Board-Certified Neurosurgeon

Medically reviewed on June 11, 2026  

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice. Individual cases vary. Always consult a qualified spine specialist about your specific imaging, symptoms, and treatment options before making any decision about surgery or delay.

Key Points

✓ For most non-emergency spine problems, guidelines recommend 4 to 8 weeks of conservative care first. Over 85% of acute disc herniations improve without surgery. ¹ ²

✓ Watchful waiting is not doing nothing. It means active physical therapy, anti-inflammatories, activity modification, and re-evaluation if symptoms change. ²

✓ Early surgery and prolonged conservative care lead to similar one-year outcomes for sciatica but early surgery brings faster pain relief. ³

✓ Once sciatica lasts 4 to 12 months, surgery clearly outperforms more waiting. Long delays are a trade-off, not a safe default. ⁴

✓ Cauda equina syndrome is an emergency. Saddle numbness, new bladder or bowel changes, or rapid leg weakness need decompression within 24 to 48 hours. ⁵ ⁶

✓ Nerves compressed longer than 3 months are more likely to leave permanent numbness or pain, even after a successful operation. ⁷

✓ Nerves heal slowly about 1 mm per day. Severe, long-standing compression may never fully recover. ⁸

✓ The type of surgery matters as much as the timing. Deuk Laser Disc Repair® treats disc-driven pain; Deuk Plasma Rhizotomy® treats facet-driven pain — both without fusion or hardware. ¹¹ ¹²

Why Timing Is One of the Hardest Questions in Spine Care

If you have been told you may need spine surgery, you are probably hearing two opposite messages at the same time. One voice says, “Wait. Most back problems get better on their own.” Another voice says, “Don’t wait too long, or the nerve damage becomes permanent.”

Both statements can be true at the same time, which is exactly what makes the question difficult. The right amount of time to wait depends on what is wrong, what symptoms you have, and how those symptoms are changing.

This article walks through what the published evidence actually says about timing: when watchful waiting is reasonable, when it is risky, and when it stops being an option at all.

The Default for Most Non-Emergency Spine Problems: 4 to 8 Weeks of Active Conservative Care

For the most common reason patients are told they “need” spine surgery a lumbar disc herniation pressing on a nerve root, causing sciatica. First-line treatment is almost always non-operative, unless there is a significant neurologic deficit or signs of cauda equina syndrome. A 2025 systematic review of treatment guidelines for lumbar disc herniation concluded that conservative treatment is typically recommended for 6 weeks to 2 months before surgery is considered, because more than 85% of patients with acute herniation and radicular symptoms improve over time, and spontaneous reabsorption of the herniated disc material has been documented in more than half of cases managed non-surgically. ¹

Other systematic reviews report a similar consensus: most surgical guidelines use failure of 4 to 6 weeks of conservative therapy, neurologic progression, or worsening imaging findings as the transition criteria from non-operative to operative care. ²

In practical terms, that “waiting period” should not be passive. It typically includes structured physical therapy, short courses of anti-inflammatory medication when appropriate, activity modification, and in selected cases, image-guided epidural steroid injections. Patients who simply rest in bed and wait for the pain to disappear are not following a conservative plan; they are just waiting.

What the Evidence Says About Surgery Sooner vs. Later for Sciatica

A frequently cited randomized trial published in The New England Journal of Medicine enrolled 283 patients with severe sciatica that had already lasted 6 to 12 weeks and randomly assigned them to early surgery or to prolonged conservative treatment with the option of surgery later. Of patients assigned to early surgery, 89% had a microdiscectomy at a mean of 2.2 weeks after randomization. Of patients assigned to conservative care, 39% eventually crossed over to surgery at a mean of 18.7 weeks. ³

The headline result is the one most people miss: at one year, the two groups had similar outcomes for disability and perceived recovery, but the early-surgery group reached those outcomes faster, with quicker pain relief. ³ For a patient deciding between operating now versus waiting, that is the honest framing. Both paths can work; surgery tends to shorten the suffering, while waiting allows a meaningful fraction of patients to avoid an operation altogether.

A separate, more recent NEJM trial looked at a different population: patients whose sciatica had already lasted 4 to 12 months and was caused by a lumbar disc herniation at L4–L5 or L5–S1. Those randomized to microdiscectomy had significantly greater leg-pain reduction at 6 months than those who continued non-operative care. ⁴ The implication: once symptoms have been present for many months, “more waiting” is not a neutral choice. It can mean more months of preventable pain.

The Real Danger Zone: When “Waiting” Is the Wrong Answer

There are situations where the calendar stops mattering and the clock starts. These are not subtle, and they should not be managed at home or through a primary care follow-up two weeks from now.

Cauda equina syndrome (CES) is the most important of these. It occurs when the bundle of nerve roots at the bottom of the spinal canal is severely compressed, typically by a large central disc herniation. Classic warning signs include numbness in the “saddle” area (inner thighs, genitals, buttocks), new urinary retention or incontinence, new bowel dysfunction, and rapidly progressive bilateral leg weakness. CES is a neurosurgical emergency: research consistently supports surgical decompression within 24 to 48 hours of symptom onset, with outcomes particularly bladder and bowel recovery is generally better the sooner surgery is performed. ⁵ ⁶ The 48-hour window is debated in the literature, with some studies finding no sharp threshold, but the clinical standard remains “as soon as humanly possible, not the next morning if it can be avoided.” ⁶

The other situations that compress the timeline include:

• Progressive motor weakness a foot drop that is getting worse week over week, or new weakness in a major muscle group, is a sign the nerve is losing function, not just transmitting pain. Surgical guidelines treat this as an indication to move from conservative care to surgical evaluation. ²
• Spinal cord compression with myelopathy in the neck or upper back. These signs include hand clumsiness, balance problems, gait changes, and hyperreflexia. Once a spinal cord is being squeezed, the question is not “should we wait?” but “how soon can we decompress?”
• Spinal infection, tumor, or unstable fracture each has its own urgency, and none belong in a watchful-waiting protocol.

If any of these apply to you, this article is not the place to make a decision. An in-person evaluation by a spine specialist or an emergency department is.

Can Waiting Cause Permanent Damage? What the Research Actually Shows

Yes, it can and the evidence is more specific than most patients are told.

A study referenced in clinical commentary on lumbar spinal stenosis found that, at two years after surgery, patients who had numbness for longer than 3 months before their operation had worse leg pain and worse quality of life than patients who had surgery earlier. ⁷ The interpretation offered by the authors and treating clinicians: a compressed nerve can tolerate pressure for only so long before some of the damage becomes resistant to even a technically excellent decompression. Surgery after three months still helps. Just not as completely as it would have helped earlier. ⁷

This is consistent with what spine surgeons describe in clinical practice. Mild irritation of an inflamed nerve root can resolve within days or weeks after decompression. Severe or prolonged compression; particularly involving the spinal cord, as in cervical myelopathy. Often leaves residual numbness, weakness, or pain that improves only partially and over many months. ⁸ ⁹

There is also a biological speed limit on the upside. After surgery, peripheral nerves typically regenerate at roughly one millimeter per day, or about an inch per month. ⁸ That is why a patient whose foot has been weak for many months may not see complete recovery for a year or more and may not see complete recovery at all. The longer the nerve was compressed before surgery, the more of that recovery window is lost.

A Canadian prospective study of 166 patients awaiting surgery for lumbar degenerative spinal stenosis found that, although patients’ quality of life deteriorated while they waited, two-year postoperative outcomes were not statistically different between shorter and longer waits, though longer waits did delay recovery during the first postoperative year. ¹⁰ The deterioration happens; the eventual recovery is mostly preserved. That is a different finding than “waiting causes permanent damage”. It is “waiting causes preventable suffering, and sometimes slower recovery, without necessarily changing the destination.”

The two findings only seem to contradict each other. Read carefully, they say the same thing: what damages a nerve permanently is not waiting on a calendar; it is leaving pressure on the nerve while specific warning signs accumulate.

When Surgery Is the Right Call, the Type of Surgery Matters as Much as the Timing

Most of this article has been about when to operate. The other half of the question is what operation. The wrong procedure at the right time can be just as damaging as the right procedure at the wrong time, because a permanent, hardware-based operation that fuses motion segments forever is not interchangeable with a targeted, repair-based procedure that addresses only the actual pain generator. The decision to wait or operate should always include a serious look at whether a less invasive, motion-preserving option fits your specific anatomy.

At Deuk Spine Institute, the two procedures most commonly used to address the underlying drivers of chronic back and neck pain are designed around that principle.

Deuk Laser Disc Repair® is the minimally invasive solution to disc herniations

Deuk Laser Disc Repair® is a proprietary, full-endoscopic laser procedure developed for chronic pain caused by herniated discs, bulging discs, degenerative disc disease, sciatica, radiculopathy, and spinal stenosis in other words, the conditions that cause most people’s back pain. ¹¹ The procedure is performed through a 4 to 7 millimeter incision. Smaller than a dime under light sedation in an outpatient surgery center. A tubular retractor, an endoscopic camera, and a Holmium YAG laser are used to remove only the inflamed, pain-generating tissue inside the disc, specifically the torn annular fibers and the portion of the nucleus pulposus producing the symptoms. No fusion. No screws, rods, or cages. No artificial implant. The disc is repaired rather than removed, and the spine’s natural motion is preserved. ¹¹

For a patient who has already worked through the 4-to-8-week conservative window without improvement, who has imaging that correlates with the symptoms, and who would otherwise be looking at a microdiscectomy or a fusion, this is the kind of motion-preserving alternative worth asking about before consenting to a larger operation. ¹¹

Deuk Plasma Rhizotomy® is the minimally invasive solution to facet pain

Not all spine pain is coming from a disc. A large share of chronic back and neck pain. Particularly in older adults and in patients whose pain is worse with extension, twisting, or standing. Pain comes from the facet joints themselves, the small paired joints that connect each vertebra to the next. When these joints become arthritic, hypertrophied, or otherwise inflamed (facet arthropathy, facet arthritis, facet hypertrophy, sacroiliac joint pain), there is a worn out joint generating pain.

Deuk Plasma Rhizotomy® is designed for exactly that problem. It is a roughly 10-to-20-minute outpatient procedure performed through a 4 mm incision under twilight sedation. Using medical image guidance, the proprietary Deuk Plasma Wand® delivers plasma energy to the small sensory nerve branches that carry pain signals away from the affected facet joint or sacroiliac joint, permanently destroying those pain fibers while preserving the joint’s movement. ¹² No fusion. No implanted hardware. No long recovery.

The clinical question this procedure answers is the one most patients with facet-driven pain are never asked clearly: if the joint itself is the pain generator and the nerves carrying that pain are accessible, why operate on the disc, install hardware, or fuse a level that is not causing the problem in the first place? Deuk Plasma Rhizotomy® treats the actual source. ¹²

The broader point applies regardless of which procedure is on the table: before you accept any timing recommendation, make sure the operation being timed is the right operation for your specific pain generator.

How Long Should I Wait For Spine Surgery?

A reasonable framework, distilled from the guidelines and trials cited above, looks like this:

• Emergency — operate now. Cauda equina syndrome, acute spinal cord compression with new neurological signs, unstable fracture, infection, or rapidly progressive major weakness. Goal: decompression within 24–48 hours when indicated. ⁵ ⁶
• Urgent — weeks, not months. A clear, focal neurologic deficit (such as a foot drop) caused by an identified compressive lesion, especially if it is worsening. Conservative care is reasonable only if the deficit is mild and stable, and only with close re-evaluation. ²
• Elective — 4 to 8 weeks of active conservative care first. Sciatica from a herniated disc without major weakness, mechanical back pain, mild stenosis. Most patients in this category will improve without surgery; for those who do not, surgery becomes a reasonable next step around the 6-week mark, with stronger evidence for surgery the longer severe symptoms persist into the 3-to-12-month range. ¹ ² ³ ⁴ For disc-driven pain that has not resolved, a motion-preserving option such as Deuk Laser Disc Repair® may be a less invasive alternative to fusion or microdiscectomy. ¹¹
• Facet-driven pain follows a different curve. When the imaging and symptoms point to the facet joints rather than to a compressed nerve, the urgency is different. There is no nerve compression clock to beat, but there is no reason to live indefinitely with chronic joint pain when a targeted procedure like Deuk Plasma Rhizotomy® can disconnect the pain pathway without fusion or hardware. ¹²
• Reassess at every step. New numbness, new weakness, new bladder or bowel changes, or pain that is escalating rather than slowly improving any of these should trigger a same-week re-evaluation, not a “wait and see another month.”

The most important sentence in this framework is the last one. Watchful waiting is only safe if someone is actually watching.

Questions to Ask Before You Agree to Wait or Operate

Whether your surgeon is recommending an operation now or telling you to give it more time, ask:

• What exactly is compressing the nerve, or which joint is generating the pain, and how confident are we about that? A clear MRI correlation with your specific symptom pattern is the foundation of any timing decision.
• What neurologic findings would change your recommendation tomorrow? You should leave the visit knowing the specific symptoms that mean “stop waiting and call me.”
• Is my deficit improving, stable, or progressing? A formal exam: strength, reflexes, sensation is the only honest answer to this question.
• If we wait, what is the realistic best-case outcome, and what is the realistic worst-case outcome? Both should be quantified, not described in adjectives.
• If we operate, what is the least invasive procedure that addresses my specific finding and is a motion-preserving, repair-based alternative available? Surgery for a contained herniated disc, surgery for facet-driven pain, and surgery for multi-level instability are not the same operation, and they should not be discussed as if they were.

Frequently Asked Questions

If most disc herniations improve on their own, why does anyone need surgery?

Because not all of them do, and because some symptoms tell us a nerve is being damaged in real time rather than simply hurting. More than 85% of patients with an acute lumbar disc herniation and radiculopathy improve with conservative care, ¹ but the remaining minority can have prolonged disability, progressive weakness, or in rare cases; features of cauda equina syndrome. Surgery exists for the patients who do not get better on the expected curve and for those whose symptoms make waiting unsafe. For that group, motion-preserving options such as Deuk Laser Disc Repair® are worth comparing against larger, hardware-based operations before any final decision is made. ¹¹

How long is “too long” to wait for sciatica?

There is no single number, but the evidence supports a few anchors. Guidelines generally recommend 4 to 8 weeks of conservative care before considering surgery for sciatica caused by a disc herniation. ¹ ² Randomized data show that early surgery shortens the time to pain relief but produces similar one-year outcomes compared to prolonged conservative care, ³ while patients whose sciatica has already lasted 4 to 12 months see significantly better pain reduction with surgery than with continued non-operative care. ⁴ Translating those numbers into a rule of thumb: a few weeks of waiting is usually reasonable, several months is a decision point, and a year of severe symptoms without improvement is not “patient.” It is unaddressed.

What symptoms mean I should stop waiting and seek emergency care?

Numbness in the saddle area (the parts of the body that would contact a saddle), new difficulty starting or controlling urination, new bowel incontinence, or rapidly worsening weakness in one or both legs are signs of possible cauda equina syndrome and require emergency evaluation. Outcomes are best when surgical decompression occurs within 24 to 48 hours of symptom onset. ⁵ ⁶ Do not wait for a scheduled appointment. Go to an emergency department.

Can waiting too long cause permanent nerve damage?

It can, particularly when the compression is severe, when the symptoms include numbness or weakness rather than only pain, and when the duration of compression exceeds about 3 months. Research on lumbar spinal stenosis suggests that patients with preoperative numbness longer than 3 months have worse two-year outcomes than patients operated on earlier. ⁷ Nerves also regenerate slowly after decompression. Roughly one millimeter per day, so any deficit present at surgery may take many months to recover, and severe, prolonged compression can leave residual deficits that surgery cannot fully reverse. ⁸ ⁹

What if my pain is coming from the facet joints rather than from a disc. Does timing still matter?

The timing logic is different for facet-driven pain. Facet arthropathy, facet hypertrophy, facet arthritis, and sacroiliac joint pain do not produce the same nerve-compression clock that drives the urgency for disc-related surgery, so there is no equivalent “operate within X hours” rule. But that does not mean indefinite delay is harmless. Living with chronic facetogenic pain leads to deconditioning, disability, opioid exposure, and a steady decline in quality of life. Deuk Plasma Rhizotomy® is a targeted, outpatient procedure that uses plasma energy delivered through a 4 mm incision to permanently disconnect the sensory nerve branches carrying pain from the affected joint, without fusion or hardware. ¹² When the imaging and physical exam point to a facet source, this is the kind of procedure that addresses the actual pain generator rather than treating the wrong structure.

If I have already been waiting for a long time, is it too late to benefit from surgery?

Almost certainly not. Patients with persistent sciatica lasting 4 to 12 months still showed clear, statistically significant benefit from surgery compared to continued conservative care in randomized trials. ⁴ A Canadian study of patients waiting for lumbar stenosis surgery found that two-year outcomes were similar between shorter and longer waits, though longer waits delayed first-year recovery. ¹⁰ Late surgery for the right patient usually still helps. It just may help less completely, and more slowly, than the same operation done earlier. Which is one more reason that, when surgery becomes the right call, the least invasive, motion-preserving option available is generally the one worth pursuing first. ¹¹ ¹²

What if my surgeon is pressuring me to operate immediately for non-emergency back pain?

Ask for the specific clinical or imaging finding driving the urgency. Outside of true emergencies: cauda equina syndrome, progressive major weakness, instability, infection, tumor, cord compression with myelopathy. Most spine surgery is elective, and the evidence supports a trial of conservative care first in the absence of red-flag findings. ¹ ² A confident surgeon should be able to name the precise finding that makes your case different, should be comfortable explaining what would happen if you waited four to six weeks, and should be willing to discuss whether a motion-preserving, repair-based alternative exists for your specific MRI findings before recommending fusion or hardware.

