The surgical battlefield

The spine doesn’t just support you – it bears your pain and helps you dance again

There was no war, no raging Armageddon. And yet, as the postoperative X-ray glowed on the monitor in the operating room, it bore a striking resemblance to a landscape once ravaged, now reclaimed. Screws gleamed like swords embedded deep into the vertebral columns — a battleground not of bloodshed, but of precision and purpose. The spine, once bent and unstable and in pain, had found its resurrection. Harmony, at last, was restored.

Pramila was a woman in her late fifties with a presence so warm and abundant that one couldn’t help but be reminded of the Laughing Buddha, not in jest but in reverence. She limped into our outpatient clinic, her wide smile shadowed by months of unrelenting pain shooting down both legs. She was dressed in a vibrant green saree, hair pulled back in a ballerina bun, but the picture of grace stopped there. “I’m miserable,” she said to me in Gujarati. “I can barely walk a few steps, and that too with complete dependence on the stick,” she spoke, breathless from the ache. “She used to be a dancer,” her son interjected, while she quickly shushed him with a nudge on his thigh under the table. “Gone are the days,” she lamented, her eyes welling up.

Her spinal MRI revealed the underlying chaos: a compressed lumbar canal, thickened ligamentum flavum pressing down like a stubborn boulder, and listhesis — a slipping of one vertebra over the other — disrupted the spinal alignment. If the spine is a stack of pearls on a string, hers had begun to unravel. Beauty and fragility are always side by side in the world of anatomy.

Since she had tried a year of medication and physiotherapy, I told her the only solution lay in surgery, specifically, a laminectomy to remove the pressure-inducing lamina and ligament, and fusion with rods and screws to restore strength and stability. Pramila and her son took their time to think. I half-expected them to come back with a detailed list of pros and cons, complete with colour coding and lamination. But a couple of days later, she simply walked in, flashed her slow, knowing smile, and declared, “Let’s do it.” In my experience, people are more fearful of undergoing spine surgery than a brain operation – probably because if spine surgery goes wrong, you can’t run away from your problems.

In the operating theatre, we carefully positioned her prone. The drapes were placed, the OT lights dimmed to spotlight intensity, and the battle began — not against disease, but against the pressure crushing her from within. I drilled the lamina along with the facet one after the other over three levels and elevated chunks of bone shaped like perfectly symmetrical butterflies, a fleeting sculpture of calcium and curve, nature’s poetry even in fragments. It was a reminder that beauty resides in even the most hardened of places. And then I momentarily paused to think, “What if butter flies had bones?” “Then their graceful flight would turn into clumsy moans!” retorted an intern who was assisting us. Oftentimes, surgery is a perfect mix of science and silliness.

The spine is a remarkable structure. More than a column of strength, it is the silent stem that holds up the mind’s crown. Where the brain commands, the spine obeys, bearing the weight of movement, memory, and meaning. Unlike brain surgeries that whisper of celestial complexity, spine surgeries have a grounded rawness to them, almost like carpentry, yet deeply delicate. There is elegance even in the act of chiselling.

Beneath the lamina, the thickened ligamentum flavum loomed like a rock — heavy, oppressive, and unmoving. As we unearthed it with each bite, the compressed dura pulsated gently as we finally decompressed it, and with each millimetre of freed space, I imagined her nerves sighing in relief. We inserted pedicle screws across multiple levels, and the rods joined them, forging a new alliance in her spine. When the intraoperative X-ray lit up the screen, we paused. The image was arresting. The screws, aligned like warriors, were embedded in the vertebrae like swords in soil. A battleground won. A spine reclaimed.

Pratima woke up smiling. Her legs no longer bore the same pain. And as she chuckled her deep, vibrant laugh, one that echoed in the halls of recovery, I felt the triumph not of a surgeon, but of nature allowed to realign itself. The spine is not just a pillar of support. It is the silent bearer of weight and pain, of motion and memory. It arches in defiance, bends in surrender, and endures in silence. In realigning Pratima’s spine, we did not just restore anatomy, we renewed grace in posture, laughter in breath, and lightness in every step forward in the hope that someday she would dance again.

Over the next few days, she was walking unaided. When I went to see her on the day she was getting discharged, the walker she was using before surgery was confined to one corner of the room. Her son was drying his washed underwear on it. I looked towards it with raised eyebrows and then towards him. “It’s of no use to her now, we’re just finding other uses for it,” he said.