 I am Dr Vidyadarayas, head of the department and consultant spine surgeon at Manipal Hospital, Bangalore. This final surgery is the last specialty to develop in medical science because it is one of the riskiest of the surgeries to perform because anything going wrong, patients will not die and you are not spared. So, having said that there is very simple three indications for any or every spinal problem which may fit into 95% of condition. One weakness of upper or lower limb which is an absolute indication for surgery or bowel and bladder involvement that is urine or motion either you are not able to pass or you are not able to fold. And these two indications we say they are absolute. When I say absolute even if you go to 20 doctors they should talk about surgery nothing else. And here we say that time is money because it is this weakness of bowel bladder involvement is secondary to some nerve or spinal cord which is getting pinched. And the earlier you release the pressure the better is the outcome, faster is the outcome. And after these two the third indication is functionally disabling back pain or neck pain for more than three consecutive months. Mark my words it is functionally disabling neck or back pain for more than three consecutive months. It becomes a relative indication because pain is subjective. You know pain is pain. You ask five people each one's pain is different for the same amount of pressure. In a school you would have seen some children cry when the teacher raises their hand and some children get four on the bum and they don't feel the pain. So pain is subjective that's why this indication becomes relative. And this is a very very individualizing functional disability because of pain. Now each one has a different expectation in life and each one has a different ability. So if you think the gap between your expectation and ability is significant and it is more than three months you have two ways to treat one bring down expectations and live like an elderly man on the screen. Or you take the help of science and technology pinpoint the problem and get the scientific intervention done so that you are back to what you want to do. So these form 95% of indication for surgery whereas there are exceptions like say spinal infections, spinal tumors, spinal deformities. The indications are very very individualized. Grossly speaking in scoliosis 50 degree is the cutoff. Like less than 50 degree can be managed with observation or brazing more than 50 degree needs to surgery. Now again there are a lot of different aspects to it depending on the age, depending on the expectation and all the other things. So that I think needs to be taken care on individual to individual basis.