In clinical medical practice, it may be difficult to distinguish between treatment a patient needs; treatment that may be desirable;and treatment that could be deemed frivolous. At one end of this spectrum for example, any practising clinician would accept that a child with fulminating meningococcal meningitis needs rapid access to medical care. At the other end, rarely could a young healthy woman be deemed to need breast augmentation. Numerous surgical procedures fall into this spectrum: particularly, this is so in our ageing Western population, where there is an ever-increasing prevalence of painful, but not life-threatening disorders: typified by the ageing spine.