Sources

1. Treatment Guidelines for Lumbar Disc Herniation. Neurospine. 2025. https://www.e-neurospine.org/journal/view.php?number=1714
2. Surgery vs. Conservative Treatment for Lumbar Disc Herniations. ScienceDirect. 2025. https://www.sciencedirect.com/science/article/pii/S2772529425014389
3. Peul WC, et al. Surgery vs. Prolonged Conservative Treatment for Sciatica. NEJM. 2007. https://www.nejm.org/doi/full/10.1056/NEJMoa064039
4. Bailey CS, et al. Surgery vs. Conservative Care for Persistent Sciatica. NEJM. 2020. https://www.nejm.org/doi/full/10.1056/NEJMoa1912658
5. Chaudhary R, et al. Cauda Equina Syndrome Beyond 48 Hours. Case Reports in Surgery. 2025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540004/
6. Timing of Surgical Intervention in Cauda Equina Syndrome. World Neurosurgery. 2013. https://www.sciencedirect.com/science/article/abs/pii/S1878875013014186
7. Carlson JR. Can a Pinched Nerve Cause Permanent Damage? OSC Ortho. https://www.osc-ortho.com/blog/will-my-compressed-spinal-nerve-heal-or-be-damaged-permanently/
8. Spine Surgery Recovery: Myths vs. Facts. Florida Spine Associates. 2025. https://floridaspineassociates.com/2025/12/15/mythbusters-spine-surgery-recovery/
9. Symptoms of Nerve Damage After Back Surgery. Lanman Spinal Neurosurgery. 2025. https://www.spine.md/insights/symptoms-of-nerve-damage-after-back-surgery
10. Wait Time and Outcomes in Lumbar Spinal Stenosis Surgery. CMAJ / PMC. 2016. https://pmc.ncbi.nlm.nih.gov/articles/PMC4933598
11. Deuk Laser Disc Repair® procedure overview. Deuk Spine Institute. https://deukspine.com/treatment-options/deuk-laser-disc-repair/
12. Deuk Plasma Rhizotomy® procedure overview. Deuk Spine Institute. https://deukspine.com/treatment-options/deuk-plasma-rhizotomy/

Medically reviewed on June 9, 2026

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice. Individual results vary. Always consult a qualified spine specialist about your specific condition, imaging, and treatment options.

Key Points

✓ In London and across England, a growing number of clinics advertise “minimally invasive” and “laser” spine surgery. The label has marketing value, so it gets used loosely. In many cases the operation actually being performed is a traditional open decompression or a fusion with hardware, just described with newer language. ¹ ²

✓ “Minimally invasive” is not a single defined operation. It describes a spectrum. A true endoscopic, laser-based disc procedure through a 4–7 mm incision and a tubular retractor “muscle-splitting” fusion that still removes the disc and installs permanent hardware are both sometimes marketed under the same phrase, even though the recovery, tissue damage, and permanence are completely different. ³ ⁴

✓ The published data is consistent: full-endoscopic discectomy produces pain and disability outcomes comparable to open discectomy, with shorter hospital stays, less tissue disruption, and in large case studies a remarkably lower rate of complications (0.6% endoscopic vs 3.4% open). The technique matters. ¹ ²

✓ Deuk Laser Disc Repair® is a Registered Trademark procedure performed only at Deuk Spine Institute in Florida, USA. It is not a generic “laser spine surgery” available from any clinic that uses similar wording on its website. If a London or England clinic is using language that sounds like ours, that does not mean they perform our procedure, because they cannot. ⁵

✓ Before you travel anywhere, or consent to anything, the protection is not the brochure. It is a small set of specific questions about incision size, disc removal, hardware, anesthesia, and personal complication rates that a marketing label cannot answer for you.

Why “Laser Spine Surgery” Means Less Than Patients Think

If you live in London or anywhere in England and you have searched for “laser spine surgery” or “minimally invasive spine surgery,” you have almost certainly seen clinics promising small incisions, fast recovery, and a high-tech alternative to open back surgery. The pages look reassuring. The language is modern. The before-and-after framing is persuasive.

Here is the problem. “Laser spine surgery” and “minimally invasive spine surgery” are descriptive marketing phrases, not regulated, standardized operations. There is no single procedure that the words guarantee. Minimally invasive techniques are used across a wide variety of spine procedures, and the same phrase can sit on top of operations that are worlds apart in how much tissue they damage and what they permanently change in your spine.

That gap is where patients get misled, not always intentionally, but reliably. A clinic can truthfully say a procedure is “minimally invasive” while still removing your disc, cutting bone, and placing permanent fusion hardware, simply because the skin incision was smaller than a traditional open approach. The recovery you were imagining and the operation you actually receive can be very different things.

The Spectrum Hiding Behind One Phrase

It helps to understand that “minimally invasive” describes a spectrum, not a destination.

At one end is genuine full-endoscopic, laser-based disc surgery: a procedure performed through an incision a few millimeters wide, using a camera and laser to treat the disc itself, typically without general anesthesia, without fusion hardware, and without removing the disc. The disc is repaired, and motion is preserved.

At the other end is “minimally invasive” fusion or decompression, which may use a tubular retractor and a smaller skin incision than traditional open surgery, but still involves removing disc material, cutting bone, and implanting permanent screws, rods, or cages that eliminate motion at that level. This is a major, permanent structural operation. The smaller incision does not change that.

Both can be, and are, advertised with the same words.

The published literature is actually encouraging about the genuinely endoscopic end of that spectrum. Systematic review and meta-analysis comparing endoscopic discectomy to conventional surgical techniques for lumbar disc herniation found similar pain relief, shorter hospital stays, and comparable complication rates, with less tissue disruption and faster recovery. In a large multi-center database analysis, endoscopic discectomy showed a significantly lower rate of total adverse events than open discectomy — 0.6% versus 3.4% — along with a shorter length of stay. A broader review of endoscopic spine surgery similarly concluded that endoscopic discectomy yields shorter operative times, lower infection rates, and comparable pain and functional outcomes versus open microdiscectomy.

The takeaway is not that “laser” or “minimally invasive” is meaningless. It is that the specific technique, not the marketing phrase, is what determines your outcome. A clinic that genuinely performs endoscopic disc surgery and a clinic that performs open fusion under a modern banner are not offering you the same thing, even when their websites read almost identically.

A Word of Caution for Patients in London and England

Because these phrases carry weight with patients, they get borrowed. Across London and England, you will find clinics whose websites lean heavily on language like “minimally invasive laser spine surgery,” sometimes describing procedures, outcomes, and recovery in terms that closely echo specialist centers abroad, including ours.

We want to be direct and fair about what that does and does not mean:

• Similar-sounding language on a clinic’s website is not proof that the clinic performs the same procedure. Words are easy to copy. A specific surgical technique, with its instrumentation, training, and published results, is not.
• A clinic advertising “laser spine surgery” may be performing a laser-assisted step within an otherwise traditional operation, or may be using “laser” loosely. That is a question to resolve directly with the surgeon, not something to assume from the homepage.
• Deuk Laser Disc Repair® is a trademarked procedure developed and performed only at Deuk Spine Institute in Melbourne, Florida. No clinic in London or anywhere else in England performs Deuk Laser Disc Repair®(DLDR). If you are searching specifically for our procedure and you land on a UK clinic that sounds like us, you have not found us. You have found a different clinic using familiar-sounding words. ⁵

We are not telling you that every London or England spine clinic is the same, or that you cannot get good care closer to home. We are telling you that the burden is on the marketing to prove itself, and you hold the questions that make it prove itself.

The Red Flags That a Smaller Incision Is Still a Major Operation

You do not need to be a surgeon to catch the most common mismatches. Watch for these:

1. The word “fusion” appears anywhere in your consent paperwork. Fusion permanently eliminates motion at a spinal level and relies on hardware. It can be done through smaller incisions, but it is not a minor procedure, and it is not disc repair. ⁴
2. The plan involves removing your disc. “Discectomy,” “microdiscectomy,” and “decompression” all involve taking tissue out. A repair-based approach aims to treat the disc and preserve it. These are different philosophies, not different brand names for the same thing.
3. General anesthesia and an overnight hospital stay are required. Genuine endoscopic disc procedures are frequently performed under sedation or local anesthesia on an outpatient basis. A required hospital admission is a signal that the operation is larger than the label suggests. ⁵
4. Recovery is described in weeks of restricted activity, but the procedure is sold as “minimally invasive.” The recovery profile should match the procedure. If the recovery sounds like open surgery, it probably is open surgery.
5. No one will quote you about their personal complication and reoperation rate. A center confident in its technique can give you numbers, not adjectives.

What Deuk Laser Disc Repair® Actually Is

So patients can compare honestly, here is what our procedure is, in plain terms. Deuk Laser Disc Repair® is a full-endoscopic, laser-based procedure performed through a 4 to 7 mm incision, about the diameter of a pencil eraser. In most cases there is no hospital admission, no general anesthesia, no fusion hardware, and no artificial implant. The herniated, bulging, or torn disc is treated and repaired rather than removed, and spinal motion is preserved.

Deuk Spine Institute publishes its own track record openly: a reported complication rate of 0.01% and more than 2,700 procedures completed. ⁵ Those are the clinic’s published figures, and we state them as such, because honest, verifiable numbers are exactly what patients deserve and what a marketing label can never provide. No responsible surgeon, anywhere, can promise a zero-percent complication rate, and you should be cautious of any clinic, in any country, that claims one.

This is the point of the entire article. The strength of a spine procedure is not in the words on a website. It is in the specific technique, the surgeon’s training, the anesthesia and incision reality, and the published outcomes. Those are the things you can check.

What You Should Do Before Consenting to Any “Minimally Invasive” or “Laser” Spine Surgery

Whether the clinic is in London, elsewhere in England, or abroad, ask these questions and require specific answers:

• What exactly is the operation called, and will you be removing any disc material or placing any permanent hardware? If the answer includes fusion, screws, rods, cages, or disc removal, you are considering a major structural operation, regardless of incision size.
• How large is the incision, and what type of anesthesia is used? A few millimeters under sedation describes a very different procedure than a tubular approach under general anesthesia.
• How many of this exact procedure have you personally performed in the last 12 months, and what is your personal complication and reoperation rate? Ask for numbers.
• Is there a motion-preserving, repair-based alternative for my specific MRI findings? And if there is, why is it not being offered to me?
• If I am searching for a specific named procedure, are you actually performing that procedure, or one with a similar name? For Deuk Laser Disc Repair® specifically, the honest answer from any UK clinic is no, because the procedure is performed only at Deuk Spine Institute in Florida. ⁵

A clinic that answers all of these with specifics has earned your trust. A clinic that retreats to “it’s minimally invasive, you’ll be fine” has told you something important.

Frequently Asked Questions

Sources

1. Khandge AV, et al. A systematic review of full endoscopic versus micro-endoscopic or open discectomy for lumbar disc herniation. PubMed. 2021. https://pubmed.ncbi.nlm.nih.gov/34420416/
2. Comparative effectiveness of minimally invasive endoscopic discectomy versus conventional surgical techniques for lumbar disc herniation: a systematic review and meta-analysis. Annals of Medicine and Surgery / PMC. 2025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12577904/
3. Evaluation of Endoscopic Versus Open Lumbar Discectomy: A Multi-Center Retrospective Review Utilizing the ACS-NSQIP Database. PMC. 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9213256/
4. A Systematic Review and Meta-Analysis of Preoperative Characteristics and Postoperative Outcomes in Patients Undergoing Endoscopic Spine Surgery: Part I Endoscopic Microdiscectomy. PMC. 2025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12524356/
5. Deuk Spine Institute. Deuk Laser Disc Repair® procedure overview and reported track record. https://deukspine.com/treatment-options/deuk-laser-disc-repair/
6. Endoscope-Assisted Spine Surgery: A Comprehensive Review of Clinical Applications. PMC. 2025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12285748/

Medically reviewed on June 4, 2026

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice. Individual results may vary. Always consult with a qualified spine specialist about your specific condition and treatment options.

Key Points

✓ Both neurosurgeons and orthopedic spine surgeons operate on the spine. The title alone does not tell you who should be treating your condition or whether either is recommending the right procedure.

✓ Neurosurgeons complete a 7-year residency centered on the nervous system. Orthopedic spine surgeons complete a 5-year musculoskeletal residency plus an optional 1–2 year spine fellowship. Different foundations. Meaningful overlap in practice. ¹ ²

✓ For disc herniations, disc bulges, and discogenic pain, neither fusion nor open decompression is the only option. Both are frequently over-recommended for conditions that do not require removing the disc or eliminating motion.

✓ The Deuk Laser Disc Repair® addresses herniated discs, bulging discs, and annular tears through a 4–7 mm incision. No fusion, no hardware, no disc removal. The disc is repaired, not replaced. Motion is fully preserved. It is the same result most patients are told they need fusion or major decompression to achieve. ³

✓ Specialty matters less than most patients assume. What matters is whether the recommended procedure matches your actual pathology and whether a less invasive, motion-preserving option was offered before a permanent operation was put on the table.

Why This Question Matters More Than You Think

Most patients arrive at a spine surgeon consultation without knowing whether they are sitting across from a neurosurgeon or an orthopedic surgeon. They know the person is a “spine doctor.” They know surgery has been recommended. What they often do not know is that the two specialties represent fundamentally different training philosophies.  And in certain conditions, that difference is meaningful.

It is also a question the medical community has spent years trying to answer with data, with inconsistent results. Studies comparing outcomes between the two specialties have been published across national databases, trauma centers, and single-institution reviews. The findings are nuanced. Sometimes neurosurgeons come out ahead. Sometimes orthopedic surgeons do. Most of the time, the differences are statistically small and clinically insignificant. ³

What the data consistently shows is that the question itself is incomplete. The relevant variables are not just specialty. They are surgical volume, fellowship training, institutional experience, and most importantly; whether the recommended procedure is the right one for the problem being treated. A highly experienced orthopedic spine surgeon with 2,000 posterior fusions is not the right person to remove an intradural spinal cord tumor. A neurosurgeon who splits their time evenly between brain and spine is not the same as one who has spent 20 years exclusively on spine. Titles create categories. Categories are not always clinically useful.

The goal of this article is to give you an understanding of what separates these two specialists at the level of training, clinical strengths, and procedure-specific outcomes, so that when you are given a recommendation, you can ask the right questions.

How Each Surgeon Is Trained: The Foundation of the Difference

Before comparing who is “better” for spine surgery, it is worth understanding what each surgeon actually spent their training years doing. Because the differences start earlier, run deeper, and are largely influenced by the number of procedures that a surgeon has done for that exact condition.

1. Neurosurgical Training: The Spine Is Central From Day One

A neurosurgeon completes medical school followed by a 7-year residency in neurological surgery. The entire residency is oriented around the nervous system: the brain, the spinal cord, the peripheral nerves, and the complex anatomy that either protects or compresses them. Spine surgery is not a rotation within a broader musculoskeletal training; it is a core domain of every neurosurgical training program in the country.

A 10-year analysis of ACGME case logs found that neurosurgery residents performed an average of 433.8 spine procedures during residency. Over that same period, spine cases represented 33.5% of all surgical cases performed by neurosurgery residents. ¹ From the first year, neurosurgery residents are learning to work with the delicate neural structures that orthopedic training is not designed to prioritize: the dura, the spinal cord itself, the nerve roots, the microsurgical environment inside the spinal canal.

Intraoperative neuromonitoring the real-time tracking of spinal cord and nerve function during surgery. Is standard practice in neurosurgical training. So is microsurgical technique: operating under high magnification in confined spaces where a millimeter of error can change a patient’s neurological status permanently. These are not skills that can be acquired from a structural-alignment training program. They are the result of years of repetition in the right environment.

After residency, many neurosurgeons complete an additional 1–2 year spine fellowship, narrowing their focus further to complex spinal pathology, minimally invasive techniques, or specific anatomical regions.

2. Orthopedic Spine Training: Structural Mastery as the Core Discipline

An orthopedic spine surgeon completes medical school followed by a 5-year orthopedic residency. The focus of that residency is the musculoskeletal system in its entirety: bones, joints, tendons, ligaments, cartilage, and the mechanical architecture of the body. Spine is one component of their training, a meaningful one, but not the exclusive focus.

ACGME data shows orthopedic surgery residents averaged 119.5 spine procedures during residency. Far fewer than their neurosurgical counterparts, with spine representing only 6.2% of all orthopedic cases logged over the same 10-year period. ¹ What orthopedic residency provides that neurosurgical training does not is deep immersion in structural biomechanics: how bones align, how hardware interfaces with bone, how deformities develop and how they can be corrected through instrumentation and reconstruction.

Because the general orthopedic residency provides limited spine exposure by volume, most orthopedic surgeons who pursue spine as their clinical focus complete an additional 1–2 year spine surgery fellowship after residency. Fellowship is optional, but among serious spine practitioners, it is nearly universal. That fellowship is where complex spinal reconstruction, multilevel instrumented fusion, and deformity correction techniques are developed to a clinical level. ²

The practical result of this training structure is an orthopedic spine surgeon who enters independent practice with deep expertise in the structural spine: alignment, hardware, fusion mechanics, and deformity. And relatively less immersion in the neural anatomy and microsurgical environment that forms the core of neurosurgical training.

What the Outcomes Data Actually Shows

The question of whether neurosurgeons or orthopedic surgeons produce better spine surgery results has been studied repeatedly in large national databases. The consensus is more nuanced than either specialty’s advocates tend to acknowledge.

A systematic review and meta-analysis reviewing published studies across PubMed and Scopus found that neurosurgeons and orthopedic spine surgeons have similar readmission, complication, and reoperation rates for spine surgery overall, regardless of procedure type. ³ A scoping review of 10 comparative studies similarly concluded that surgeon specialty alone shows no significant association with short-term spine surgery outcomes, and that surgical volume and fellowship training are the variables most likely to explain performance differences. ⁵

These findings are important. They mean patients should not assume that seeing a neurosurgeon automatically produces better results for back pain than seeing an orthopedic spine surgeon, or vice versa. For the procedures that dominate spine surgery volume: lumbar decompression, single-level fusion, microdiscectomy. A fellowship-trained, high-volume surgeon in either specialty is likely to produce comparable outcomes for the right patient.

Where the data gets more specific and more actionable for patients is at the level of individual procedure types. A study analyzing anterior cervical discectomy and fusion (ACDF) outcomes found that neurosurgeons perform approximately three times as many ACDF procedures as orthopedic surgeons and showed statistically shorter hospital stays, lower perioperative blood transfusion rates, and lower sepsis rates in the neurosurgical cohort. ⁶ A matched analysis of TLIF outcomes found that after controlling for surgical experience (only surgeons with at least 250 procedures were included), both specialties produced similar surgical complications, but neurosurgeons had higher all-cause medical complication rates. ⁷

Neither specialty dominates across all procedures. Both perform spinal surgery safely at high rates in experienced hands.

Where the Specialties Genuinely Differ

For the large overlap in conditions: herniated discs, spinal stenosis, degenerative disease, single-level fusion. The data supports the conclusion that experience and volume matter more than specialty. But there are clinical domains where the training difference is not trivial and where specialty genuinely guides who should be operating.

