It is very important to listen to patients and be open-minded to their options. I now offer acupuncture as an option rather then them takng strong pain medications. This has satisfied many of my patients and helps build a bridge of trust. More traditional treatments with a physical therapist are just as important as a Patient choice. Some patient want to go directly to surgery as they have already tried many options and understand removing a disc fragment or opening up spinal canal as a treatment for their stenosis is their best chance for return to activity.Managing options and patients expectations is extremely important!