Surgery — What You Need to Know

Summary

• Spinal fusion is effective for spondylolisthesis, fractures, tumors, and infections — conditions with a clear structural problem
• For chronic low back pain without an identifiable cause, an 11-year follow-up study found no difference between fusion and rehabilitation (Mannion 2013)
• Discography has a high false-positive rate — it cannot reliably identify patients who need surgery
• Most MRI "abnormalities" are normal aging — they are not, by themselves, a reason for surgery
• Surgical risks include early complications, adjacent segment disease, and FBSS — each occurring at meaningful rates
• Major guidelines (NICE, ACP) do not recommend fusion for nonspecific chronic low back pain
• Surgery is not the problem — operating on the right indication is what matters