Doctor saheb, aa operation thi mane kai pan faaydo nathi thayo," said Mr Shah when he visited me for a follow-up three months after I had operated on his lumbar spine. Pre-surgery, his bones had degenerated and the thickening of the spinal ligaments pressing down on his nerves, left him with severe pain and a tingling in his legs when he walked. This condition, we call, lumbar canal stenosis. His vertebrae also had an abnormal movement. I discussed the options with him: a slightly larger surgery, which would require some screws and rods, or a smaller, minimally invasive one, where we'd simply release the pressure on his nerves by drilling the hypertrophied bone and biting off the compressing ligaments.

Given that he was 77, had osteoporosis, uncontrolled diabetes, and varicose veins, he opted for the latter—and rightly so.