"My leg's given out on me," said Edgar, the metal sculptor, with his fringe of white hair growing like a collar around his bald head.He peered through his round, steel-rimmed glasses, sitting across from me, his long legs twisted awkwardly and uncomfortably before him. While working on a particularly large bronze piece on Sunday morning, he felt a pop in his lower back, then severe back pain and weakness in his left thigh and leg. I made a diagnosis of a ruptured L3-L4 disc, confirmed it by examination, and then by MRI, and sent him on to the department chair of neurosurgery, who scheduled him for the indicated laminectomy.When it flowed this way, practicing neurology felt exhilarating, like singing an aria. A careful history generated a diagnosis, supported by the examination and verified by laboratory tests, and a proven cure was prescribed. There was no room for doubt or secondguessing, as a well-trained mind and body crafted the right solution, hit the perfect note. Of course, unlike Beethoven's Ninth, in medicine, our compositions sprang from good, evidence-based science, and not from the well of creativity. Or so I once thought.For Edgar's wife sought a second opinion and sent him to her neurologist, a phenomenal clinician with 40 years of experience, who called to say that he didn't think surgery was necessary. I was unconvinced. This was the standard of care for a large traumatic disc with focal signs and not operating quickly could lead to permanent weakness.Yes, said Dr. Great Clinician, this was true as a rule, but he wanted me to reconsider my position. We both knew, he said, that Edgar was exceptionally fit, and we both concurred that the weakness in his leg didn't prevent him from walking. And while it was true that the disc was large and compressive on the MRI, would