Neurosurgeon here. Many people have talked about the importance of exercise, which is critical. I won't comment about what specific exercises to do, schemes devised to swindle desperate people out of their money, nor about the centralization of peripheral nerve pain. However, some posters have talked about surgery for back pain, which concerned me enough to post.

In general, indications for surgery at my institution are:

1) Nerve pain
2) Spinal cord compression
3) Cancer
4) Trauma

(1) Nerve pain: Some posters have talked about nerve pain related to their back. As some have posted already, the vast majority of nerve pain resolves spontaneously. Surgeons can do a world of good for people with intractable nerve pain. But most reasonable people (including yourself) should wait for a few months for it to get better on its own. It's worth noting that a subset of people with a pinched nerve don't have pain; in this case, people will develop numbness in a specific part of their limb, or weakness in one or more joint in their limbs. Finally, if at any point with back pain you can no longer pee, have stool incontinence, or lose sensation in your groins, go to the emergency room immediately (do not pass go, do not collect $200).

(2) Spinal cord compression: This is serious. Some surgeons at my institution will twist patients into having an operation (even if they feel fine!) if there is evidence that the spinal cord is at risk. Signs to look out: progressive difficulty with walking and/or manipulating fine objects; dropping objects and falls; and bladder/bowel dysfunction.

(3) Differentiating cancer pain from normal back pain can be tricky. Doctors are taught to look out for several cardinal "B signs", including fever and unexplained weight loss, which helps point people in the right direction. The diagnosis is made easier if someone has a previous history of cancer (most commonly for the HN readers: prostate and breast), or having pain that is unrelenting, dull and present at night. If your pain is constant and present even when you're not moving, that's a concerning feature. However, even if you are diagnosed with metastatic cancer to the spine, most people still don't need an operation -- many people can be treated with radiation therapy alone.

(4) Some people who break their neck or their backs (from falls, motor vehicle collisions, etc.) don't need an operation. Others absolutely do. In general, if you break your back or your neck severely enough to impact either the nerves or the spinal cord, you probably need an operation. If your nerves aren't affected, ask your surgeon why you need it in your particular case (have the bones dislocated? Is there objective evidence that the ligamentous complex has been damaged?) and what non-surgical options are available.

Most (but not all) people with back pain don't need to see a surgeon. If you are referred to a surgeon for back pain, bring all of your scans to the appointment. But before signing up for surgery, be sure to ask the surgeon two important questions: First, what recommendations does the literature say about surgery for isolated back pain and how does it apply to your specific case, and (2) what is the likelihood you'll be back for more surgery after your first operation. An honest surgeon will say that high-quality data for isolated back pain are lacking in the literature.