Conditions Where a Neurosurgeon’s Training Carries More Weight

Intradural spinal surgery operations that take place inside the dura mater, the membrane that directly encloses the spinal cord and nerve roots. It is almost exclusively the domain of neurosurgeons. Spinal cord tumors, arachnoid cysts, tethered cord, and intradural arteriovenous malformations require microsurgical technique and a level of familiarity with neural anatomy that orthopedic residency does not provide at the same depth. Neurosurgeons perform the substantial majority of intradural spine surgeries in the United States. ⁴

Craniocervical junction surgery is the region where the skull meets the top of the cervical spine. Similarly demands the kind of neural anatomy expertise that is core to neurosurgical training. The proximity to brainstem structures, the complexity of stabilization without damaging the cord, and the need for neuromonitoring throughout make this a neurosurgical domain.

Acute spinal cord injury with neurological deterioration is typically managed by neurosurgeons at Level I trauma centers. Where nerve preservation and decompression timing are as important as structural stabilization, neural expertise carries direct clinical weight. ⁸

Conditions Where an Orthopedic Spine Surgeon’s Training Carries More Weight

Complex spinal deformity: adult and pediatric scoliosis, kyphosis, flatback syndrome, pelvic obliquity. Has historically been the domain of orthopedic spine surgeons with fellowship training in deformity correction. The instrumentation strategies, the understanding of sagittal balance and alignment parameters, and the multi-level fusion mechanics involved in deformity correction represent a specialized body of knowledge that develops most completely in orthopedic spine fellowship training. Orthopedic spine surgeons perform over 70% of spinal fusion surgeries annually in the United States. ⁴

Spinal trauma with significant structural instability: burst fractures, fracture-dislocations, high-grade spondylolisthesis. Often favors the orthopedic surgeon’s structural reconstruction training, particularly for the long-segment instrumented constructs these cases require.

Pediatric spine surgery: including congenital deformities and growth-directed instrumentation, has more procedural volume in orthopedic training than in neurosurgical training, where pediatric spine cases represent a smaller proportion of residency exposure. ²

What These Categories Don’t Tell You

Fellowship Training Is the Variable That Closes the Gap

A board-certified orthopedic surgeon without fellowship spine training and a fellowship-trained orthopedic spine surgeon are not clinically equivalent for complex spine pathology. The same is true in neurosurgery: a neurosurgeon who divides their practice equally between brain surgery and spine is not the same as one who has devoted 15 years exclusively to spine surgery. The title on the door does not capture that distinction. Asking specifically whether the surgeon is fellowship-trained in spine, how many of your specific procedures they perform per year, and what their personal complication and reoperation rates are will give you more useful information than any specialty label.

Surgical Volume Is the Most Consistent Predictor of Outcome

The relationship between surgical volume and outcome is one of the most replicated findings in surgical outcomes research. It applies across specialties, procedure types, and institutional settings. A high-volume spine surgeon whether neurosurgeon or orthopedic. Can consistently outperform a low-volume surgeon in the same specialty for the same procedure. Before consenting to spine surgery with any surgeon, ask specifically how many times they have performed your recommended procedure in the past 12 months. Not how many spine surgeries they do. But how many times they’ve done the specific spine surgery recommended for you. ⁵

The Procedure Being Recommended Is a Separate Question Entirely

The debate between neurosurgeons and orthopedic spine surgeons is a question about who performs a procedure. The more important question. One that is almost never asked is whether the procedure being recommended is the correct one for your specific pathology. A fellowship-trained, high-volume surgeon in either specialty recommending a fusion for a condition that does not require motion elimination is not a better option than a less-decorated surgeon who recommends the correct operation. Specialty confers training. It does not guarantee that the recommendation you are receiving is the right one for what is actually wrong with your spine.

What You Should Do

There is no universally superior choice between a neurosurgeon and an orthopedic spine surgeon for spine care. The question is too broad. For the large category of degenerative spine conditions: herniated discs, stenosis, degenerative disc disease the outcomes in experienced, fellowship-trained hands are comparable between specialties. For intradural pathology, cord tumors, and complex neural conditions, neurosurgical training carries more weight. For spinal deformity, scoliosis, and structural reconstruction, orthopedic spine fellowship training typically represents deeper expertise.

What both specialties share is the capacity to recommend procedures that may not be the most appropriate for a given patient’s anatomy. A second opinion is ideally from a surgeon in the same specialty or the complementary one is not a delay in care for a stable degenerative condition. It is the most clinically justified step available to you before committing to a permanent structural change to your spine.

Before any spine surgery, ask your surgeon two questions. First: are you fellowship-trained in spine surgery, and how many of this specific procedure have you performed in the last year? Second: is there a motion-preserving or less-invasive alternative to what is being recommended for my specific MRI findings? The answers will tell you more than the specialty label ever could.

Frequently Asked Questions

Is a neurosurgeon or orthopedic spine surgeon better for back surgery?

For most common degenerative conditions: herniated discs, spinal stenosis, and single-level fusion the outcomes are statistically similar between fellowship-trained, high-volume surgeons in either specialty. The more relevant variables are the surgeon’s experience with your specific procedure and whether the recommended operation is actually indicated for your condition. For conditions involving the spinal cord, intradural pathology, or the craniocervical junction, a neurosurgeon’s training carries more clinical weight. For complex spinal deformity and multi-level structural reconstruction, an orthopedic spine surgeon with deformity fellowship training is typically the more appropriate choice.

Do neurosurgeons do more spine surgery than orthopedic surgeons during training?

Substantially more. A 10-year analysis of ACGME case logs found that neurosurgery residents averaged 433.8 spine procedures during residency, compared to 119.5 for orthopedic surgery residents. A 3.6-fold difference that widened over the study period. ¹ Spine represented over 33% of all surgical cases in neurosurgical training, versus less than 7% in orthopedic training. This training-volume gap is partially closed for orthopedic surgeons who complete a 1–2 year spine fellowship, but the raw residency exposure remains significantly higher for neurosurgery.

Should I see a neurosurgeon or orthopedic surgeon for a herniated disc?

Both specialties routinely treat herniated discs and perform the associated procedures: microdiscectomy, laminotomy, and decompression. For a standard lumbar or cervical herniated disc without spinal cord compression, either a fellowship-trained neurosurgeon or fellowship-trained orthopedic spine surgeon is an appropriate choice, and your decision should focus on the surgeon’s specific experience and complication rate rather than their specialty. If your herniated disc involves significant spinal cord compromise, myelopathy, or intradural involvement, a neurosurgeon’s training in neural anatomy and microsurgical cord decompression carries more direct relevance.

Can an orthopedic surgeon do spinal cord surgery?

Orthopedic spine surgeons routinely operate within the spinal canal for decompression, fusion, and structural reconstruction. What they do not typically perform is intradural surgery. Procedures that open the dura and operate directly on the spinal cord, nerve roots, or intradural tumors. Intradural spine surgery, cord tumor resection, and surgery at the craniocervical junction remain primarily within the neurosurgical domain, reflecting the depth of neural anatomy and microsurgical training that neurosurgical residency provides and orthopedic training does not. ⁴

Who performs more spinal fusions? Neurosurgeons or Orthopedic surgeons?

Orthopedic spine surgeons perform the majority of spinal fusion surgeries in the United States. Approximately 70% annually by some estimates. Reflecting their training emphasis on structural stabilization, instrumentation, and biomechanical reconstruction. ⁴ Neurosurgeons also perform fusion procedures routinely, but their proportionally higher volume skews toward decompressive and nerve-related procedures. For multilevel fusion, complex deformity correction, and instrumented reconstruction, orthopedic spine fellowship training typically represents the deeper concentrated experience.

What questions should I ask a spine surgeon before agreeing to surgery?

Ask five. First: are you fellowship-trained specifically in spine surgery? Second: how many of this specific procedure have you performed in the past 12 months; not total spine surgeries, but this operation? Third: what is your personal reoperation rate for this procedure at two and five years? Fourth: is there a motion-preserving or minimally invasive alternative to what you are recommending for my MRI findings? Fifth: what happens if I choose not to have surgery. What is the natural history of my condition without intervention? A surgeon who cannot answer all five questions with specific numbers and evidence deserves a second opinion before you consent.

Sources

1. Pham MH, et al. Trends in spine surgery training during neurological and orthopaedic surgery residency: a 10-year ACGME analysis. J Bone Joint Surg Am. 2019;101(22):e122.
2. Daniels AH, et al. Variability in spine surgery procedures during orthopaedic and neurological surgery residency: an ACGME case log analysis. J Bone Joint Surg. 2014;96:e196.
3. Bhullar A, et al. Spine surgical subspecialty and patient outcomes: a systematic review and meta-analysis. Spine. 2023.
4. Princeton Brain, Spine & Orthopedics. The Electrician vs. The Carpenter. princetonbrainandspine.com.
5. Manickam A, et al. Spine surgeries between specialties: neurosurgeons versus orthopedic surgeons — a scoping review. Int J Res Med Sci. 2023.
6. Alomari S, et al. Early outcomes of elective ACDF for degenerative spine disease correlate with surgeon specialty. Neurosurgery. 2022.
7. Shukla GG, et al. Matched analysis of TLIF outcomes: no difference between experienced neurosurgeons and orthopedic surgeons. Spine. 2024;49(11):772–779.
8. Sedighim S, et al. Neurosurgery vs. orthopedic spine consultation at a Level I trauma center. Brain Spine. 2024;4:102808.

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice. Sam, the chatbot described in this article, also does not provide medical advice, diagnosis, or treatment. Individual results vary. Always consult a qualified spine specialist about your specific condition and treatment options. If you are experiencing a medical emergency, call 911 or go to the nearest emergency department.

Key Points

✓ Sam is a free, always-on chatbot now available across every page of the Deuk Spine Institute website. It is built specifically to help patients who have already been told they need spine surgery understand their options before they consent to an operation.

✓ Sam exclusively understands Dr. Deukmedjian’s published clinical content. Peer-reviewed research, procedure pages, patient testimonials, and the Deuk Spine blog; not the open internet. It does not invent answers, and it does not pull from unverified sources.

✓ Sam does not diagnose, prescribe, or replace a physician. It is an information tool. When a question requires clinical judgment, Sam says so and directs you to speak with Dr. Deuk for a free virtual MRI review .

✓ Sam is available 24 hours a day, seven days a week, including the late-night hours when patients facing a fusion or laminectomy recommendation are most likely to be researching their options.

✓ Sam recognizes red-flag symptoms: cauda equina syndrome, progressive weakness, loss of bladder or bowel control, severe pain after trauma. And instructs patients to seek emergency care immediately rather than continuing the conversation.

✓ When a patient is ready for a real opinion on their actual imaging, Sam sends a direct link to the Free MRI Review form, where Dr. Deukmedjian’s team reviews the case personally.

Why We Built Sam

Most patients who land on DeukSpine arrived after a surgeon, somewhere else, told them they need a fusion, a laminectomy, or a discectomy. They are not casually browsing. They are anxious, often in pain, and trying to figure out their options. Usually alone at night wondering whether the operation they have been scheduled for is the right one.

The published evidence on second opinions in spine surgery makes their anxiety entirely rational. A scoping review in Cureus found that 61.3% of second opinions in spine surgery disagree with the original recommendation, and 75% of those disagreements recommend conservative care instead of the proposed operation.¹ A separate prospective study of 485 patients already recommended for spine surgery found that only 15.5% received the same surgical recommendation after a structured second-opinion review.² The diagnosis itself changed in 59.8% of cases.²

In other words, the patient who is up at 2:00 a.m. searching “do I really need spinal fusion” is asking exactly the right question. The problem has never been the question. The problem has been getting a trustworthy answer at the moment the question is being asked.

Sam exists to close that gap.

What Sam Is

Sam is an artificial intelligence chatbot integrated into every page of deukspine.com. It opens with a single click. There is no login, no patient form, no insurance check, and no fee. You can ask it a question in plain English, the way you would ask a friend who happened to be a spine surgeon, and it will respond with information drawn directly from Dr. Deukmedjian’s clinical work.

What makes Sam different from a general-purpose AI chatbot is the source material. Sam is not pulling answers from random forums, content farms, or the open web. Its knowledge is restricted to:

• Dr. Deukmedjian’s peer-reviewed publications and patents
• The Deuk Spine Institute procedure pages for Deuk Laser Disc Repair®, Deuk Plasma Rhizotomy®, and Deuk Piriformis Release®
• The full Deuk Spine blog archive, including comparisons of fusion, laminectomy, discectomy, and minimally invasive alternatives
• Verified patient testimonials and live surgery archives
• The Deuk Spine FAQ and educational resources

If a question falls outside that body of clinical content, Sam says so. It does not guess.

What Sam Can Help You With

Patients arrive at the Deuk Spine site at different points in their decision. Sam is built to be useful at any of them.

Understanding Your Diagnosis

Patients are routinely told they have a “bad disc,” “stenosis,” or “degeneration” without anyone explaining what those words actually mean for their spine, their pain, or their treatment options. Sam can walk you through:

• What a herniated disc is and how it generates pain
• The difference between a disc bulge, a protrusion, and an extrusion
• What spinal stenosis is and why it produces leg symptoms
• How facet joint pain differs from disc pain
• What “degenerative disc disease” actually is and what it does not

Sam will also help decode the terminology in your MRI report. If your imaging mentions a “paracentral protrusion at L4-L5 with effacement of the traversing L5 nerve root,” Sam can translate that into plain English or other languages and explain which symptoms typically correlate with that finding.

Understanding the Surgery You’ve Been Recommended

If a surgeon has recommended a spinal fusion, a laminectomy, or a discectomy, Sam can explain. Citing Dr. Deukmedjian’s published positions and the broader medical literature. What the procedure actually involves, what the published complication rates are, what the recovery looks like, and what the long-term track record is, including the risk of adjacent segment disease and Failed Back Surgery Syndrome.

This is not a substitute for the conversation you should be having with your surgeon. It is preparation for that conversation. Patients who walk into a pre-operative consultation already understanding the procedure ask sharper questions and consent more carefully.

Understanding the Alternatives

Most patients who are told they need fusion are not told what else exists. Sam can explain the minimally invasive alternatives Deuk Spine has to offer.

Sam can explain the procedures Dr. Deukmedjian developed and performs at Deuk Spine Institute, including Deuk Laser Disc Repair® for discogenic pain and Deuk Plasma Rhizotomy® for facet and SI joint pain. And the Deuk Piriformis Release for Piriformis syndrome. Sam will describe how they work, what conditions they treat, what the incision size and recovery time, and how they differ from traditional open surgery.

Practical Questions About the Process

Sam can also answer the logistical questions patients have once they are seriously considering treatment at Deuk Spine. These include:

• How the Free MRI Review works and what to expect from it
• How workers’ compensation cases are handled
• What to expect on the day of surgery and during recovery
• How to access the live surgery archive and patient testimonials

When a question requires personalized information: like coverage for your specific plan, your specific medical history, or your specific imaging. Sam will tell you the next appropriate steps.

What Sam Will Not Do

The boundaries matter as much as the capabilities. For a chatbot operating in the spine-surgery space, the things it refuses to do are the most important things about it.

Sam will not diagnose you. A diagnosis requires examination, imaging review by a physician, and clinical correlation. Sam can explain what a finding on your MRI typically means and what symptoms typically correlate with it. It cannot tell you what is causing your pain. Only a physician reviewing your actual imaging and your actual symptoms can do that.

Sam will not recommend a specific treatment for your specific case. Sam can describe the treatment options that exist for a given condition. It will not say “you should have Deuk Laser Disc Repair” or “you should not have fusion.” Those are clinical decisions that require an examination and an MRI review by Dr. Deukmedjian or another qualified specialist.

Sam will not prescribe, adjust, or comment on your medications. Medication management is the responsibility of your prescribing physician.

Sam will not handle protected health information. Sam is an informational tool. It does not collect, store, or transmit personal medical information. When the conversation reaches the point where your actual imaging needs to be reviewed, Sam sends you a link to the Free MRI Review form, where the appropriate intake happens in a secure environment.

Sam will not minimize emergency symptoms. If you describe symptoms consistent with cauda equina syndrome. A sudden loss of bladder or bowel control, rapidly progressive weakness in both legs. Sam will stop the educational conversation and instruct you to call 911 or go to the nearest emergency department immediately. The same applies to suspected acute spinal cord compression, unstable spinal fracture, or rapidly progressive motor weakness such as foot drop developing over hours.

A second opinion is appropriate for an elective fusion recommendation. It is not appropriate for cauda equina syndrome. Sam knows the difference.

How Sam Connects You to Real Care

Sam is the first step, not the destination. The destination is for any patient who wants an actual independent opinion on their actual spine to request a free virtual consultation of their MRI.

When a conversation with Sam reaches the natural point where the next step is to have Dr. Deukmedjian’s team look at your imaging, Sam sends you a direct link to the Free MRI Review form. You upload your MRI. Dr. Deuk reviews it. Then Dr. Deuk will speak with you and explain the MRI findings and give you surgery options to treat your spine condition.

There is no charge. There is no obligation to travel to Florida. There is no obligation to choose Deuk Spine for your care. The review exists because the published evidence on second opinions in spine surgery is strong enough that we believe every patient facing fusion deserves one, regardless of where they ultimately get their treatment.

Sam exists to make the front door of that process easier to find at the moment the patient actually wants it. Any day of the week 24/7/365. Sam is here to help you.

Who Sam Is Built For

Sam is built for the patient who:

• Has been told they need a spinal fusion, a laminectomy, or another open spine procedure and is not sure it is the right choice
• Wants to understand what their MRI report actually says before their next consultation
• Has been told their condition is “degenerative” and wants to know whether non-surgical options have been fully explored
• Is researching alternatives to open back surgery and wants to understand minimally invasive options
• Has had previous spine surgery and is now being told they need a revision
• Is helping a parent, spouse, or family member make a major spine-surgery decision and wants to understand the choices on their behalf

Sam is not built to replace the conversation with your surgeon, your primary care doctor, or your physical therapist. It is built to help you walk into those conversations better informed than you walked out of the last one.

How to Use Sam

Sam appears as a chat icon on every page of deukspine.com. Click it. Type your question. Read the answer. Ask the next question. There is no script and no menu of pre-set options — you can write the way you would write a text message to a knowledgeable friend.

A few practical suggestions for getting the most out of it:

1. Be specific. “I have lower back pain” is harder to help with than “I have lower back pain that goes down my left leg to my foot, my MRI mentions an L5-S1 disc herniation, and my surgeon recommended a fusion.”
2. Bring your MRI report. You can paste sections of your radiology report directly into the chat. Sam can help translate the terminology.
3. Ask the follow-up questions. If an answer is unclear, ask Sam to explain it differently. If you want sources, ask for the source. If you want to know how a procedure compares to another, ask.
4. Use Sam before, not instead of, your consultation. The goal is to walk into the appointment knowing what questions to ask.

