Surgery for common spinal disorders has changed dramatically in the last several decades. The failed surgical back syndrome patients populate a vast number of chronic pain clinics and rehabilitation facilities. New surgical procedures promise better outcomes. Yet documented improvement in imaging studies and the original promise of newer technologies have not consistently resulted in better clinical outcomes. More important than the technical success is the improved state of the patient. The search for the ''properly selected patient'' is a commonly used euphemism to explain away less ideal outcomes. Yet the phrase continues without clear specificity. The study is a review of some of the problems in planning the surgical care for the spinal patient. Spinal surgeons generally do not follow their patients after surgery long enough to fully comprehend the results and the impacts of their procedures, especially as viewed by the patient. We present an alternative approach that reduces the role of the spinal surgeon by encouraging more input from those who are likely to follow the patient who might not fare well. Experience in the treatment of surgical failures educates these practitioners to provide an evidence-based approach to surgical indications not as readily available to the spinal surgeon in many modern surgical practices.