Wondering if surgery is an option for your back pain?
The myBackPain assessment identifies whether your presentation has features that warrant surgical assessment — or whether conservative management has the better evidence for your specific situation.
proportion of back pain cases are appropriate for surgery — most people do not need it
3–6
months of well-managed conservative care should typically precede surgical consideration for non-emergency cases
Right
patient at the right time — surgery for the correct indication produces good results; for the wrong indication, it often does not
When surgery is clearly indicated
Cauda equina syndrome — emergency decompression surgery. Not optional — go to A&E immediately.
Progressive neurological deficit — worsening leg weakness or foot drop despite conservative management
Significant structural instability — high-grade spondylolisthesis, fracture with instability
Tumour or infection — requiring surgical decompression or debridement
Common procedures and their evidence
Microdiscectomy
Removal of the herniated disc fragment compressing a nerve root. Good evidence for sciatica that has not resolved after 6–12 weeks of conservative management. Outcomes are generally positive.
Decompression laminectomy
Removal of bone and tissue causing spinal stenosis. Effective for neurogenic claudication significantly affecting quality of life. Good medium-term outcomes.
Spinal fusion
Joining two or more vertebrae permanently. Appropriate for instability and high-grade spondylolisthesis. Evidence for fusion in non-specific back pain is weak — outcomes for this indication are often no better than conservative management.
Vertebroplasty / kyphoplasty
Injection of bone cement into a vertebral compression fracture. Effective for pain relief from osteoporotic fractures with specific criteria.
When surgery is less likely to help
Non-specific back pain without a clear structural cause
Back pain with significant central sensitisation or psychological factors not yet addressed
Disc degeneration alone without significant nerve involvement or instability
Before adequate conservative management has been properly tried
The most important principle
Surgery for the right indication, at the right time, in the right patient produces good results. Surgery as a response to pain that has not responded to conservative management — without a clear structural target — frequently does not improve outcomes and carries real risks. A spinal surgeon who recommends conservative management first is not withholding treatment — they are applying the evidence correctly.
Find out which treatment is most appropriate for your specific back pain
The myBackPain assessment identifies the most likely cause of your pain — and guides you toward the treatment approaches with the best evidence for your specific presentation.