The Bottom Line

The decision to undergo spine surgery is one of the most consequential medical decisions a person will ever make. Hardware cannot be unscrewed. Fused vertebrae cannot be unfused. Removed bone does not grow back. Between 10% and 40% of traditional spine surgery patients develop chronic pain that persists or worsens after the operation,³ ⁴ and the success rate of each subsequent revision drops sharply.³

Patients deserve to walk into that decision informed. They deserve to understand their diagnosis, the procedure they have been offered, and the alternatives that exist. They deserve answers to the questions they are asking at 2:00 a.m., not just the questions that fit into a 15-minute office visit.

That is what Sam is for. Open the chat on any page of deukspine.com and ask the question you’ve been carrying around. If the answer points to a need for a real review of your actual imaging, the Free MRI Review is one click away.

The cost of an extra conversation is nothing. The cost of the wrong spine surgery is everything.

Frequently Asked Questions

Is Sam a real doctor?

No. Sam is an AI chatbot. It is grounded in Dr. Deukmedjian’s published clinical content, but it is not a physician, and it does not provide medical advice, diagnosis, or treatment. Any clinical decision about your spine should be made with a qualified spine specialist who has reviewed your actual imaging and examined you in person — which is exactly what the Free MRI Review is for.

Is Sam free to use?

Yes. Sam is free, available on every page of deukspine.com, and does not require an account, a login, or any personal information to start a conversation.

Does Sam store my medical information?

No. Sam is an informational tool and is not designed to collect or store protected health information. When the conversation reaches a point where your actual medical details need to be shared — for example, to have your MRI reviewed — Sam sends you a link to the Free MRI Review form, where intake happens through the secure clinical process.

Can Sam tell me whether I really need surgery?

No. That determination requires a physician to examine you and personally review your imaging. Sam can explain what your diagnosis means, what your surgical options are, and what the alternatives look like. To get an actual second opinion on whether the surgery you’ve been recommended is appropriate, submit your MRI for a Free MRI Review.

What languages does Sam speak?

Sam responds in the language you write in. For complex clinical questions, we recommend using the language you are most comfortable reading carefully in, since precision matters more than convenience when the subject is your spine.

Will Sam recommend Deuk Spine over my current surgeon?

No. Sam is not built as a sales tool. It is built to explain conditions, procedures, and alternatives accurately. When a patient asks about Deuk Spine’s procedures, Sam will explain them — the same way it will explain fusion or laminectomy if asked. The decision about where to receive care is yours.

What if Sam doesn’t know the answer to my question?

Sam will tell you it does not know. It will not invent an answer. In most cases, it will then direct you either to the relevant page on deukspine.com, to the Free MRI Review, or — if your question is outside the scope of what a chatbot can responsibly address — to a phone call with the Deuk Spine team or a visit to your own physician.

Is Sam available outside of business hours?

Yes. Sam is available 24 hours a day, seven days a week, including evenings, weekends, and holidays. The Free MRI Review form is also available around the clock; the review itself is performed by Dr. Deukmedjian’s team during clinical hours.

Can I use Sam on my phone?

Yes. Sam is available on the full deukspine.com website, including the mobile site.

What if I’m experiencing a medical emergency?

Do not use Sam. Call 911 or go to the nearest emergency department. Sudden loss of bladder or bowel control, saddle numbness, rapidly progressive weakness, severe spine pain after trauma, or fever with severe back pain can indicate cauda equina syndrome, spinal cord compression, or spinal infection — all surgical emergencies that require immediate care.

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice. Individual results may vary. Always consult with your healthcare provider about your specific condition and treatment options.

Key Points

✓ The honest answer to “Can I return to work, lifting, running, and golf?” depends almost entirely on which spine surgery you have. Traditional open Spine surgeries like fusion cause extensive damage to muscle and bone. Leading to longer recovery times. While with laser spine surgery you’re up and walking in hours.

✓ Studies of return to work after lumbar fusion show roughly 75% of working-age patients return to work within 2 years, with significantly lower rates among patients with physically demanding jobs. ¹

✓ Most golfers return to the green in 6 months after a lumbar fusion. The time frame is shorter if the patient receives a laminectomy or microdiscectomy. ²

✓ Adjacent segment disease (ASD) accelerated degeneration of the discs above and below a fusion. Has a documented cumulative incidence that reaches 23.6% at 10 years and 66.7% at 15 years after lumbar fusion. ³

✓ After Deuk Laser Disc Repair®, patients walk out of the surgery center the same day, return to desk work within days, and return to lifting, running, and golf within weeks. There is no muscle cutting, no bone removal, or hardware installed during the surgery.

✓ Piriformis syndrome is one of the most overlooked causes of lingering buttock and leg pain that keeps people off the golf course and out of the gym. Deuk Piriformis Release® treats it as an outpatient procedure with immediate relief.

The Question Every Spine Surgery Patient Asks

Before anyone signs a consent form, the same three questions come up in the office.When will I be able to go back to work? Will I run again? Will I play golf? Play with my kids and be able to live an active lifestyle like: running and playing golf?

These are important questions. They are the questions that determine whether a surgery is worth doing. A procedure that “succeeds” on the MRI but leaves a patient unable to play with their children, carry groceries and participate in non-content sports. Even after a successful surgery if a patient feels limited in these areas. And can’t live the life they want. Was the surgery really a success?

The answer is that activity level after spine surgery is dictated more by the type of surgery than by the original injury. The same herniated disc treated two different ways produces two completely different restrictions for patients after spine surgery.

What Recovery Looks Like After Traditional Spine Surgery

Traditional open spine procedures: laminectomy, discectomy, and especially spinal fusion; share a common problem. They require cutting through muscle, removing bone, and in the case of fusion, locking vertebrae together with screws, rods, and cages. Minimally invasive techniques have been shown to reduce tissue damage to the spinal muscles compared with open surgery, but the traditional open approach is still the standard recommendation at most centers. ⁴ And the body responds to that level of trauma exactly the way it responds to any major surgery: with inflammation, scar tissue, and a recovery process that could take weeks to months.

Return to Work After Fusion or Laminectomy

Return to work after lumbar fusion varies widely depending on the patient and preoperative work status, with published rates ranging from 43% to 90%. ¹ A prospective cohort study of working-age patients found that approximately three-quarters of lumbar fusion patients returned to work within 2 years of surgery, and that work absenteeism was significantly higher in patients with physically demanding occupations. Only 60% of patients with predominant leg pain returned to their physically heavy occupations in the first year following lumbar fusion. ¹ A separate retrospective analysis at two academic centers in Germany found that 75% of working-age patients returned to work after anterior lumbar interbody fusion, with a median return time of 3 months. ⁵

A systematic literature review of minimally invasive versus open lumbar fusion concluded that patients undergoing the minimally invasive technique generally return to work more quickly and require less post-operative narcotic medication for pain control. ⁴ The takeaway is consistent across the studies: the bigger the surgical footprint; the more unlikely someone is to return to work.

Lifting Restrictions

Standard post-fusion instructions limit lifting to 5 to 10 pounds for the first 6 to 12 weeks, with a gradual progression that often caps below pre-injury capacity. Patients are told to avoid bending, twisting, and lifting from below the knees indefinitely. The reason is mechanical. A fused segment cannot move, so every load placed on the spine is absorbed by the segments above and below the fusion. ⁶ However, patients that undergo the Deuk Laser Disc Repair®(DLDR) have a lifting restriction of 40 pounds. And not 5 to 10 pounds. Not to mention you completely avoid adjacent segment disease. Due to the fact that no screws or rods are used in the procedure.

Running

Most surgeons advise patients to avoid running, jumping, and other high-impact activities for at least 6 months after fusion. Some recommend a permanent switch to low-impact exercise: walking, swimming, stationary cycling. The concern is that repeated impact loads on a fused spine concentrate stress at the adjacent levels. Where the documented cumulative incidence of adjacent segment disease climbs steadily over time.  Reaching 6.3% at 5 years, 23.6% at 10 years, and 66.7% at 15 years after lumbar fusion. ³ Here is the difference with the DLDR. Within days after surgery you can swim, walk and exercise if you’re lifting under 40 pounds. 

Golf

Golf is one of the most spine-intensive sports in the world. Peer-reviewed biomechanical analysis has measured peak compressive loads at the L4-L5 segment exceeding 6 to 8 times body weight during the downswing, with even higher peaks reported in other studies. ⁸ Low back injuries account for up to 50% of all injuries reported by golfers. ^{9, 7}

The implications for fusion patients are direct. In the largest published survey of North American spine surgeons, the most common recommended time for return to golf was 4 to 8 weeks after lumbar laminectomy or microdiscectomy, 2 to 3 months after anterior cervical fusion, and 6 months after lumbar fusion; a statistically significant difference. ² A subsequent retrospective single-surgeon series at Rush University and a 2021 systematic review both reported that most golfers can return to play within 12 months of cervical or lumbar fusion, with 54.3% to 80% returning to a similar or improved level of play. ^{10, 11} That is meaningful, but it also means a non-trivial percentage of golfers do not return to their previous level, and the recovery window for those who do is measured in months, not weeks.

This is the trade-off no one explains in the consultation. Fusion does not just treat a bad disc. It permanently changes how the spine moves, and the published data on adjacent segment disease shows that fused patients face a rising, time-dependent risk of needing another operation at the levels above and below the original fusion. ^{3, 6}

What Recovery Looks Like After Deuk Laser Disc Repair®

Deuk Laser Disc Repair® is a minimally invasive spine surgery. Instead of cutting muscle, removing bone, and locking vertebrae together, the procedure uses a 4mm to 7mm incision and a laser to treat the actual pain generator inside the disc. No muscle is cut. No bone is removed. No hardware is implanted. The spinal segment remains mobile. The principle that less surgical trauma produces faster recovery and fewer downstream complications is consistent with the broader endoscopic and minimally invasive spine publications. ^{4, 12}

Return to Work

Most office workers begin work within a few days. Patients with physical jobs typically return within 2 to 4 weeks, with no permanent lifting restrictions because no spinal structure has been removed or fused. There is no large surgical wound to protect, no muscle reattachment to wait for, and no hardware to settle. Research time and again has shown only positive advantages of minimally invasive back surgery. ⁴

Lifting

There is a 40 pound lifting restriction after Deuk Laser Disc Repair® that patients will need to maintain for 4 -6 months. The muscles that protect the spine were never cut. The bones that support the load were never removed. Meaning that patients can have higher lifting restrictions than open spine surgery options.

Running

Because the spine is motion-preserved and the soft tissues are largely undisturbed, patients return to running within 4 to 6 weeks in most cases. There is no fusion to protect, no hardware to stress-test, and no permanent loss of segmental motion. There are no changes to the spine that cause adjacent segment disease because of fusion hardware. ^{3, 6}

Golf

Golf is, in our experience, the activity that benefits most from a motion-preserving approach. The published data on golfers shows that the most common return-to-golf timeline after a lumbar microdiscectomy or laminectomy is 4 to 8 weeks 2 and Deuk Laser Disc Repair® is less invasive than either of those procedures. Because the lumbar segments remain mobile, the full rotational arc of the golf swing is preserved. Patients typically resume light chipping and putting within 2 to 3 weeks and a full swing within 4 to 8 weeks. They do not lose their swing because they have not lost any range of motion in the spine.

This is why patients fly to Deuk Spine Institute from across the country and around the world. The procedure does not just fix the disc. It allows you to go back to your normal life quicker than any other procedure. 

Patient Story: A Michigan Golfer Goes Back On Course

One of the clearest illustrations of what motion-preserving spine surgery can do comes from a Michigan patient who was referred to Deuk Spine Institute after more than 10 years of chronic lower back pain.

He had been seeing a doctor in Michigan and had gone through a long course of spinal injections. The injections helped for a while, but eventually they stopped working. His Michigan doctors then recommended the next step: a spinal fusion to splice his vertebrae together. Both of his daughters are nurses. Both of them told him not to do it.

A neighbor in Titusville, Florida had been to Deuk Spine Institute and recommended Dr. Deukmedjian. Before even traveling to Florida, the patient submitted his MRI for review, met with Dr. Ara Deukmedjian virtually, and learned that the actual pain generator was discogenic. A condition that Deuk Laser Disc Repair® is specifically designed to treat without fusion. He flew down, had the procedure as an outpatient, and went home.

About a month after the disc repair, he developed new pain in his buttock. On evaluation, the cause was piriformis syndrome, a condition in which the piriformis muscle in the buttock develops a tear or chronic spasm and produces pain that can radiate into the lower back and down the leg. It is commonly missed because it mimics sciatica from a disc, and it frequently shows up after years of disc disease have changed the mechanics of the hip and pelvis.

He returned to Deuk Spine Institute for a Deuk Piriformis Release®, another minimally invasive outpatient procedure. The relief was immediate. On camera with Dr. Deukmedjian shortly afterward, he confirmed that the buttock pain was completely gone, that he no longer needed pain medication, and that he was off the muscle relaxants as well.

When Dr. Deukmedjian asked him what life would look like now, his answer captured exactly why this question matters:

“Well, I’m going to get back to golf again, which I didn’t do at all this year because I couldn’t. So I’ll be back to golfing and back to some of the outside activities that I used to do. Back to the gym, working out. Back to life like it was before I started to have back pain.”

That is the answer every spine surgery should be able to produce. Not “managed.” Not “improved.” Back to life like it was before.

His final word on the experience was about the surgical approach itself. He liked the idea of the non-invasive back surgery, because rather than cutting up his back and his spine, it was, in his words, really a minimum invasion. After two procedures and zero hospital stays, he was pain-free, off medication, and planning his return to the course.

Why Piriformis Syndrome Matters for Athletes and Active Patients

A meaningful number of patients who think they have a “back” problem actually have a piriformis problem. The piriformis is a small muscle deep in the buttock that the sciatic nerve runs directly underneath (and sometimes through). When that muscle tears, spasms, or shortens, it compresses the sciatic nerve and produces pain that radiates exactly like a herniated disc.

For golfers, runners, lifters, and anyone who works on their feet, an undiagnosed piriformis problem is a season-ender. Cortisone injections, stretching, and physical therapy can help short-term, but when the muscle itself has a structural problem, Deuk Piriformis Release® is a targeted minimally invasive procedure that addresses the source. Like Deuk Laser Disc Repair®, it is performed as an outpatient procedure with rapid return to activity.

The Michigan golfer’s story is the clearest reminder of why both conditions need to be on the diagnostic table. Treating only the disc and missing the piriformis (or vice versa) leaves the patient in pain and convinced the surgery failed. Treating both lets them go back to golf.

How to Set Realistic Expectations Before Surgery

Before consenting to any spine surgery, the following questions are worth asking out loud:

• What is the specific structure on my MRI that is generating my pain, and how was it confirmed?
• What activity restrictions will I have at 6 weeks, 3 months, 6 months, and 1 year after this procedure?
• Will I be able to return to my job at full duty? My sport at full intensity?
• Will my lumbar motion be preserved, or will it be permanently reduced?
• What are the published reoperation rates and adjacent segment disease rates for this specific procedure?
• What is the least invasive option that can treat my specific pain generator?

If the answers involve months of restricted lifting, permanent activity modifications, and a non-trivial probability of a future fusion at an adjacent level, the recommended procedure may not be the right one for an active patient.  ³ As discussed in detail in our previous article on Failed Back Surgery Syndrome, the first spine surgery you get can change your life for the better or worsen it. At Deuk Spine we have the track record to prove that you’ll experience complete relief of your pain.

The Bottom Line

Whether you can work, lift, run, and play golf after spine surgery is not a fixed answer. It is a function of what was done to your spine. Traditional open procedures and fusion impose long recoveries and permanent restrictions because they remove or lock the structures that make those activities possible, and the data on return to work, return to golf, and adjacent segment disease confirms it. ^{1, 2, 3} Motion-preserving minimally invasive procedures like Deuk Laser Disc Repair® and Deuk Piriformis Release® address the actual pain generator without taking anything from the spine that you will need later.

The Michigan golfer came in with 10 years of pain and a fusion recommendation. He left pain-free, off medication, and headed back to the first tee. That outcome is not luck. It is a function of the right diagnosis, the right procedure, and a surgical philosophy that treats the spine as something to be preserved rather than rebuilt.

If you are weighing spine surgery and your real concern is whether you will get your life back: your job, your gym, your morning run, your Saturday tee time. Submit your MRI for a free virtual consultation. Dr. Deukmedjian will personally review your imaging and tell you exactly what is generating your pain and which minimally invasive option can fix it without taking the activities you care about with it.

Frequently Asked Questions

How soon can I go back to work after Deuk Laser Disc Repair®?

Most desk-job patients return within a few days. Patients with physically demanding jobs typically return within 2 to 4 weeks. Because the procedure preserves spinal anatomy and does not involve muscle cutting or bone removal, there are no permanent work restrictions. By comparison, published return-to-work timelines after lumbar fusion range widely, with one prospective study finding that approximately 75% of working-age patients returned within 2 years and significantly lower rates among those in physically demanding jobs.

Will I have lifting restrictions for the rest of my life after spine surgery?

After traditional fusion, many patients have permanent lifting and bending restrictions because the fused segment cannot absorb load the way an intact spinal segment can, and the adjacent segments are placed under increased mechanical stress. After Deuk Laser Disc Repair®, there are no permanent lifting restrictions. Patients ease back in over a few weeks, then return to full activity.

Can I run after spine surgery?

After fusion, running is often discouraged for at least 6 months and sometimes indefinitely because of accelerated stress on adjacent spinal segments and the documented long-term incidence of adjacent segment disease. 3 After Deuk Laser Disc Repair®, most patients resume running within 4 to 6 weeks, since segmental motion and soft tissues are preserved.

When can I play golf again after spine surgery?

In the largest published survey of spine surgeons, the most common recommended return to golf was 4 to 8 weeks after lumbar laminectomy or microdiscectomy and 6 months after lumbar fusion. 2 A 2021 systematic review found that 54.3% to 80% of golfers returned to play at a similar or improved level within 12 months of fusion.  After Deuk Laser Disc Repair®, which is less invasive than either microdiscectomy or laminectomy, most patients are putting and chipping within 2 to 3 weeks and back to a full swing within 4 to 8 weeks.

What is piriformis syndrome and why does it matter for golfers?

