Open back surgery is not commonly needed for all neck/back pain - only 10% of all neck/back conditions require surgery, the majority 90% can be treated conservatively successfully with medications, physical therapy (physio, chiro, osteo, tcm), injections (including radiofrequency or "laser") as long as the conditions do not worsen rapidly as they are being slowly and gradually managed.
These include majority of symptoms arising from degenerated neck/back discs (also known as cervical/lumbar spondylosis) which are natural aging processes in the first place (if there is no pre-existing congenital spinal abnormality).
There are 2 main reasons surgery is required.
1) Disc injuries
10% of the abovementioned population with "natural" spondylosis unfortunately can experience accelerated weakening of their disc (from injury, sports, occupation, sedentary, etc). It ruptures like a burst car tyre, with disc fragment compressing the adjacent spinal cord or nerve within the spine resulting in pain/weakness/numbness in arms/legs.
Only open surgery can remove the disc fragment and decompress cord/nerve before it worsens further to loss of arms/legs/bladder/bowel control (emergency).
2) Cancer/infection
Second reason for surgery is any serious "unnatural" pathology in the spine -
- Tumour
- cancer secondaries
- infection
- unstable spinal "slippage"
- fracture or
- dislocation
Although rare, they can only be detected by more advance investigation like MRI scans, and if missed/untreated will have devastating consequences of disability, paralysis and even death.
Hence the common but important advice to seek specialist evaluation if neck/back pain lasts longer than 1 month without any improvement despite medications, injections, physio, chiro, tcm, etc.
