoscopic approaches are strongly preferred at this level.

L4–S1 Most commonly affected segments, responsible for the majority of leg and back pain presentations

210+ Spine cases performed during training, with endoscopic and MIS forming the majority

Microdiscectomy

Microsurgical removal of a herniated lumbar disc fragment. A time-tested, highly effective procedure for acute sciatica that has not responded to conservative treatment.

Lumbar Laminectomy / Decompression

Removal of the lamina and thickened ligament to decompress the spinal canal. Performed open or endoscopically depending on the extent and complexity of stenosis.

Posterior Lumbar Interbody Fusion (PLIF / TLIF)

Fusion of lumbar vertebrae with an interbody cage and pedicle screws. Eliminates painful motion at a degenerate or unstable segment, performed minimally invasively where possible.

Spondylolisthesis Reduction & Fusion

Realignment and stabilisation of a vertebra that has slipped forward on the one below. Pedicle screw reduction restores alignment, and fusion prevents recurrence.

Cauda Equina Decompression

Emergency surgery to relieve compression of the cauda equina nerve bundle. Requires urgent or emergency decompression to prevent permanent bowel, bladder, and lower limb dysfunction.

Sacropelvic Fixation

Extension of lumbar instrumentation down to the sacrum and pelvis to restore and maintain lumbar lordosis and pelvic balance in long-construct deformity corrections.

Non-Surgical & Adjunct

Spine Pain Management

Surgery is not always the answer. A range of targeted, image-guided pain management procedures can provide significant relief — either as a standalone treatment or as a bridge to a definitive surgical plan.

Epidural Steroid Injection

A corticosteroid is delivered directly into the epidural space surrounding the spinal cord and nerves. Highly effective for reducing inflammation from a disc herniation or stenosis, providing weeks to months of pain relief.

Lumbar · Cervical · Thoracic

Selective Nerve Root Block (SNRB)

Steroid and local anaesthetic injected precisely around a specific spinal nerve root. Used both therapeutically for relief and diagnostically to confirm which level is responsible for the patient's pain.

Diagnostic · Therapeutic

Facet Joint Injection & Medial Branch Block

The facet joints are small joints at the back of each spinal level. Inflammation here is a common cause of axial back or neck pain. Targeted injections or nerve blocks can provide significant and lasting relief.

Facetogenic Pain

Radiofrequency Ablation (RFA)

Heat energy is used to interrupt the small nerves supplying the facet joint. When a medial branch block confirms facet joint pain is the source, RFA can provide pain relief lasting one to two years or more.

Longer-Lasting Relief

Sacroiliac Joint Injection

The sacroiliac joint (SIJ) is a commonly overlooked source of lower back and buttock pain. Image-guided injection into this joint can confirm diagnosis and provide therapeutic relief.

Lower Back · Buttock Pain

Periarticular Drug Injection in Spinal Surgery

During spinal surgery, a targeted mixture of local anaesthetic, steroids, and analgesics is injected around the operative site. This directly reduces post-operative pain and accelerates early recovery and mobilisation. The subject of Dr. Agrawal's MS thesis.

Post-Operative Pain

Your Journey

What to Expect

From first appointment to recovery, a clear, supportive process every step of the way.

Consultation

A thorough clinical assessment including your full history, examination, and review of any existing scans. You will receive a clear explanation of your diagnosis and what it means in plain language.

Imaging & Diagnosis

MRI, CT, or X-ray imaging is reviewed in detail. Dynamic X-rays may be requested to assess instability. The exact level and nature of the problem is identified before any treatment plan is formed.

Treatment Planning

All available options are discussed — conservative, pain management, and surgical. The risks, benefits, and realistic outcomes of each are explained. You make the decision with complete information.

Pre-Operative Preparation

Medical optimisation, anaesthetic assessment, and any necessary investigations are completed. You will know exactly what to expect on the day, what to bring, and what to arrange at home for after discharge.

Surgery

The procedure is performed with the least invasive approach appropriate for your condition. For endoscopic and MIS cases, many patients are discharged the same or next day.

Recovery & Follow-Up

A structured recovery plan begins immediately. Follow-up appointments, physiotherapy, and gradual return to activity are planned together. Most patients are back to desk work within two to four weeks.

Common Questions

Frequently Asked Questions

Honest answers to the questions patients ask most often before deciding on spine surgery.

Most patients with disc herniations, foraminal stenosis, or early spinal canal narrowing are suitable candidates for endoscopic surgery. Advanced instability, significant deformity, or multilevel fusion requirements may require an MIS or open approach instead. Your suitability will be determined after reviewing your imaging at consultation.

Endoscopic surgery uses a camera and small working channel (around 8mm) to perform decompression procedures such as disc removal or nerve decompression — no bone fusion is involved. MIS surgery uses slightly larger tubes (around 18–22mm) to perform more complex procedures such as fusion, fixation, or deformity correction, but still avoids the large open incisions of traditional surgery. Both are far less disruptive than conventional open approaches.

Recovery varies by procedure. After endoscopic discectomy, most patients mobilise on the same day and return to sedentary work within two to three weeks. MIS fusion procedures typically require four to six weeks before light activity, and three to six months for full functional recovery. Open deformity surgery may take six to twelve months. A specific recovery timeline will be discussed before your procedure.

Yes — for most procedures, a structured physiotherapy programme forms an important part of the recovery plan. Core strengthening, posture correction, and graduated return to activity help protect the spine and maximise the long-term result of surgery. Physiotherapy referral is arranged as part of your post-operative care.

All surgery carries risk, and these vary by procedure. Common considerations include infection, bleeding, nerve irritation, and anaesthetic risks. Specific to spine surgery: dural tear (CSF leak), incomplete relief of symptoms, and in rare cases, neurological injury. Minimally invasive and endoscopic approaches significantly reduce many of these risks compared to open surgery. All risks relevant to your specific procedure will be discussed in full at your consultation.

Absolutely. Epidural injections, nerve root blocks, and facet joint procedures can provide meaningful relief — sometimes for months or more — and are always considered before surgery is recommended. They also serve a diagnostic role: if a targeted injection to a specific level relieves your pain, it confirms that level as the source, which is valuable information for surgical planning if you eventually proceed.

Yes — and it is always reasonable to seek one. Not every surgeon is trained in endoscopic or MIS techniques, and patients are sometimes offered open surgery simply because it is what their treating surgeon performs. Dr. Agrawal will review your imaging and clinical history and give an honest opinion on whether a less invasive approach is appropriate for your condition, or confirm that the original recommendation is correct.

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