I have carried a bias that a microdiscectomy meant my failure as a physical therapist. Microdiscectomy was appropriate when the patient had loss of arm or leg strength or reflexes. I now am adding a third criteria: when you have longstanding intractable pain.
I don’t have this bias when somebody has a fracture or a ligament tear.
I think this bias comes from physical therapy school but I cannot nail its origin.
When everything else has failed you, and anatomy is causing the problem, we need to change anatomy with surgery.
The challenge then is restoring full strength, motion, and tissue health in physical therapy.