The piriformis is a small muscle deep in the buttock that lies directly over the sciatic nerve. When it tears or spasms, it produces sciatica-like pain that mimics a disc problem. For golfers, runners, and lifters, an undiagnosed piriformis problem can be a season-ender. Deuk Piriformis Release® is a minimally invasive outpatient procedure that treats it directly.

Can both a disc problem and piriformis syndrome be treated at Deuk Spine Institute?

Yes. As the Michigan golfer’s case shows, both conditions frequently coexist, and both can be treated as separate minimally invasive outpatient procedures. Treating one and missing the other leaves the patient in pain. Treating both restores normal function.

Do I have to travel to Florida to be evaluated?

No. The initial consultation is a free virtual MRI review. Dr. Deukmedjian reviews the imaging and discusses options remotely. Patients travel to Florida only for the procedure itself, which is performed on an outpatient basis.

Sources

1. Return to work within 2 years of lumbar fusion: a prospective cohort study. PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12357179/
2. Abla AA, Maroon JC, Lochhead R, Sonntag VK, Maroon A, Field M. Return to golf after spine surgery. Journal of Neurosurgery: Spine. 2011;14(1):23-30. https://thejns.org/spine/view/journals/j-neurosurg-spine/14/1/article-p23.xml
3. Temporal Patterns of Risk Factors for Adjacent Segment Disease After Lumbar Fusion: 5 Years or More and up to 15 Years. Journal of Clinical Medicine. 2025. https://www.mdpi.com/2077-0383/14/10/3400
4. Wang X, Borgman B, Vertuani S, Nilsson J. A systematic literature review of time to return to work and narcotic use after lumbar spinal fusion using minimal invasive and open surgery techniques. BMC Health Services Research. 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488344/
5. Return to Work Following Anterior Lumbar Interbody Fusion with Percutaneous Posterior Pedicle Fixation: A Retrospective Analysis from Two Academic Centers in Germany. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC11433232/
6. Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. PubMed. https://pubmed.ncbi.nlm.nih.gov/15534420/
7. Lim YT, Chow JW, Chae WS. Lumbar spinal loads and muscle activity during a golf swing. PubMed. https://pubmed.ncbi.nlm.nih.gov/22900401/
8. Gluck GS, Bendo JA, Spivak JM. The lumbar spine and low back pain in golf: a literature review of swing biomechanics and injury prevention. Spine Journal. 2008;8(5):778-788. https://pubmed.ncbi.nlm.nih.gov/17938007/
9. Low back pain and golf: A review of biomechanical risk factors. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC9219256/
10. Shifflett GD, Hellman MD, Louie PK, Mikhail C, Park KU, Phillips FM. Return to Golf After Lumbar Fusion. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC5435149/
11. Return to Golf Following Cervical and Lumbar Spinal Fusion: A Systematic Review. PubMed. https://pubmed.ncbi.nlm.nih.gov/34438101/
12. Full-endoscopic versus microscopic lumbar discectomy for lumbar disc herniation: a systematic review and meta-analysis. European Spine Journal. 2024. https://pubmed.ncbi.nlm.nih.gov/41512930/

Medically reviewed on May 13, 2026

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice. Individual results may vary. Always consult with your healthcare provider about your specific condition and treatment options.

Key Points

✓ Yes, patients can absolutely get worse after spine surgery. Published research estimates that between 10% and 40% of traditional spine surgery patients develop Failed Back Surgery Syndrome (FBSS). ¹

✓ FBSS is most commonly caused by inaccurate preoperative diagnosis, epidural fibrosis (scar tissue around the nerves), adjacent segment disease after fusion, recurrent disc herniation, and direct surgical nerve injury. ²

✓ Revision spine surgery has steeply declining odds of success: roughly 50% on the first surgery, 30% on the second, 15% on the third, and 5% on the fourth. ³

✓ As much as 58% of FBSS cases trace back to undiagnosed lateral stenosis of the lumbar spine. A structural problem the original surgery never addressed. ²

✓ Deuk Laser Disc Repair® treats the actual pain generator through a 4mm to 7mm incision with no muscle cutting, no bone removal, and no hardware. Eliminating the surgical trauma that causes FBSS in the first place.

Yes, Patients Get Worse After Spine Surgery, and It Has a Name

One of the most painful conversations in a spine clinic happens when a patient sits down, points to their scar, and says, “I’m worse than I was before.” They followed every instruction. They did the physical therapy. They took the medications. They consented to the surgery their doctor recommended. And now they hurt more, move less, and have lost faith in the system that put them there.

This is not rare. It is not “in their head.” It is a recognized medical condition called Failed Back Surgery Syndrome (FBSS), sometimes referred to as post-laminectomy syndrome or post-surgical spine syndrome. The International Association for the Study of Pain defines FBSS as lumbar spinal pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal pain originally in the same topographical location.^{4 9}

Multiple large studies place the incidence of FBSS at 10% to 40% of all traditional spine surgeries. ^{1 2} For laminectomy specifically, national data place the rate between 10% and more than 40% of patients, and patients with post-laminectomy syndrome have a relative risk of requiring reoperation that is 6.14 times higher than those without postoperative back pain. Compared with other chronic conditions such as rheumatoid arthritis, FBSS produces lower quality of life and higher rates of disability and unemployment. ⁵ In other words, a failed spine surgery can be more disabling than the disease it was meant to treat.

What Failed Back Surgery Syndrome Actually Is

FBSS is not a single diagnosis. It is a syndrome. An umbrella term covering any situation where the patient continues to have chronic pain, develops new pain, or loses function after spine surgery. ⁷ Symptoms can include:

• Persistent or worsening low back pain in the same location as before surgery
• New back or leg pain that did not exist before the operation
• Radiating sciatica, burning, or numbness down the legs
• Foot drop or weakness, often from L5 nerve root injury or compression Reduced mobility, stiffness, and inability to return to work ⁷
• Dependence on opioid medications for daily function
• Depression, anxiety, and loss of independence tied to chronic pain

The pain can show up immediately after surgery, in the weeks of recovery, or years later as adjacent levels of the spine break down from carrying the load of a fused or destabilized segment. ⁷

Why Does Spine Surgery Fail? The Real Causes of FBSS

Spine surgery does not fail because patients did something wrong. It fails because of identifiable medical and surgical causes that often trace back to the decisions made before the patient ever entered the operating room.

1. Inaccurate Preoperative Diagnosis

This is the single largest driver of FBSS. Peer-reviewed research has shown that up to 58% of FBSS cases trace back to undiagnosed lateral stenosis of the lumbar spine.² A structural problem the original surgery never addressed. If the surgeon does not correctly identify which structure is generating the pain, the operation removes the wrong tissue and leaves the actual pain generator in place. The patient wakes up with a surgical wound and the original pain.

2. Epidural Fibrosis (Scar Tissue Around the Nerves)

Open spine surgery, including laminectomy, microdiscectomy, and fusion, requires cutting through muscle, removing bone, and manipulating the nerves. The body responds to that trauma by laying down dense scar tissue (epidural fibrosis) around the nerve roots. ⁶ This scar tissue tethers the nerves, restricts their natural movement, and produces a chronic burning, shooting pain that is often worse than the original symptoms. Epidural fibrosis is one of the most common causes of FBSS and one of the hardest to treat once it forms. ⁶

3. Adjacent Segment Disease (ASD)

When vertebrae are fused, the spinal segments above and below the fusion are forced to absorb extra motion and stress. Over time, those adjacent levels degenerate at an accelerated rate, producing new disc herniations, new stenosis, and new pain. ⁶ Adjacent segment disease is one of the most documented long-term consequences of lumbar fusion and a leading reason patients return to the operating room years after their original “successful” surgery.

4. Recurrent Disc Herniation

After a traditional microdiscectomy, the disc itself is not repaired. A window is cut into the annulus and the herniated piece is removed, but the tear remains open. In a significant percentage of patients, the disc re-herniates through that same defect. Sometimes within weeks, sometimes years later. ⁷

5. Hardware Failure

Fusion relies on screws, rods, plates, and cages. These implants can loosen, migrate, fracture, or pull out of the bone. When that happens, patients develop new mechanical pain and often need revision surgery to remove or replace the hardware. ⁶

6. Iatrogenic Nerve Injury

Direct trauma to a nerve root during surgery from retraction, drilling, or manipulation can produce permanent neurologic deficits. Foot drop, persistent radicular pain, and chronic numbness are well-documented complications of traditional open spine procedures. ⁷

7. Pseudarthrosis (Failed Fusion)

In a fusion, the vertebrae are supposed to grow together into one solid bone over 6 to 12 months. When the bone graft fails to fuse, the construct is unstable, and the patient is left with hardware, motion at a level that was supposed to be locked, and pain.⁶

8. Wrong Procedure for the Pain Generator

A fusion cannot fix an inflamed annular tear. A laminectomy cannot fix a facet joint. A discectomy cannot fix instability. Recommending the wrong operation for the wrong pain source guarantees a poor outcome, and it is the single most preventable cause of FBSS. ²

The Brutal Math of Revision Surgery

Patients with FBSS are often told the answer is another surgery. The published data on revision spine surgery is sobering. A review article in the Asian Spine Journal documented the following declining success rates: ³

• First spine surgery: up to 50% success
• Second spine surgery: up to 30% success
• Third spine surgery: up to 15% success
• Fourth spine surgery: up to 5% success

Each repeat operation involves cutting through more scar tissue, removing more bone, and creating more fibrosis. The odds get worse with every attempt.

Patients with FBSS also face a documented risk that is often left out of the conversation. One peer-reviewed analysis found that opioid overdose was the most common cause of death following lumbar fusion surgery. ⁷ When pain persists after surgery, the prescription cascade that follows can become more dangerous than the original condition.

This is why the goal at Deuk Spine Institute is not to do “better” failed back surgery. The goal is to avoid causing FBSS in the first place. And when a patient already has it, to treat the actual pain generator with the least invasive procedure possible.

Who Is Most at Risk of FBSS?

Research has consistently identified the patient populations most likely to develop Failed Back Surgery Syndrome. A 2022 analysis using a national insurance database found the highest rates of FBSS occurred in: ⁸

• The elderly, particularly the 70–74 age group
• Patients receiving their procedure in an inpatient setting rather than outpatient
• Patients undergoing multi-level surgery rather than single-level procedures
• Patients with decompression and posterior lumbar fusion procedures

Additional preoperative risk factors documented in the literature include inadequate diagnostic workup, smoking (which impairs bone healing and increases pseudarthrosis rates), and untreated psychological comorbidity such as depression and anxiety. ^{2 10}

If you fall into any of these categories and a surgeon has recommended a large open operation, a second opinion is not optional. It is essential.

How FBSS Is Diagnosed

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Diagnosing the cause of FBSS is more important than diagnosing FBSS itself, because the syndrome is just a description. The cause is what determines treatment. ² A proper workup includes:

• Detailed history of the original pain, the original surgery, what changed, and what triggers symptoms now
• Physical examination to localize pain, identify weakness, test reflexes, and check for instability
• Updated MRI to look for recurrent herniation, scar tissue, adjacent segment disease, foraminal stenosis, and pseudarthrosis
• CT scan when hardware needs to be evaluated or fusion status confirmed
• Diagnostic injections to confirm which specific structure is generating pain

At Deuk Spine Institute, we use the Deuk Spine Exam®, which combines detailed clinical evaluation with imaging review to identify the true pain generator. Without that step, any treatment plan is a guess.

Treatment Options for Failed Back Surgery Syndrome

Treatment depends entirely on the cause. There is no single procedure that “fixes” FBSS as a category. Conservative management is generally recommended before any invasive technique in patients without indications for emergency surgery, and the options fall broadly into four tiers. ⁶

Conservative and Pain Management

• Physical therapy aimed at core stabilization and gentle mobilization
• NSAIDs and non-opioid medications
• Targeted epidural steroid injections
• Medial branch blocks and radiofrequency ablation for facet pain
• Spinal cord stimulation (SCS) for neuropathic pain that has not responded to other measures

These approaches manage symptoms but do not repair the structural problem causing them. ⁷ They have a role, but they are not a cure when there is an identifiable, treatable pain generator.

Targeted Minimally Invasive Procedures

When the cause of FBSS is a specific structural problem (a recurrent disc herniation, an untreated annular tear, foraminal stenosis, or facet-mediated pain) a precise, motion-preserving procedure can address it without repeating the trauma of the original operation:

• Deuk Laser Disc Repair® for residual or recurrent disc pathology, performed through a 4mm to 7mm incision with no hardware and no bone removal.
• Deuk Plasma Rhizotomy® for facet joint and SI joint pain, which is a frequent and under-recognized source of pain after lumbar fusion.
• Endoscopic decompression for foraminal stenosis at the original level or at an adjacent segment that has degenerated.

A 2024 systematic review in the European Spine Journal found that full-endoscopic discectomy produced outcomes comparable to or better than traditional open microdiscectomy with significantly less tissue trauma. ¹⁰ The clinical principle is straightforward: less surgical trauma means less of the fibrosis and instability that drives FBSS.

Revision Surgery (When Truly Required)

Revision fusion or hardware removal is sometimes necessary for pseudarthrosis, broken hardware, or true mechanical instability. But the bar should be high. The declining success rate of repeat surgery is not a marketing slogan. It is published data, and patients deserve to know it before they consent. ³

How to Avoid FBSS in the First Place

The best treatment for Failed Back Surgery Syndrome is not having it. Avoiding the initial development of FBSS may, in fact, be the most effective way of reducing the condition’s burden on patients. ⁷ Before consenting to spine surgery, every patient should be able to answer the following:

• What specific structure on my MRI is generating my pain?
• How was that pain generator confirmed: physical exam, imaging correlation, diagnostic injection?
• What is the least invasive procedure that can treat that specific structure?
• What is the surgeon’s documented complication rate, infection rate, and reoperation rate?
• What are the motion-preserving alternatives to the procedure being recommended?
• What happens if I do nothing for 6 more months?

If a surgeon cannot answer these questions with specifics, the recommended procedure is not ready to be performed. Hardware cannot be unscrewed. Fused vertebrae cannot be unfused. The removed bone does not grow back. The first surgery is the one most likely to succeed, ³ which is also why it is the one most worth getting right.

The Deuk Spine Approach to Patients With FBSS

A meaningful portion of the patients who come to Deuk Spine Institute have already had at least one spine surgery somewhere else. They arrive frustrated, in pain, and skeptical that anything will help. Our approach is simple:

1. Re-image and re-diagnose. We do not assume the original diagnosis was correct. The MRI is reviewed in detail, and the pain generator is identified using the Deuk Spine Exam®.
2. Identify what is treatable. Some FBSS is from scar tissue and central sensitization, which requires pain management. Much of it, however, comes from a specific structure that can still be repaired. A residual disc herniation, an untreated facet, an adjacent segment.
3. Choose the least invasive option that addresses the real problem. When the source is a disc or facet, theDeuk Laser Disc Repair® or Deuk Plasma Rhizotomy® can treat it without repeating the trauma that caused the original failure.
4. Be honest about what cannot be undone. Fused segments stay fused. Removed bone stays gone. We are direct about what is and is not fixable, because patients who have already failed once deserve straight answers.

The Bottom Line

Yes, patients can absolutely get worse after spine surgery, and a large body of peer-reviewed medical literature confirms it. ^{1 2 6} Failed Back Surgery Syndrome is not a rare event, not a character flaw, and not something patients should be asked to “just live with.” It is most often the predictable downstream consequence of either the wrong diagnosis or the wrong procedure performed on the right diagnosis. ²

The good news is that for most patients, the original injury is still treatable. Often by a much less invasive procedure than the one that failed them. A precise diagnosis, an honest conversation about alternatives, and a procedure that targets the actual pain generator rather than the whole spinal segment is what separates lasting relief from another failed surgery.

If you or a loved one is living with pain after a previous spine surgery, submit your MRI for a free virtual consultation. Dr. Deukmedjian will personally review your imaging and explain what is causing your pain and whether a minimally invasive option can finally fix it.

Frequently Asked Questions

Has anyone actually gotten worse after spine surgery?

Yes. Studies estimate that between 10% and 40% of patients undergoing traditional spine surgery develop Failed Back Surgery Syndrome, meaning their pain persists or worsens after the operation. ^{1 2} This is not a rare complication. It is one of the most common reasons patients seek second-opinion spine consultations.

What is Failed Back Surgery Syndrome?

The International Association for the Study of Pain defines FBSS as lumbar spinal pain of unknown origin either persisting despite surgical intervention or appearing after surgical intervention for spinal pain in the same topographical location. ⁴ It is not a single condition but an umbrella term covering many causes.

What are the most common causes of FBSS?

The leading causes are inaccurate preoperative diagnosis (especially missed lateral stenosis, which accounts for as much as 58% of cases), epidural fibrosis from open surgical trauma, adjacent segment disease after fusion, recurrent disc herniation, hardware failure, pseudarthrosis (failed fusion), and direct nerve injury during surgery. ^{2 6 7}

Can FBSS be fixed?

Often, yes, but it depends on the cause. Structural problems like a recurrent disc herniation, an untreated facet joint, or an adjacent segment disc can frequently be treated with targeted minimally invasive procedures. Diffuse pain from scar tissue and central sensitization is harder to reverse and is usually managed rather than cured. ⁶

Is more surgery the answer to a failed surgery?

Usually not. Each successive revision surgery has lower odds of success. Roughly 50%, 30%, 15%, and 5% for the first, second, third, and fourth operations respectively. ³ More invasive surgery on an already-traumatized spine compounds the problem. A precise minimally invasive procedure targeting the true pain generator is almost always preferable to another large open operation.

How long after spine surgery does FBSS show up?

It varies. Some patients wake up from surgery already worse. Others develop new pain in the weeks of recovery as nerve irritation and scar formation evolve. Adjacent segment disease often appears years after a fusion as the levels above and below break down under the added stress. ⁸

Can Deuk Laser Disc Repair® help patients with FBSS?

In many cases, yes. When the cause of ongoing pain is a residual or recurrent disc problem, Deuk Laser Disc Repair® can treat the disc through a 4mm to 7mm incision without removing bone, cutting muscle, or implanting hardware. Candidacy depends on the specific findings on MRI and what the original surgery did.

How do I find out if I have Failed Back Surgery Syndrome?

The first step is having an updated MRI reviewed by a spine surgeon experienced in motion-preserving and endoscopic procedures. Not only by the surgeon who performed the original operation. Submit your MRI for a free virtual consultation with Dr. Deukmedjian to find out what is generating your pain and which options remain.

