There are many things that we do not know about low back pain or chronic pain.  Yet there are many facts that are clear.  Here is a list of what we know:

• Exact diagnosis of LBP is usually unclear
• Discs normally degenerate with age
  • Little association as a cause of low back pain
• Prognosis for return to work worsens with increasing time off of work
• Depressed patients are more disabled
• History of past abuse worsens prognosis
• Prognosis is worse in patients on worker’s comp
• Patients in chronic pain become sensitized to pain
• Repeated spine surgeries have decreasingly positive outcomes with each operation
• Psychological profile is a better predictor of the success of surgery than the anatomic lesion
• Surgeons have a limited capacity to assess patients’ stress levels
• Real success rate of lumbar fusion is overestimated
• Structured non-operative care can be successful
• Downside of a failed back surgery can be severe
• Insurance doesn’t pay for aggressive structured care

It is critical that you understand the current thinking of the spine surgery community. Spine surgery for the appropriate reasons has a wonderful success rate.  Surgery for ill-defined indications is unpredictable and can be catastrophic.  Be careful!

BF