Surgery can correct issues such as spinal stenosis—a narrowing of the areas where nerves branch off the spinal chord—or bulging and herniated disks, the most common problem. Treatment ranges from procedures to clear nerve openings by removing the bone or ligament that pressures the offending nerve, to operations that repair the cartilage in problem disks, to spinal fusions. For some issues, Dr. Frank J.E. Falco will recommend implantable stimulators that send a mild electrical signal up the spine. The sensation registers not as pain, but as a mild vibration. Because the stimulator can be removed easily, the patient doesn’t have to commit to a daunting and irreversible procedure.

“You get a chance to test it, take it around the block, see if it’s right for you. That takes some of the fear out of it,” Falco says. “There’s no way to try out a fusion. And once you’ve had a fusion, you’ve had a fusion.”But Yalamanchili cautions that though stimulators can sometimes restore normal functioning, they only mask the pain, not remove the cause. For 10 percent of his patients, surgery is the best option. Still, it’s a difficult decision. Yalamanchili estimates that 60 percent to 80 percent will respond well to surgery. The decision is, of course, the patient’s to make. Rest assured, “We don’t want to make anyone worse,” he says. “The key for us is to make sure patients know what they’re in for.”