Sources

1. Risk factors analysis and risk prediction model for failed back surgery syndrome: A prospective cohort study. PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1175558/
2. Baber Z, Erdek MA. Failed back surgery syndrome: current perspectives. Journal of Pain Research. https://pmc.ncbi.nlm.nih.gov/articles/PMC5106227/
3. Daniell JR, Osti OL. Failed Back Surgery Syndrome: A Review Article. Asian Spine Journal. 2018;12(2):372-37. https://pubmed.ncbi.nlm.nih.gov/2713421/
4. Orhurhu VJ, Chu R, Gill J. Failed Back Surgery Syndrome. StatPearls Publishing, National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK53777/
5. Ampat G, George JS, Clynch AL, Sims JMG. Spinal fusion surgery: the need to follow the ‘BRAN’ toolkit. Journal of Surgical Case Reports. 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4186/
6. Orhurhu VJ, Chu R, Gill J. Failed Back Surgery Syndrome. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK53777/
7. Failed Back Surgery Syndrome (FBSS): What It Is and How to Avoid Pain after Surgery. Spine-Health. https://www.spine-health.com/treatment/back-surgery/failed-back-surgery-syndrome-fbss-what-it-and-how-avoid-pain-after-surgery
8. The incidence of failed back surgery syndrome varies between clinical setting and procedure type. Clinical Neurology and Neurosurgery. 2022. https://pubmed.ncbi.nlm.nih.gov/35810607/
9. Prevalence of Chronic Pain After Spinal Surgery: A Systematic Review and Meta-Analysis. PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10423077/
10. Full-endoscopic versus microscopic lumbar discectomy for lumbar disc herniation: a systematic review and meta-analysis. European Spine Journal. 2024. https://pubmed.ncbi.nlm.nih.gov/4151230/

Medically reviewed on May 7, 2026

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice. Individual results may vary. Always consult with your healthcare provider about your specific condition and treatment options.

Key Points

✓ British Columbia and Alberta have the longest neurosurgeon and orthopedic spine surgery wait times in Western Canada. In some cities, up to 71 weeks from doctor referral to treatment.¹

✓ The Fraser Institute’s 2025 annual report recorded a national median wait of 28 weeks. The second longest in 30 years of recording surgery wait times. With neurosurgery now averaging 49 weeks.²

✓ An estimated 432,000 Canadians are expected to seek medical care abroad in 2025. An 44% increase from two years prior with spine surgery among the most commonly pursued procedures.³

✓ Patients from Vancouver, Calgary, and Edmonton flying into Orlando, Florida can be seen, evaluated, and scheduled for surgery at Deuk Spine Institute within 1 to 2 weeks of their first inquiry.

✓ Deuk Laser Disc Repair® is an outpatient procedure through a 4–7mm incision, with no fusion, no hardware, no hospital stay, and patients walking within one hour of surgery.

The Two Provinces Driving Western Canada’s Medical Tourism Wave

Not all of Canada waits equally.

If you live in Prince Edward Island or New Brunswick, the wait times are long. If you live in Ontario, they are somewhat shorter. But if you live in British Columbia or Alberta and you have a spine condition. You are statistically among the most likely Canadians to be told to wait for care that your body cannot afford to wait for.

This is not an opinion. It is what the data consistently shows, year after year.

The Fraser Institute’s 2024 annual report found that wait times from a Primary Care Physician referral to neurosurgical treatment were 71 weeks in British Columbia and 48 weeks in Alberta.¹ For orthopedic spine surgeons, the wait was 61 weeks in Alberta and 42 weeks in British Columbia.¹ These figures do not include the initial wait to see your family doctor. They begin the clock only after you already have a specialist referral in hand.

A published study in the Canadian Journal of Surgery found that every additional 100 days waiting for spine surgery is independently associated with worse perioperative outcomes and longer hospital stays once surgery finally happens.⁴ The cost of waiting is not just pain. It is measurable, documented physical harm.

It is no coincidence that the U.S. spine surgery centers most frequently cited by Canadian patients and by Canadian physicians who refer patients abroad are consistently from Vancouver, Calgary, and Edmonton as their top three source cities.⁵ Western Canada’s patients are not waiting. They are flying to Florida for speedy minimally invasive spine surgery.

What Is Happening to the Spine System in British Columbia and Alberta

British Columbia

British Columbia has the highest per-capita rate of spinal surgery needed of any Canadian province. A peer-reviewed study published in the Canadian Journal of Surgery found that males in British Columbia had a statistically significant elevated risk of spine surgery across nearly all age groups compared to Ontario, and that British Columbia recorded the highest provincial rate of spinal surgery at 89 per 100,000 population.⁶

Despite this demand, the BC wait times have been moving in the wrong direction. The Fraser Institute’s 2025 report placed British Columbia’s total median wait at 32 weeks, up from 29 weeks the year before. Thereby, making it the second highest wait time in the country among the larger provinces.²

In the Q4 of 2022 alone there was 1,840 spinal and back surgery cases were sitting on surgery schedule lists in British Columbia and that number represents only patients already past the specialist consultation stage, not those still waiting to see a surgeon for the first time.¹

The practical reality for a patient in Vancouver with a herniated disc: the wait to see a general practitioner, the wait for a specialist referral, the wait for diagnostic imaging and an MRI can take 10 weeks to schedule in Canada. ⁷ And then the wait for surgery can easily compound into two to three years for a patient in constant pain.

Alberta

Alberta tells a similar story with different numbers. The Fraser Institute’s 2024 report found that the median wait time for orthopedic surgery in Alberta was 66 weeks.¹ Direct surgical referrals in Calgary for spine consultation have been documented at up to 24 months.⁸

A patient in Calgary with sciatica, a herniated disc compressing a nerve root, or degenerative disc disease causing chronic lower back pain faces a system where:

• Seeing a family doctor may itself involve a wait time of weeks
• Specialist referrals are screened and triaged by surgeons who, within a publicly funded system, have less institutional incentive to operate quickly
• An estimated 80% of patients referred directly to a spine surgeon are deemed non-surgical by that surgeon upon first review. ⁵ Meaning countless patients are sent back through the queue to restart the process again

For patients whose pain is real and whose nerve compression is clinically significant, this is not a healthcare system that is failing to prioritize them. It is a system that by its design cannot move fast enough to meet the actual volume of need.

The result is that Calgary, Edmonton, and Vancouver have become the cities from which a large and growing number of Canadians board flights to Florida.

Why Florida? And Why Now?

For many years, Canadians who wanted minimally invasive endoscopic spine surgery traveled to Germany. German surgeons pioneered full-endoscopic disc surgery techniques, and the procedures simply did not exist in North America at the same level of sophistication.

Things have completely changed with the endoscopic spine surgery offered at Deuk Spine Institute.

The most advanced minimally invasive spine surgery in the world is now performed in Melbourne, Florida, at Deuk Spine Institute. Deuk Laser Disc Repair®, developed by Dr. Ara Deukmedjian, is built on Korean and German endoscopic foundations and extends them with a proprietary Holmium: YAG laser that targets the actual pain generator inside the damaged disc. And the annular tear and the inflammatory nucleus material pressing on the nerve.

For a patient in Vancouver or Calgary, this changes the calculation entirely:

• The flight is under 5 hours. Vancouver to Orlando is a direct or single-connection flight under 6 hours. Calgary to Orlando is comparable. Compare that to a transatlantic flight to Germany; which is at least 10 hours.
• The time zone difference is minimal. Recovery is easier on the body when you are not crossing multiple time zones.
• Care is entirely in English. Consent, discharge instructions, post-operative communication, and follow-up calls happen without translation.
• The procedure is not available through provincial health plans. Deuk Laser Disc Repair®(DLDR) is a true endoscopic, motion-preserving disc repair. It is not available through Canada’s public health care system. Which means traveling to Florida is not bypassing care you could get at home. It is accessing care that isn’t offered in the provinces of Canada.

The shift is documented. Canadian patients from across BC and Alberta who once traveled to Germany are now researching flights to Florida.

The Wait vs. The Alternative: A Direct Comparison

The numbers tell the story plainly.

The Medical Tourism Association estimates Canadians can save 30% to 90% on procedures depending on destination and procedure type.³ When the comparison is between a private lumbar fusion in Canada at $60,000–$90,000 CAD and an outpatient Deuk Laser Disc Repair® with no hospital stay, no hardware, and return to work in three days. The cost difference becomes a secondary argument. The clinical argument comes first.

What Is Deuk Laser Disc Repair®?

Deuk Laser Disc Repair® (DLDR) is a minimally invasive endoscopic procedure performed through a 4–7mm incision. An endoscopic camera guides a precision Holmium: YAG surgical laser to the inside of the damaged disc, where it:

• Vaporizes the inflamed, herniated nucleus material pressing on the nerve
• Treats the annular tear and the actual pain generator. That conventional imaging often identifies but conventional surgery does not directly treat
• Debrids the damaged inner disc tissue that causes chronic discogenic pain

What it does not do is equally important:

• No bone is cut, drilled, or removed
• No muscle is stripped from the vertebrae
• No screws, rods, plates, or cages are implanted
• No spinal motion is sacrificed through fusion
• No opioid narcotics are required after surgery

Total procedure time is approximately 20 minutes per disc level. The disc retains its full height, hydration, and range of motion. The annular tear then heals naturally over the following 9 to 12 months.

A 2024 systematic review in the European Spine Journal found that full-endoscopic discectomy produced outcomes comparable to or better than traditional open microdiscectomy with significantly less tissue trauma.⁹ A prospective clinical study of Deuk Laser Disc Repair® in cervical disc disease documented a 94.6% success rate with no perioperative complications.¹⁰

Across more than 2,700 procedures performed at Deuk Spine Institute, the documented outcomes are:

• 99% pain elimination rate
• 0.01% complication rate
• 0% infection rate

For comparison, traditional open spine surgery in North American hospitals reports infection rates of 1% to 4%, depending on the procedure and setting.¹⁰

Conditions Treated for Patients from British Columbia and Alberta

The most common spine conditions driving patients from Vancouver, Calgary, and Edmonton to Florida are the same conditions that flood the wait lists of Canadian spine surgery centers:

• Herniated discs causing back pain, neck pain, arm pain, or leg pain
• Bulging discs with contained displacement of nucleus material
• Annular tears producing chronic discogenic lower back pain
• Sciatica and cervical radiculopathy from nerve root compression
• Spinal stenosis caused by disc pathology
• Degenerative disc disease where discogenic pain is the primary symptom
• Stable spondylolisthesis with disc-related pain

For facet joint pain  a common source of neck and lower back pain that is distinct from disc pathology. Deuk Spine Institute offers the Deuk Plasma Rhizotomy®, an outpatient procedure that uses a precision plasma wand to permanently eliminate the pain-generating nerves in affected facet joints without surgery, fusion, or implants.

For piriformis syndrome the Deuk Piriformis Release® offers a comparable outpatient solution.

The Patient Journey: From Vancouver or Calgary to Florida

One of the reasons medical tourism from Western Canada to Florida has grown so quickly is that the logistics are now genuinely straightforward. The path from chronic pain in BC or Alberta to walking pain-free in Florida looks like this:

Step 1 — Free MRI Review. Submit your existing MRI scans online at no cost. Canadian patients do not need to obtain a new MRI in Florida. The MRI you already have or that your family doctor can request will be reviewed directly by Dr. Deukmedjian before your first conversation.

Step 2 — Virtual Consultation. Dr. Deuk reviews your imaging and goes through your options on a video call. For patients in Vancouver or Calgary who are skeptical, this is typically where skepticism ends. The consultation is specific, direct, and based on your actual scan. Not a general overview of what back surgery involves.

Step 3 — Scheduling. Surgery is typically scheduled within 1 to 2 weeks of the consultation. And not in months.

Step 4 — Book Your Flight. Most patients from Vancouver fly into Orlando International Airport (MCO) via Air Canada, WestJet, or a connecting flight through a U.S. hub. Calgary and Edmonton patients have comparable options. Flight time is under 6 hours in most cases.

Step 5 — Surgery Day. The procedure is performed at Deuk Spine Institute’s outpatient surgical center in Melbourne, Florida under local anesthesia with light sedation. Patients walk within 1 hour and are discharged to a nearby hotel within 2 to 3 hours. No hospital admission. No overnight stay.

Step 6 — Short Recovery in Florida. Patients typically remain in Florida for 3 days or less for a post-operative follow-up visit. Patients are walking an hour after surgery.

Step 7 — Home to BC or Alberta. Most patients are back in Vancouver, Calgary, or Edmonton within days of their spine surgery. Return to desk-based work typically happens within 3 days of surgery.

Recovery: What Patients from Western Canada Can Expect

Recovery after Deuk Laser Disc Repair® does not look like recovery from the open spine surgery a BC or Alberta patient would eventually receive through the public system.

No opioid narcotics are prescribed because there is no significant internal tissue trauma. No muscle is cut. No bone is removed. There is no post-surgical hospitalization to recover from.

Understanding the Cost

Cost is the first question most Canadian medical tourists ask, and also the most commonly misunderstood one.

Traditional lumbar fusion in the United States: $80,000–$150,000 USD
Private spinal fusion in Canada: $60,000–$90,000 CAD
Deuk Laser Disc Repair® at Deuk Spine Institute: a fraction of either, with no hospital admission, no implanted hardware, no extended rehabilitation, and no lost income from a 6-to-12-month recovery

What Canadian patients from BC and Alberta are increasingly calculating is not just the surgical fee. They are calculating the total cost of waiting: lost wages, pain management prescriptions, physiotherapy that does not resolve the root cause, and the compounding functional deterioration that makes surgery harder and recovery longer the longer it is postponed.

According to the Fraser Institute, wait times for non-emergency surgery in Canada cost Canadians $3.5 billion in lost wages and productivity in 2023 alone.¹¹ For the individual sitting in Calgary waiting 66 weeks for orthopedic surgery while unable to sit at a desk, those numbers have a personal translation.

When the full picture is laid out: surgical fee, flights, a few nights in a Florida hotel, over-the-counter ibuprofen, and return to work in three days. Medical tourism to Florida is not an extravagance. For many patients from BC and Alberta, it is the financially rational decision.

Choosing the Right Option: What to Ask Before You Commit

A growing number of medical tourism facilitators in Canada package surgery abroad with flights and hotels. Some serve patients well. Others operate on referral commissions and limited clinical accountability.

If you are a patient from British Columbia or Alberta evaluating options for spine surgery abroad, ask these questions:

• Will any bone be cut, drilled, or removed? If yes, it is not truly minimally invasive.
• Will any screws, rods, plates, or cages be implanted? If yes, it is not truly minimally invasive.
• What is the exact incision size? True endoscopic procedures use 4–7mm.
• How many of this specific procedure has the surgeon personally performed? Volume proves genuine expertise.
• Is there peer-reviewed outcome data specific to this surgeon and this procedure?
• What are the documented complication and infection rates?

At Deuk Spine Institute, the surgeon reviews your MRI before you arrive, performs your surgery, and is available for follow-up. There is no broker between you and the physician responsible for your outcome.

When to Seek Medical Attention

Seek evaluation from a spine specialist if you experience:

• Back or neck pain radiating into your arms or legs
• Numbness, tingling, or muscle weakness in the extremities
• Symptoms that have not meaningfully improved after several weeks of conservative care

Seek emergency care immediately for:

• Sudden loss of bladder or bowel control
• Saddle anesthesia: numbness in the groin or inner thighs
• Rapidly progressive weakness in both legs

These are signs of cauda equina syndrome, a surgical emergency that cannot wait for a referral, a triage queue, or a flight to Florida.

Frequently Asked Questions

Why are patients from British Columbia and Alberta the most likely Canadians to travel for spine surgery?

BC and Alberta consistently record some of the longest spine-specific wait times in Canada. The Fraser Institute’s data documents waits of 42–71 weeks from primary care doctor referral to treatment with a spine surgeon in these two provinces, depending on specialty.¹ Both provinces also have high rates of spine surgery need per capita,⁶ meaning more patients are competing for the same limited surgical resources. The combination of high demand and constrained capacity drives the highest rates of outbound medical tourism from Western Canada.

How do patients from Vancouver or Calgary get to Deuk Spine Institute in Florida?

Most patients fly into Orlando International Airport (MCO), which is served by direct and connecting flights from Vancouver and Calgary on Air Canada, WestJet, and major U.S. carriers. The flight is typically 5 to 6 hours from Vancouver and similar from Calgary. Deuk Spine Institute’s patient coordinators assist with hotel recommendations near the surgical center in Melbourne, Florida, approximately 75 miles southeast of Orlando.

Will my provincial health plan cover spine surgery at Deuk Spine Institute?

Provincial health plans in British Columbia and Alberta do not cover elective procedures performed in the United States as a standard benefit. Some patients have pursued reimbursement after the fact through provincial out-of-country appeals processes, but approval is not guaranteed and requires advance documentation. Patients should consult their provincial health authority before traveling. Deuk Spine Institute’s team can provide documentation to support reimbursement applications where applicable.

Is it safe to fly back to BC or Alberta after surgery?

Yes. Most patients are cleared to fly within 2 days after Deuk Laser Disc Repair®. The procedure involves no significant internal trauma, no implanted hardware, and no hospital recovery. The short flight time from Orlando to Vancouver or Calgary is under 6 hours. And is well within the post-operative guidelines for the procedure.

What if I need follow-up care when I return to BC or Alberta?

Deuk Spine Institute maintains post-operative communication with all patients by phone and video after they return home. Canadian patients are encouraged to have a family physician or GP who is aware of the procedure and willing to provide routine follow-up care domestically. Deuk Spine Institute provides full discharge documentation for continuity of care.

