Poor outcomes frequently occur due to lack of attention to details.  What do I mean by that?  Many times, I see that my peers are treating imaging studies (e.g. MRIs) and not the patient.  Sometimes, the patient’s complaint has nothing to do with an abnormality on an MRI.  It is not always obvious what the source of pain or complaints are.  For example, did you know that hip pain has multiple etiologies and is not always caused by a hip problem.  SI joint problems and lower back problems are other causes of hip pain that are often missed.  Similarly, knee pain can be caused by other problems such as hip arthritis or a pinched nerve in the back. 

Obviously, doing surgery for an asymptomatic disk problem is not going to work.  Doing the wrong surgery is a common cause of poor outcome. 

Likewise, doing a fusion surgery on someone with severe vitamin D deficiency will fail.  If a spinal instability is not adequately biomechanically stabilized, the fusion will not heal, and the fixation will fail (another cause of failed fusion surgery).