Many people awake each day to an aching back. In fact, back pain is the second-most common reason Americans go to the doctor-right behind colds and the flu. While chronic spinal pain and the osteoarthritis (OA) that often causes it are common, its not completely clear what type of treatment will ease the condition.For many, surgery may seem like a solution, but there is no clear rule of thumb as to when surgery is the best answer, according to Cleveland Clinic orthopaedic surgeon Thomas Mroz, MD.The decision to use spinal fusion surgery to permanently connect two or more vertebrae in the spine to treat back pain is a sticky issue, says Dr. Mroz, director of the Spine Surgery Fellowship at Cleveland Clinic. How we treat patients with back pain in the United States is very heterogeneous. We need to ask what is good for the patient and, at the same time, we need to decide what works best for their particular type of pain.