Sources

1. Moir, M. & Barua, B. Waiting Your Turn: Wait Times for Health Care in Canada, 2024 Report. Fraser Institute. https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2024
   
2. Moir, M. & Barua, B. Waiting Your Turn: Wait Times for Health Care in Canada, 2025 Report. Fraser Institute. https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2025
   
3. Medical Tourism Grows as Canadians Bypass Delays for Surgery Abroad. Benefits and Pensions Monitor. https://www.benefitsandpensionsmonitor.com/news/industry-news/medical-tourism-grows-as-canadians-bypass-delays-for-surgery-abroad/392249
   
4. The growing burden of spine surgical wait times: a retrospective cohort study of longitudinal trends and impact on perioperative outcomes. Canadian Journal of Surgery. 2026;69(2):E164–E172. https://www.canjsurg.ca/content/69/2/E164
   
5. San Jose Neurospine. The Problem with Spine Care in Canada. https://sanjoseneurospine.com/canada-patients/spine-surgery-in-canada.html
   
6. The incidence of spinal surgery in Canada. PubMed / Canadian Journal of Surgery. https://pubmed.ncbi.nlm.nih.gov/9492749/
   
7. Desert Institute for Spine Care. Why Canadians Travel for Spine Surgery. https://www.sciatica.com/blog/why-canadians-travel-for-spine-surgery/
   
8. Caleo Health, University of Calgary. Spine Assessment Information. https://caleohealth.ca/spine-assessment-information/
   
9. Full-endoscopic versus microscopic lumbar discectomy for lumbar disc herniation: a systematic review and meta-analysis. European Spine Journal. 2024. https://link.springer.com/journal/586
   
10. Deukmedjian AR, et al. Deuk Laser Disc Repair® for cervical disc disease: a prospective clinical study. Deuk Spine Institute peer-reviewed publications. https://deukspine.com/publications/
    
11. Fraser Institute. Health Care Wait Times — Lost Wages and Productivity Data, 2023. https://www.fraserinstitute.org/categories/health-care-wait-times
    

Medically reviewed on May 6, 2026

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice. Individual results may vary. Always consult with your healthcare provider about your specific condition and treatment options.

Key Points

✓ Medical tourism in Canada has grown rapidly as wait times for elective spine surgery in the public healthcare system stretch into months for major cities like: Toronto, Vancouver, Calgary & Montreal over the years.

✓ The median Canadian wait for a doctor referral was 30 weeks in 2024 and 28 weeks in 2025, the two longest waits ever recorded.¹˒²

✓ Traveling to Florida for Deuk Laser Disc Repair® at Deuk Spine Institute typically takes patients from inquiry to surgery in 1 to 2 weeks, with no hospital stay, no fusion, and no hardware.

✓ Deuk Spine Institute has performed more than 2,700 minimally invasive spine surgery procedures with a 99% pain elimination rate and a 0.01% complication rate.

✓ Most Canadian medical tourists flying into Orlando are walking within an hour of surgery, and are back in Canada within 24 hours.

What Is Medical Tourism?

Medical tourism is the practice of traveling outside one’s home country to receive medical care. For Canadians, this almost always means traveling to access a procedure faster, with a more advanced technique, or with a surgeon whose specific expertise is not available domestically.

The reason why Canadians in: Vancouver, Toronto, Calgary & Montreal; pursue medical tourism includes three things:

• A wait time at home that is unacceptable given the level of pain or disability
• A procedure or technology not offered, or rarely offered, within the Canadian healthcare system
• A surgeon with verifiable, peer-reviewed outcome data that exceeds what local surgeons can provide

Medical tourism Canada is no longer a niche choice. It has become a practical response to a system that, for elective spine care in particular, often cannot deliver timely treatment. Canadians are now traveling for cardiac procedures, orthopedic replacements, dental work, and increasingly, minimally invasive spine surgery.

For chronic back and neck pain, the destination that consistently produces the best clinical outcomes is Deuk Spine Institute in Melbourne, Florida.

Why Canadians Travel for Spine Surgery

The Canadian public health system is widely respected for emergency care and primary care. For elective spine surgery, the data tells a different story.

• Median wait time for a referral for treatment in Canada in 2024: 30 weeks, the longest ever recorded and 222% longer than the 9.3 weeks recorded in 1993.¹
• Median wait time in 2025: 28 weeks, the second-longest ever recorded.²
• Median wait time for neurosurgery in 2024: 46 weeks.¹
• Median wait time for orthopaedic surgery in 2024: 57 weeks.¹
• In Nova Scotia, half of patients wait at least 112 days for back surgery.³
• In Nova Scotia, half of patients wait at least 78 days for neck (cervical spine) surgery.⁴
• Direct surgeon referrals in Calgary: are up to 24 months for an initial consultation.⁵
• Wait times for elective spine surgery between 2009 and 2020 have increased in most Canadian cities by 72%.⁶

Every additional 100 days of waiting has been independently associated with measurable increases in adverse outcomes and longer hospital stays once surgery finally happens.⁶ Pain that could have been resolved in weeks becomes pain that is endured for years.

This is the gap that medical tourism for Canadians is filling. It is not about luxury. It is about getting out of pain on a timeline that matches the human cost of waiting.

Why Canadians Used to Fly to Germany and Why They Now Come to Florida

For many years, Canadians who wanted minimally invasive endoscopic spine surgery had limited options. Germany was a global leader in endoscopic spine techniques, and a steady stream of Canadian patients made the long flight across the Atlantic to access procedures that did not exist at home.

That has changed.

Today, the most advanced minimally invasive spine surgery in the world is performed in Melbourne, Florida. Deuk Laser Disc Repair®, developed and refined at Deuk Spine Institute, is built on Korean and German endoscopic foundations but extends them with a proprietary Holmium:YAG laser technique that targets the actual pain generator inside the disc.⁵ For Canadians, this means a shorter flight, the same time zone for travelers from Toronto or Montreal, English-speaking care, and outcomes that no European centre has matched at scale.

The result: a clear shift in where Canadians choose to travel for advanced spine surgery. From Toronto, Vancouver, Calgary, Montreal, and beyond, Canadian patients are no longer flying to Munich or Frankfurt. They are flying to Orlando.

Why Canadians Choose Florida and Deuk Spine Institute

Medical tourism companies in Canada offer a range of destinations, including Mexico, Costa Rica, Eastern Europe, and the United States. Why Canadians travel to Deuk Spine Institute:

• Same continent, short flight. Most Canadian patients reach Orlando, Florida in under 4 hours of flying. Recovery in the same time zone is easier on the body than transatlantic travel.
• English-speaking medical environment. No translation required for consent forms, discharge instructions, or post-operative communication.
• A procedure that isn’t available in Canada. Deuk Laser Disc Repair® is a true endoscopic, laser-based, motion-preserving disc repair surgical procedure. It is not offered as a standard treatment option through provincial health plans.
• Outpatient surgery. No hospital stay. Patients are discharged within 2 to 3 hours and recover at a nearby hotel for a few days before flying home.
• Documented outcomes. Deuk Spine Institute publishes its complication rates, infection rates, and pain-elimination rates and backs them with peer-reviewed publications.⁷

Why do Canadian patients from abroad come to Deuk Spine?  It is access to a procedure that preserves the spine instead of fusing it, and it is getting that procedure within weeks instead of months. That is making Canadians leave the cold and come to sunny Florida for back surgery.

What Is Deuk Laser Disc Repair®?

Deuk Laser Disc Repair® is a minimally invasive endoscopic spine procedure developed at Deuk Spine Institute by Dr. Ara Deukmedjian. It uses a 4mm to 7mm incision, an endoscopic camera, and a Holmium:YAG surgical-grade laser to repair damaged discs from the inside.

What makes it different from what is typically offered through medical tourism companies in Canada or in Canadian hospitals:

• No bone is cut, drilled, or removed.
• No muscle is stripped from the vertebrae.
• No screws, rods, plates, or cages are implanted.
• No spinal motion is sacrificed through fusion.
• No opioid narcotics are required after surgery.

The laser vaporizes inflamed tissue inside the disc, removes any herniated nucleus material that is pressing on a nerve, and debrides the painful annular tear. The disc retains its height, hydration, and full range of motion. The annular tear then heals naturally over the next 9 to 12 months.

Total procedure time is approximately 20 minutes per disc.

Conditions Treated for Canadian Travelers Seeking Medical Treatment Abroad

Deuk Laser Disc Repair® (DLDR) can effectively treat the conditions that send the majority of Canadians to spine surgeons in the first place:

• Herniated discs causing back, neck, arm, or leg pain
• Bulging discs with contained displacement of disc material
• Annular tears producing chronic discogenic pain
• Sciatica and cervical radiculopathy from nerve root compression
• Many cases of spinal stenosis caused by disc pathology
• Stable, low-grade spondylolisthesis with disc-related pain
• Degenerative disc disease where discogenic pain is the primary symptom

For facet joint pain, sacroiliac joint pain, and piriformis syndrome, Deuk Spine Institute offers two additional outpatient procedures: Deuk Plasma Rhizotomy® for permanent facet pain relief, and Deuk Piriformis Release® for piriformis syndrome.

Two Canadian Patient Stories

The fastest way to understand why Canadians come to Deuk Spine Institute is to hear from Canadians who have already made the trip.

Canadian Patient Avoids Cervical Fusion, Finds Permanent Neck Relief with Deuk Plasma Rhizotomy®

A Canadian patient suffering from severe neck pain, right-side scapula pain, shooting arm pain, and finger numbness travelled to Deuk Spine Institute in Melbourne, Florida after being told his only option in Canada was a two-level anterior cervical discectomy and fusion. A procedure requiring a metal plate, screws, and permanent loss of neck mobility. Unwilling to accept that outcome, he spent time researching alternatives online and discovered Dr. Ara Deukmedjian through YouTube. The free MRI consultation, where he spoke directly with Dr. Deukmedjian at no obligation, gave him the confidence to make the trip.

His diagnosis identified arthritic facet joints at C5-6 and C6-7 as the true source of his pain and not the disc herniations his Canadian surgeon had planned to fuse. Dr. Deukmedjian performed Deuk Plasma Rhizotomy® (DPR), a minimally invasive outpatient procedure using a precision plasma wand to permanently eliminate the pain nerves in the affected facet joints. No metal hardware, no fusion, and no loss of neck movement.

Less than 24 hours after surgery, the patient reported his neck pain was gone, with only minor muscle soreness from the procedure itself. He described feeling “great” and expressed relief that he had paused before agreeing to fusion surgery a decision he credited to getting the right diagnosis first and finding a treatment that matched it.

Canadian Patient Ends Years of Chronic Back Pain with Deuk Laser Disc Repair®

A Canadian patient with debilitating chronic lower back pain had been unable to sit for years. He worked at a standing desk, stood while eating, and nearly broke down in tears during a 45-minute drive to physiotherapy appointments that offered no lasting relief. His Canadian doctors walked him through a slow process of elimination: pills, prolonged physiotherapy, and spine clinic consultations. None of which resolved his pain.

After two and a half years of researching alternatives online, he discovered Dr. Ara Deukmedjian. Initially skeptical of spine surgery and dismissing it as a “marketing gimmick,” he continued watching videos until his questions were answered one by one. He eventually traveled to Melbourne, Florida, where Dr. Deukmedjian performed Deuk Laser Disc Repair® on two lumbar discs, using a laser to clear the annular tears causing his chronic pain.

Less than 24 hours after surgery, he was sitting comfortably and completely pain-free with no opioid medication in his system. He described the result as almost unbelievable, saying he had been “in disbelief” that his pain he lived with for years was simply gone. In his own words: “This is amazing.”

The Canadian Patient Journey: How Medical Tourism to Deuk Spine Works

One of the reasons Canadian travel to Florida has grown is that the logistics are now genuinely simple. The path from chronic pain in Canada to walking pain-free in Florida looks like this:

• Step 1: Free MRI Review. A Canadian patient submits their existing MRI online.
  Step 2: Virtual Consultation. Dr. Deuk reviews your MRI and goes over treatment options with you on Zoom
• Step 3: Scheduling. Surgery is typically scheduled within 1 to 2 weeks of the consultation, not 28 weeks.
• Step 4: Travel to Florida. Most patients fly into Orlando International Airport (MCO). The Institute’s patient coordinators assist with hotel recommendations near the surgical centre.
• Step 5: Surgery Day. The procedure is performed in an outpatient surgery centre under local anesthesia with light sedation. The patient walks within 1 hour and is discharged within 2 to 3 hours.
• Step 6: Short Local Recovery. Patients typically remain in Florida for 3 to 5 days post-procedure for a follow-up visit before flying home.
• Step 7: Return to Canada. Most Canadian patients are home within days after their surgery. Return to desk-based work generally happens within 3 days of surgery.

What Are The Costs For A Canadian Patient At Deuk Spine Institute?

Cost is one of the questions every Canadian medical tourist asks first, and it is also one of the most misunderstood. Let’s compare your options:

• Traditional lumbar fusion in the United States: $80,000 to $150,000 USD
• Private spinal fusion in Canada: comparable, often $60,000 to $90,000 CAD
• Deuk Laser Disc Repair® (DLDR) at Deuk Spine Institute: typically a fraction of either, with no hospital admission, no implanted hardware, and no extended rehabilitation costs

What Canadian patients should compare is not just the surgical fee. The total real-world cost of a fusion includes:

• Hospital stay (3 to 5 days)
• Hardware (screws, rods, cages)
• Opioid pain management
• 6 to 12 months of restricted activity and lost income
• High likelihood of future adjacent-segment surgery

The total real-world cost of a Deuk Laser Disc Repair® includes:

• The surgical fee
• Flights and a few nights in a Florida hotel
• Over-the-counter ibuprofen or acetaminophen
• Return to desk-based work within 3 days

When Canadians ask whether medical tourism for spine surgery is “worth it,” the answer is usually clearer once both the medical and financial sides are calculated.

Recovery Time for Canadian Patients After Laser Spine Surgery

Recovery time is one of the clearest dividing lines between Deuk Laser Disc Repair® and the open back or neck surgery a Canadian patient might otherwise wait years to receive.

Recovery after Deuk Laser Disc Repair®:

• Within 1 hour: Patients walk
• Within 2 to 3 hours: Discharged to a nearby hotel
• Same day: Showering resumes, walking encouraged
• Within 3 to 5 days: Cleared to fly back to Canada
• Within 3 days of surgery: Return to desk-based work with lifting restrictions
• Weeks: Low-impact activities (swimming, cycling, walking)
• Several months: High-impact activities (running, jumping, contact sports)
• 9 to 12 months: Annular tear completes natural healing

No opioid narcotics are prescribed because there is minimal internal trauma. No muscle is cut. No bone is removed. There is no hospital stay to recover from.

Compare that to what awaits a Canadian patient who eventually reaches the top of a fusion or laminectomy waitlist:

• Laminectomy with fusion: 3-inch incision, 3 to 5 day hospital stay, mandatory opioid prescriptions, 6 to 12 months of restricted recovery, and a roughly 50% likelihood of needing fusion later if a laminectomy alone was performed
• Microdiscectomy: Muscle stripping, partial bone removal, weeks to months of recovery, and permanent alteration of spinal mechanics

What Is the Success Rate of the Deuk Laser Disc Repair® for Patients?

Outcomes do not depend on whether a patient is American or Canadian. They depend on accurate diagnosis and surgical technique. The published numbers for Deuk Laser Disc Repair® are the same regardless of where the patient flies in from.

• A 2024 systematic review in the European Spine Journal found that full-endoscopic discectomy produced outcomes comparable to or better than traditional open microdiscectomy, with significantly less tissue trauma.⁸
• A prospective study of Deuk Laser Disc Repair® in cervical disc disease reported a 94.6% success rate with no perioperative complications.⁷
• Current outcomes across more than 2,700 Deuk Laser Disc Repair® procedures document a 99% pain elimination rate, a 0.01% complication rate, and a 0% infection rate.

By comparison, traditional spine surgery in North American hospitals reports infection rates of 1% to 4%, depending on the procedure and setting.⁷

Choosing Between Medical Tourism Companies in Canada

A growing number of medical tourism companies in Canada act as middlemen, packaging surgery abroad with flights, hotels, and ground transportation. Some are excellent. Some are simply selling whatever facility offers the highest commission.

If you are evaluating medical tourism Canada options for spine surgery specifically, ask the same questions you would ask any spine surgeon at home, and require specific answers:

• Will any bone be cut, drilled, or removed? If yes, the procedure is not truly minimally invasive.
• Will any hardware, screws, plates, or cages be implanted? If yes, it is not truly minimally invasive.
• What is the actual incision size? True endoscopic procedures use a 4mm to 7mm incision.
• How many of this specific procedure has the surgeon personally performed? Thousands of cases prove genuine experience.
• Is there peer-reviewed outcome data? Real procedures with real results that are published.
• What are the documented complication and infection rates?

The best medical tourism for a Canadian patient is the option where the surgeon, not a broker, owns the relationship and the outcome.

When to Seek Medical Attention

Visit a spine specialist if you experience:

• Back or neck pain radiating into the arms or legs
• Numbness, tingling, or muscle weakness
• Symptoms that have not improved after several weeks of conservative care

Seek emergency care immediately for:

• Sudden loss of bladder or bowel control
• Saddle anesthesia (numbness in the groin or inner thighs)
• Rapidly progressive weakness in both legs

These are signs of cauda equina syndrome, a surgical emergency that should never wait for a referral, a triage queue, or a flight.

If you have been dealing with chronic back or neck pain in Canada and have been told your scheduled surgery is months or years from now. Submit your MRI for a free virtual consultation with Ara Deukmedjian, MD. He will personally review your MRI and provide the best minimally invasive surgery options for your specific condition, along with a clear explanation of what traveling to Florida would actually involve.

Frequently Asked Questions

What is medical tourism?

Medical tourism in Canada refers to Canadians traveling outside the country to receive medical care, most often to bypass long wait times in their healthcare system or to access procedures and technologies that are not routinely offered domestically. For chronic back and neck pain, an increasing number of Canadians are traveling to the United States, particularly Florida, for minimally invasive spine surgery.

Why do Canadians travel to Florida for spine surgery?

Canadians travel to Florida for spine surgery primarily because of wait times and the procedure itself. The median Canadian wait from referral to treatment was 30 weeks in 2024, with neurosurgery cases waiting 46 weeks and orthopaedic surgery cases waiting 57 weeks.¹ Deuk Spine Institute in Melbourne, Florida offers Deuk Laser Disc Repair®, an endoscopic, motion-preserving disc repair that is not standard within the Canadian medical system, with surgery typically scheduled within 1 to 2 weeks of consultation.

Is medical tourism for spine surgery safe?

Safety depends on the surgeon, the facility, and accurate diagnosis. Deuk Spine Institute documents a 0.01% complication rate and a 0% infection rate across more than 2,700 Deuk Laser Disc Repair® procedures, compared to 1% to 4% infection rates reported for traditional spine surgery.⁷ Endoscopic minimally invasive spine surgery, performed by an experienced surgeon on a properly selected patient, has very low complication rates.⁸

How long do Canadian patients stay in Florida for surgery?

Most patients are in Florida for a total of 4 to 7 days. Surgery itself is outpatient. After Deuk Laser Disc Repair®, patients walk within 1 hour, are discharged within 2 to 3 hours to a nearby hotel, and are typically cleared to fly home within 3 to 5 days after a follow-up visit.

