Does your back hurt…and has your doctor suggested that surgery might help? If so, don’t be too quick to take the bait. Instead, take 10 seconds to check out a simple chart that can help you determine whether you are a good candidate for back surgery—or not.

Why this is so important: In today’s profits-before-people health-care environment, patients who complain of back pain often get hooked into having operations that they don’t need and that probably won’t help. Even worse, back surgery can carry risks for infection and nerve damage that can cause sexual dysfunction, incontinence or even paralysis.

As a consumer, you can and must take a proactive stance to ensure that you aren’t pushed into unnecessary and potentially catastrophic surgery. Spine procedures are costly and surprisingly ineffective, statistically speaking—surgery for nonspecific lower-back pain has a success rate of less than 30%—yet for the hospitals and physicians involved, these operations are highly profitable.

Take spinal fusion, for instance, a procedure in which two or more vertebrae are joined together. With more than 450,000 spinal fusions being done in the US each year, the operation has become more common than hip replacement—though it seldom helps. What’s more, new research shows that as many as half of these surgeries are done on people who do not meet the medical criteria for needing them.

I spoke about this with David Hanscom, MD, a Seattle-based orthopedic surgeon and author of Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain. Dr. Hanscom told me that he has been called upon to perform corrective procedures on hundreds of patients who have suffered terribly from botched, ineffective and/or unnecessary spinal fusions. Statistically, 15% to 20% of patients having spinal fusion require another surgery within one year. Dr. Hanscom cited research showing that, in his home state of Washington, only 15% of workers who underwent spinal fusion for lower-back pain had enough reduction in pain a year later to be able to return to their jobs.


Back pain affects four out of five people at some point. Despite how common the problem is, though, its treatment often is shrouded in mystery, Dr. Hanscom said. In his view, factors that contribute to the current crisis in back-pain care include deficiencies in physician training and understanding as to what does and doesn’t help with back pain…an emphasis on the bottom line rather than patient welfare (because of course, surgeons make their money by performing surgery, not by steering patients away from operations)…and patients who have grown so desperate for help that they will agree to anything that they think might relieve their suffering.

But often, the reality boils down to one key point. “The main thing to understand is that if a back problem cannot be ‘visualized’—meaning seen via an imaging test—then there should be no operation regardless of what other treatments have or have not already been tried. And in the vast majority of cases, back pain cannot be visualized because it has nonspecific causes and is located in soft tissue, which means that surgery cannot solve the problem,” Dr. Hanscom said.

When surgery won’t help, Dr. Hanscom recommends that his patients follow a “structured care program” that he devised called Defined, Organized, Comprehensive Care (DOCC), which we will get to in a moment. First though, let’s take a look at the clear and simple formula that he developed to help patients and their doctors determine whether it makes sense to even consider back surgery.


Back pain is complicated, with many potential causes. Absent a clear cause such as an injury or a defect of the spine, most cases of back pain eventually resolve on their own without treatment. But other factors, including the nature of the pain…your overall health…your stress level…and even how well you sleep can have a huge impact.

If your back pain does not go away on its own and if an imaging study reveals damage or an abnormality, surgery may help—or it may make matters worse. So to increase the odds that you will make the right decision, check out the chart below and choose the description that best fits you with regard to your symptoms and your lifestyle…then find the intersection of the two to see whether or not you’re a good candidate for back surgery. (Of course, all patients should discuss the potential benefits and risks of surgery with their own doctors, so after you find your place on the chart, take this information to your doctor to discuss your particular situation.)

Back chart 170


Regardless of where you fall on the chart, the odds are that your back pain will improve dramatically if you learn and practice the techniques involved in Dr. Hanscom’s DOCC structured program. Its basic premise is that pain is a perception rooted in neurological pathways, and understanding this allows you to gain control of what you feel. He outlines a step-by-step program that calms the nervous system so it can heal…while also retraining your brain so you literally no longer feel the pain. “It’s an organized approach to solving pain in which all aspects of pain are addressed simultaneously,” he said.

For details on Dr. Hanscom’s DOCC program, read our recent article, Stop Chronic Back Pain Without Surgery…and get ready to feel much better, whether or not surgery turns out to be in your future.