In general both the patient and physician should discuss the issue. However, since many patients have no idea how serious their back disorder is, they may not always be aware of all the possible options. Patients are always at a major disadvantage when it comes to dealing with surgeons. Physicians and surgeons in general will recommend therapies which they know are expensive- irrespective whether they work or not. The best advice is to read up on your back pain, talk to other people and not agree to any treatment without a second opinion. It is the rare patient who ever improves with back surgery
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