What is the success rate of Deuk Laser Disc Repair® for medical tourism patients?

The peer-reviewed success rate for Deuk Laser Disc Repair® in cervical disc disease is 94.6%, with no perioperative complications reported.⁷ Across more than 2,700 procedures performed at Deuk Spine Institute, the documented pain elimination rate is 99% with a 0.01% complication rate.

Sources

1. Moir, M. & Barua, B. Waiting Your Turn: Wait Times for Health Care in Canada, 2024 Report. Fraser Institute. https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2024
2. Moir, M. & Barua, B. Waiting Your Turn: Wait Times for Health Care in Canada, 2025 Report. Fraser Institute. https://www.fraserinstitute.org/sites/default/files/2025-12/waiting-your-turn-2025-17913.pdf
3. Back Surgery (Adult) Wait Time. Patient Access Registry Nova Scotia (PAR NS). https://waittimes.novascotia.ca/procedure/back-surgery-adult
4. Cervical Spine (Neck) Surgery Wait Time. Patient Access Registry Nova Scotia (PAR NS). https://waittimes.novascotia.ca/procedure/cervical-spine-neck-surgery
5. Spine Assessment Information. Caleo Health, University of Calgary. https://caleohealth.ca/spine-assessment-information/
6. The growing burden of spine surgical wait times: a retrospective cohort study of longitudinal trends and impact on perioperative outcomes. Canadian Journal of Surgery. 2026;69(2):E164-E172. https://www.canjsurg.ca/content/69/2/E164
7. Deukmedjian AR, et al. Deuk Laser Disc Repair® for cervical disc disease: a prospective clinical study. Deuk Spine Institute peer-reviewed publications. https://deukspine.com/publications/
8. Full-endoscopic versus microscopic lumbar discectomy for lumbar disc herniation: a systematic review and meta-analysis. European Spine Journal. 2024. https://link.springer.com/journal/586

✓ Patent US12239362B2 refines the wanding technique — rather than holding the probe in a fixed position, the surgeon moves it through the treatment zone to achieve more complete nerve disruption and reduce the likelihood of pain returning.

✓ Deuk Plasma Rhizotomy® targets the source of pain directly — plasma energy is used to permanently disrupt the sensory nerves transmitting pain signals, rather than masking symptoms with injections or medications.

✓ The procedure is minimally invasive and image-guided — a small incision and real-time imaging allow for precise targeting of affected nerves while protecting surrounding tissue, muscle, and bone.

✓ Patients can have their pain treated across multiple areas of the body — facet joints in the cervical, thoracic, and lumbar spine, as well as knees and other arthritic joints, can all be addressed using this patented approach.

✓ Recovery is measured in hours, not weeks — the outpatient procedure is designed for same-day discharge, with most patients returning to normal activity quickly and without reliance on opioid medications.

✓ Dr. Ara Deukmedjian’s innovation addresses a critical gap in care — with back pain affecting nearly 39% of U.S. adults and chronic pain rates climbing sharply with age, this refined technique offers a durable, patient-centered alternative to traditional surgery.

Chronic joint and spine pain affects millions of people. According to the CDC’s National Health Interview Survey, nearly 39% of U.S. adults reported back pain in a recent three-month period, yet many treatments only provide temporary relief. ¹ Dr. Ara Deukmedjian being a spine specialist understands the gap in effective care for back pain became the driving force behind continuous innovation. His second patent, US12239362B2, represents a major improvement in minimally invasive spine surgery and nerve pain treatment.

This refined approach to Deuk Plasma Rhizotomy® improves precision, consistency, and long-term outcomes by enhancing how pain-causing nerves are treated at their source.

Deuk Plasma Rhizotomy® is a minimally invasive procedure designed to eliminate chronic pain by targeting sensory nerves responsible for transmitting pain signals. Unlike traditional spine treatments such as spinal fusion, steroid injections, or long-term medication use, this procedure focuses on directly treating the source of pain. By using plasma energy to disrupt pain-transmitting nerves, the procedure offers a more targeted and efficient alternative for patients seeking relief from back pain, neck pain, and joint pain, which are conditions that radiofrequency-based approaches have long sought to address. ² The Deuk Plasma Rhizotomy® stops signals from pain nerves.

The Second Patent US12239362B2

The second patent, US12239362B2, introduces an important technical refinement that enhances the effectiveness of the DPR®.

This patent focuses on improving how energy is delivered to the nerve through a technique known as wanding. Instead of keeping the probe in a fixed position, the surgeon moves the probe tip within the treatment area to ensure more complete nerve disruption.

Key Features of the Patent

• Controlled probe movement within the treatment zone
• Image guided precision targeting of affected nerves
• Enhanced disruption of pain transmitting pathways
• Minimally invasive approach with improved consistency

These features are described within the patent documentation and represent a refinement of earlier rhizotomy techniques.

Why the Wanding Technique Improves Pain Relief

Traditional nerve ablation procedures may leave portions of a nerve untreated, and often the nerve will eventually regenerate. In some cases, joint pain can return as a result of static or incomplete probe positioning. ³ The wanding technique described in the Deuk Plasma Rhizotomy patent improves treatment coverage by allowing movement of the probe across the nerve pathway. This method enhances precision, improves consistency, and reduces the likelihood of incomplete nerve disruption.

Benefits of Deuk Plasma Rhizotomy for Patients

With the refinements introduced in Dr. Ara Deumedjian’s patent. Patients can experience several benefits supported by minimally invasive spine research.

• Long lasting pain relief
• Faster recovery compared to traditional surgery
• Reduced reliance on pain medications
• Lower complication rates
• Treats pain in the Facet joints in the neck, back & knees

Minimally invasive spine procedures are widely associated with shorter recovery times, less post-surgical pain due to limited muscle and tissue damage, and reduced risk of infection compared to open surgery. ⁴

Conclusion

Through the development of US12239362B2, Ara Deukmedjian, MD has refined the technique to improve precision, consistency, and long-term effectiveness. As chronic pain disproportionately affects older populations, with rates rising from 12.3% among those aged 18 to 29 to 36% among those 65 and older, innovations like this continue to shape the future of spine care for patients seeking minimally invasive solutions. ⁵ submit your MRI for a free virtual consultation with Dr. Deuk. And discover minimally invasive options to end your back or neck pain for good.

Frequently Asked Questions

Sources

1. https://www.cdc.gov/nchs/products/databriefs/db415.htm
2. https://mayfieldclinic.com/pe-rf_ablation.htm
3. https://www.ucsfhealth.org/care/treatments/radiofrequency-ablation
4. https://my.clevelandclinic.org/health/treatments/17235-minimally-invasive-spine-surgery
5. https://www.cdc.gov/nchs/products/databriefs/db518.htm

Board-Certified Neurosurgeon, Deuk Spine Institute  

Medically reviewed on April 9, 2026 

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice. Individual results may vary. Always consult with your healthcare provider about your specific condition and treatment options.

Key Points

✓      Low back pain is the single most common golf-related injury, accounting for roughly 25% of all golf injuries, and affects between 15% and 55% of golfers depending on skill level. ^1,2

✓      The modern power swing generates compressive loads on the lumbar spine exceeding six times a golfer’s body weight during the downswing, placing extraordinary stress on intervertebral discs. ^3,4

✓      The modern swing’s emphasis on restricted pelvic rotation and increased thorax rotation increases torque on the lumbar spine beyond what it can safely accommodate, contributing to disc herniation and early spinal degeneration. ^5,6

✓      Elite golfers including Tiger Woods, Fred Couples, Rory McIlroy, Jason Day, and Justin Rose have all battled serious, career-affecting back problems despite access to world-class medical care.

✓      Disc herniation and degenerative disc disease are among the most common causes of low back pain, affecting an estimated 80% of the population at some point during their lifetime. ⁷

✓      Traditional spine surgeries such as microdiscectomy, laminectomy, and spinal fusion treat the consequences of disc damage rather than the source, often leaving patients in a cycle of repeated procedures.

✓      Deuk Laser Disc Repair® is the only FDA-approved, peer-reviewed procedure that treats the inflamed annular tear at the root of discogenic pain. It is minimally invasive, performed as an outpatient procedure, and has patients back on their feet within one hour.

✓      The free virtual Deuk Spine Exam® delivers a precise diagnosis with 99% accuracy. Submitting your MRI for a free review at deukspine.com is the first step toward permanent pain relief.

If you are a golfer, whether you are teeing off at your local club every Saturday or watching the Masters unfold at Augusta National, you already know that back pain is the sport’s most persistent opponent. It does not matter how many hours you have logged on the range or how perfectly your swing has been tuned. The rotational forces generated by a modern golf swing are relentless, and sooner or later, many players find themselves sidelined not by a bad round, but by a pain that no amount of ibuprofen or physical therapy can touch. In fact, research shows that low back pain accounts for roughly 25% of all golf-related injuries, making it the most common ailment in the sport. ¹

At Deuk Spine Institute, we see this every day. And the stories coming out of professional golf right now are a powerful reminder that back pain does not discriminate. Not by talent, not by fame, not by fitness level. What separates the players who recover and return to peak performance from those who spend years cycling through surgeries and setbacks is finding the right diagnosis and the right treatment the first time.

Why Golf Destroys Backs and Why the Modern Swing Makes It Worse

Golf looks like a gentle sport from the outside. There is no physical contact. Players walk, pause, and swing. But what the naked eye misses is the extraordinary violence that a proper golf swing inflicts on the lumbar spine. Biomechanical studies have recorded mean peak compressive loads exceeding six times a golfer’s body weight during the downswing alone. ³ Repeat that across hundreds of swings per day, thousands of rounds over a career, and it becomes clear why the spine breaks down.

The modern power swing has made things significantly worse. Unlike the long, rhythmic swings of earlier generations such as those of Jack Nicklaus and Arnold Palmer, today’s elite golfers generate explosive torque by restricting pelvic turn while dramatically increasing thorax rotation during the backswing. Researchers Cole and Grimshaw found that the lumbar spine is incapable of safely accommodating the forces produced by this technique, directly linking it to golf-related low back injury. ⁵ The result is greater clubhead speed and longer drives, but the lumbar spine absorbs the cost.

A 2019 paper published in the Journal of Neurosurgery: Spine introduced the concept of “repetitive traumatic discopathy” (RTD), arguing that the modern golf swing causes cumulative degenerative “hits” to the spine that accelerate disc breakdown and instability at earlier ages than ever seen before. ⁶

“The torque of a golf swing causes a rotation of the lumbar area of the spine, and this puts pressure on the disc. When one adds predisposition to the repetitive trauma of constant golf swings, disc injuries can occur.”

The disc, the soft and shock-absorbing cushion between your vertebrae, is almost always at the center of the story. When a disc herniates or bulges, it can press against the nerve roots that run along the spine, producing the radiating pain, numbness, and weakness that have ended careers and derailed seasons. According to the National Institutes of Health, degenerative disc disease and lumbar disc herniation are among the most common causes of low back pain worldwide, and approximately 80% of the population will experience an episode of debilitating low back pain at some point in their lifetime. ⁷ And yet, despite how common this is, most golfers never receive a precise diagnosis of which disc is responsible, let alone a treatment that actually fixes it.

The Hall of Pain: Famous Golfers Brought Down by Back Pain

You do not have to look hard to find the toll that back pain has taken on the world’s greatest golfers. Research published in the Global Spine Journal noted that over 80% of professional golfers experience spine problems during their careers. ⁸ Their stories are cautionary tales, not because their talent was not enough, but because the treatments they received were often unable to provide the lasting relief they deserved.

There is a painful irony here. These are elite athletes with access to the finest sports medicine teams in the world. They receive physical therapy, injections, and surgical consultations from highly credentialed physicians. And yet they continue to suffer. Why? Because the treatments being offered are often aimed at managing symptoms rather than curing the underlying problem. Bone-removing surgeries, spinal fusions, and adjacent-level procedures can weaken and destabilize the spine, setting the stage for more surgeries down the road. The cycle becomes self-reinforcing.

The Deuk Difference: Curing the Pain, Not Just Managing It

At Deuk Spine Institute, we take a fundamentally different approach. Our philosophy is simple: every patient deserves freedom from pain, not an endless management plan. Surgery is never our first recommendation, and when it is recommended, it is the right surgery, not the one most insurance companies prefer or the one a hospital administrator approves fastest.

The cornerstone of our surgical treatment is the Deuk Laser Disc Repair, the only FDA-approved, peer-reviewed, and published procedure of its kind in the world. Developed by Dr. Ara Deukmedjian, a board-certified neurosurgeon, this minimally invasive endoscopic technique targets the precise source of discogenic pain: the inflamed annular tear at the posterior of the herniated disc. Research has confirmed that inflammatory mediators released through annular tears are a primary driver of the pain associated with disc herniation. ⁹ No other spine surgeon uses this technology, which is why patients treated elsewhere continue to suffer long after their procedures are complete.

Here is what makes Deuk Laser Disc Repair® different from the surgeries Tiger Woods and countless other golfers have undergone:

• No bone or joint removal. Traditional surgeries like microdiscectomy and laminectomy destroy normal bone and joints, destabilizing the spine and often leading to fusion surgery later. We do not do that.

• No rods, screws, or cages. Unlike spinal fusion, Deuk Laser Disc Repair® creates the conditions for the disc to heal naturally on its own.

• Outpatient procedure, same-day discharge. Patients are back on their feet within an hour. No hospital stays, virtually no bleeding or scarring, and a dramatically faster recovery.

• Twilight anesthesia. No general anesthesia risks. Patients remain comfortable and recover quickly.

• Proven results. Peer-reviewed and published in medical literature, not just a marketing claim.

What About Golfers Who Do Not Need Surgery?

We want to be clear about something that sets us apart from many spine centers: surgery is not always the answer. At Deuk Spine Institute, our goal is to get you out of pain, not to schedule procedures. If your condition can be effectively treated without surgery, then we won’t recommend surgery but a conservative option.

What we refuse to do is leave you guessing. Our free virtual Deuk Spine Exam® delivers a clear diagnosis with 99% accuracy, something that countless golfers living with chronic back pain have never actually received. Research confirms that a previous history of low back pain is the strongest predictor of future episodes in golfers, underscoring the importance of accurate, early diagnosis. ² Most patients have been told they have back issues or disc problems without a precise identification of which disc is causing the pain and why. That ambiguity is the reason so many end up going from surgeon to surgeon, treatment to treatment, never finding real relief.

Getting Back to the Game You Love

Golf is more than a sport. For millions of Americans, it is exercise, social connection, competition, and joy, all wrapped into eighteen holes. When back pain steals that from you, the loss goes far beyond the scorecard. We see it in every patient who comes through our doors: the frustration, the depression, and the quiet resignation that they may never play again without wincing.

That resignation is not necessary. If Tiger Woods had access to a procedure that cured the source of his disc pain rather than repeatedly patching the consequences, his story might have been very different. The same is true for Fred Couples, who has played through decades of discomfort that no treatment has fully resolved. And it is certainly true for the weekend golfer who has quietly stopped booking tee times because the 17th hole is not worth another three days of back spasms.

“We believe that every patient deserves freedom from pain as soon as possible, by offering patients the treatment that is best for their condition, not the one that is easiest to schedule.”

At Deuk Spine Institute, we treat patients who are physically and emotionally suffering from chronic back and neck pain every single day. We have mastered the science of disc pain. We know exactly where it comes from and how to fix it. And we do it in a state-of-the-art outpatient surgery center where doctors control the level of care, not hospital administrators, and where every patient receives the kind of personal attention that larger hospital systems simply cannot provide.

Ready to Stop Managing Pain and Start Curing It?

If you are a golfer living with chronic back or neck pain, whether you are a weekend player, a club champion, or a pro who has tried everything, we want to hear from you. The first step is simple: submit your MRI for a free review. Our team will analyze your imaging, identify the precise source of your pain, and give you a clear, honest picture of your treatment options. Epidemiological studies show that prevalence of golf-related low back pain ranges from 15% to 35% in amateurs and up to 55% in professionals, meaning the odds are high that the pain you feel is not just an unavoidable part of the game. ² It is a diagnosable, treatable condition.

You do not have to keep playing through it. You do not have to accept that this is just part of getting older or part of playing golf. Back pain is not a life sentence. And at Deuk Spine Institute, we have dedicated everything we do to proving that.  

Frequently Asked Questions

Sources

1. McHardy A, Pollard H, Luo K. Golf-related lower back injuries: an epidemiological survey. Journal of Chiropractic Medicine. 2007;6(1):20-26. https://pmc.ncbi.nlm.nih.gov/articles/PMC2647075/

2. Finn C. Risk Factors Associated With Low Back Pain in Golfers: A Systematic Review and Meta-analysis. Orthopaedic Journal of Sports Medicine. 2018;6(10). https://pmc.ncbi.nlm.nih.gov/articles/PMC6204638/

3. Sato K, Nimura A, Yamaguchi K, Akita K. Lumbar spinal loads and muscle activity during a golf swing. Journal of Sports Sciences. 2012;31(7):780-787. https://pubmed.ncbi.nlm.nih.gov/22900401/

4. Haddas R, Pipkin W, Hellman D, et al. Is Golf a Contact Sport? Protection of the Spine and Return to Play After Lumbar Surgery. Global Spine Journal. 2022;12(2):298-307. https://pmc.ncbi.nlm.nih.gov/articles/PMC8907648/

5. Cole MH, Grimshaw PN. The Biomechanics of the Modern Golf Swing: Implications for Lower Back Injuries. Sports Medicine. 2016;46(3):339-351. https://pubmed.ncbi.nlm.nih.gov/26604102/

6. Walker CT, Uribe JS, Porter RW. Golf: a contact sport. Repetitive traumatic discopathy may be the driver of early lumbar degeneration in modern-era golfers. Journal of Neurosurgery: Spine. 2019. https://www.sciencedaily.com/releases/2019/02/190205090519.htm

7. Dydyk AM, Ngnitewe Massa R, Mesfin FB. Disc Herniation. StatPearls. National Institutes of Health. Updated 2023. https://www.ncbi.nlm.nih.gov/books/NBK441822/

8. Haddas R, Pipkin W, Hellman D, et al. Is Golf a Contact Sport? Global Spine Journal. 2022;12(2):298-307. https://journals.sagepub.com/doi/10.1177/2192568220983291

9. Liu Z, et al. Low back pain associated with lumbar disc herniation: role of moderately degenerative disc and annulus fibrous tears. BMC Musculoskeletal Disorders. 2015;16:115. https://pmc.ncbi.nlm.nih.gov/articles/PMC4402739/