An orthopedist questions the utility of surgery for back pain.

As a practicing orthopedic surgeon, I was amused by the article, “Medical versus Surgical Treatment for Low Back Pain.”1 Most busy surgeons will tell you that surgical treatment is practically never indicated for low back pain. I estimate that I treat about 100 patients before I see one who is a surgical candidate. And such patients have leg pain, not back pain, as their primary symptom. If this is induced by exercise and the patient is elderly, a diagnosis of spinal stenosis might be considered, but again, almost all surgical candidates have leg pain. Although magnetic resonance imaging can confirm the diagnosis (and direct the surgeon to the level of the abnormality), the decision to operate should be based on symptoms. In fact, in my experience, if a patient has back pain, he or she is almost guaranteed not to improve with surgery. Rare is the patient who has singleor doublelevel degenerative disc disease who will respond to surgical fusion (usually less than one per year), and for that rare patient I would recommend surgery only if I personally have treated and gotten to know him or her over the course of a year. I suggest that physicians consider the use of caring medical treatment in all patients with back pain and make a concerted effort to avoid surgical treatment. They will doubtless have superior results.