Chronic back pain is a multifactorial condition defined by persistent spinal pain lasting longer than three months and represents one of the most common reasons for neurosurgical consultation. While the majority of cases are managed conservatively, a subset of patients develop chronic pain due to structural spinal pathology that may benefit from surgical intervention. Accurate identification of surgically correctable causes is essential to achieving meaningful symptom relief.

Patients may present with axial back pain, radicular symptoms, or neurogenic claudication. Pain is often mechanical in nature, exacerbated by activity and relieved with rest, but may become constant in advanced disease. Chronic pain is frequently associated with functional impairment, sleep disturbance, and reduced quality of life.

Neurosurgical evaluation involves comprehensive clinical assessment and correlation with advanced imaging. MRI and dynamic radiographs help identify disc degeneration, spinal stenosis, instability, deformity, or nerve compression. Importantly, imaging findings must align with clinical symptoms to justify surgical consideration.

Surgical evaluation focuses on determining whether pain arises from a correctable anatomical lesion rather than nonspecific degenerative change. Surgery is considered when patients have failed adequate conservative therapy and demonstrate objective pathology associated with neurological compromise or mechanical instability.

Surgical objectives include decompression of neural elements, stabilization of unstable segments, and restoration of spinal alignment where appropriate. Procedure selection is individualized and guided by pathology, patient goals, and functional demands.

Postoperative care emphasizes rehabilitation and long-term spine health to prevent recurrence. Surgical outcomes are optimized through careful patient selection and realistic expectation setting.

Chronic back pain requiring surgical evaluation is a nuanced neurosurgical domain where detailed assessment and precise intervention can significantly improve function and quality of life.