You can't get approved for surgery without PT in many cases anyway, so by default, most people will have to undergo PT regardless. In a lot of cases, you still can't get surgery; insurance will request pain management via injections and stuff before approving surgery. In my case, I had to go through 6 weeks of PT, then insurance asked me to do another 6 weeks after the first 6 failed to produce benefits. PT accelerated my decline because they didn't understand the mechanics in my case, so it's not always beneficial either. Also some of those conservative treatments (injections) are still being denied by insurance. My dad recently went to get another series of injections and was denied because they didn't think it would be medically beneficial despite the fact that he improved significantly from the first set and it lasted over 6 months.