When is surgery needed?

Surgery for low back pain is presented as a limited option that should usually come after physiotherapy, activity, and rehabilitation. The main idea is that many disc herniations improve on their own, MRI findings do not reliably predict future pain, and larger herniations may even have higher rates of spontaneous regression. Mild neurological deficits often recover without surgery, and even severe motor deficits do not always show clearly better outcomes with surgical treatment. Clear referral criteria are outlined: red flags, fast-progressive motor deficits, and severe pain that does not improve after six to eight weeks. Surgery is described mainly as pain relief for radiculopathy rather than a complete solution, since many patients still report back pain years later, and work outcomes are often not ideal. The summary also explains limits of morphine and similar drugs, noting short-term benefit but potential long-term problems, while exercise offers longer-lasting benefits with fewer drawbacks. Overall, low back pain management is framed as multidimensional, focusing on biomechanical, lifestyle, psychological, and social drivers to match treatment to the individual patient.