 Hi, myself Dr. Ajay Kumar SP, Consultant Spine Surgeon, Manipal Hospital, Whitefield, Bangalore. Back pain is extremely common condition and most often surgery resolves it, which is always not true. Let's know about why back pain occurs and surgery is the solution for it or not. Trauma, aging, improper biomechanics and minor wear and tear activities all will lead to back pain. Damage to any part of the back or to the nerves will lead to a back pain and related symptoms. If you have ongoing back pain, you would have wondered can back surgery will help. In fact, back surgery will be needed only in small percentage of cases and most of the back pain can be managed with anti-inflammatory, eye supplication, physiotherapy and rehabilitation and doing yoga. When conservative treatment fails, few cases back surgery may help but it is always not true that all back pain cases needs surgery. Back pain surgery may be needed when there is pressure on the nerves which causes severe leg pain, difficulty in walking and difficulty to carry day to day activities or when there is a rubbery cushion which is compressing on the nerves which leads to a physical disability of a patient or compression fractures or listosis what we say is like one bone is slipping over the other which again in term causes pressure on the nerves and lastly after all the conservative management which fails the following are the conditions which may need surgery which is progressive which is making weakness, numbness and not able to walk or deformed spine such as kyphosis where there is forward bending of spine scoliosis where there is side bending of the spine or severe pressure on the nerves which may be in the form of bone stenosis or because of the cushion which is coming out and pressing on the nerves or due to fractures which causes permanent disability. Most of the times whatever the pressure which is causing the nerve compression can be relieved just by removing the minor bone area or the rubbery cushion which is causing the compression with minimal micro-diskectomy relieving the pressure or sometimes the bone may be required to remove the complete cushion and has to be fixed with screws and rods to achieve the fusion. Types of surgeries includes diskectomy where the rubbery cushion which is pressing on the nerves is taken off with microscopic help relieving decompression where the bone area is released and which causes little opening of the spinal canal interbody fusions where instrumentation has been done to achieve the fusion vertebroplasty or kyphoplasty which was done in fractured bone in osteoporotic patients artificial disc replacement where the cushion which is present in between the bones is completely removed and replaced with a artificial disc which helps in which is a motion preservative surgery. Considering all options before agreeing to go for surgery please consider taking second opinion from qualified spine surgeon because spine surgeon knows what type needs surgery and what type which may not be addressed in surgical way can be managed in conservative ways. Spine surgeons have different opinion regarding what conditions needs surgery, what type of surgery is needed or few people may not be addressed with surgical options and which may warrant to get better with other non-surgical options. To conclude back and leg pain is a complex issue which needs to be approached with multi-disciplinary, multi-professional who needs to diagnose and carry it forward to get better outcome. Thank you.