text: what are the determining factors in whether or not somebody needs back surgery?... how is that decision made?? *original bad back/ back injury resulted from a car accident in 2000   *seeked & recieved medical attention (chicopractor) for 2-3+ years  *pain continued & has persisted 6+ years, but has gotten better  *recent car crash has completely deminished any progress & pain is almost unbareable  *no moved or slipped disks, etc..  *extreme pain in entire back- from top to bottom  *muscles & nerves very tense & tight tough question.  its a personal decision.  first off, if there is no slipped disk or nerves being pinched or associated weakness and numbness  in extremities, what exactly is the back surgeon going to fix??  i mean i doubt back surgery of any type is going to take away the pain from "top to bottom."  i think the following are the factors that you need to think about:  1)neurological symptoms like leg numbness or weakness, compromised walking.  these symptoms can progress over time and you may not get function back if you wait to long.  usually there is an identifiable lesion like a slipped disk pushing on a nerve on mri.  2)chronic back pain that is amenable to surgery.  for instance anterolithesis or posterolithesis where the vertebral body is slipped forward or backwards.  in conditions like these the pain may became unbearable (this is where personal choice is important) and you can't stand it any longer that surgery is the only option.  3)what does the back surgeon say?  its important to seek the consult of multiple back surgeons that are reputable. sometimes, more often then not, back surgery results in more pain and disability.  some people often have 1 surgery after the next to fix the problems from the previous surgeon.  if 3 surgeon says its not fixable and 1 says they can help i would trust the first 3 surgeons.  4)you have exhausted all your option.  chiropractors, medications, physical therapy, alternative medicine, massage therapy, accupucture, yoga.  my sense, again is if you have pain from "top to bottom" surgery isn't going to help.  if there is no identifiable cause of this pain, surgery will not improve your situation.  a chronic pain specialist have actually be more helpful.