Don't know how much time LackeyR spends in medical staff lounges, but I'm in one every day and talk to surgeons about this all the time. Two points stand out in my mind. One is that surgeons are generally not eager to operate on people with disk issues unless they feel it will be helpful. But the other vital point is that people with chronic and severe back pain are a desperate lot who suffer constantly and not infrequently become suicidal over their plight, not to mention addicted and abusive of opiates. The question posed about whether a surgeon should or would operate if he sees a 40% chance of benefit is naive; for comparison sake, should an oncologist administer chemo if he sees a 30% chance of cure? Most would say "of course" if the alternative is death. People with severe chronic debilitating back pain often feel the same way; they see their affliction as a death sentence and will beg surgeons to operate even if there is a less than even chance of benefit. Even in the non managed care setting, which still exists to some extent, people usually have to shop around to find a surgeon who will operate.