As it is so risky, surgery on the back and spine is almost always an elective procedure. The decision to have back surgery is almost always determined by the patient who may feel that life is no longer worth living because of extreme back pain.
Usually an orthopedic surgeon performs back surgery unless a tumor is present. Then a neurosurgeon may recommend surgery as well as perform the procedure. In some cases a neurosurgeon and an orthopedic surgeon may consult together on a case of back pain that has a complex history or pathology.