Do I Need Spinal Surgery?

by Steven Hughes, M.D.

Do I Need Spinal Surgery?

While spinal surgery is safe and produces great outcomes, the percentage of people that need surgery for their neck or their back is very low. Most people experiencing pain in their back or neck benefit more from medication, physical therapy and injections than they would from surgery. When being referred to see a spine specialist, you should understand that they are not going to immediately perform surgery but will instead try all the other methods of pain management first.  

Patients normally come into the office after experiencing pain for a month or so and have MRI scans from their family practitioner. After a brief physical exam, the patients need reassurance that this pain will not last long term and need to be talked through their scans. Most of the conditions are normal signs of aging, the same way wrinkles or gray hair are, and no special treatment is needed beyond exercise.   

Other Treatment Options 

Injections are one option for treatment. An injection of steroid medicine around the area can be helpful by shrinking the inflamed tissue and allowing the parts of the spine to start to move in synchrony again. The injection may relieve pain that isn’t relieved by simple exercise. There is some debate on the number of injections a patient should get. Once you see a 50% improvement in symptoms you should stop the injections and return to rehab or physical therapy to reach full recovery. If you are not seeing 50% improvement after one or two injections, then three is typically the maximum number of injections to try. 

We do not prescribe a lot of narcotic pain medication due to the fact that the United States has been facing an opioid crisis. Most often the pain can be effectively managed with over-the-counter medications combined with physical therapy and sometimes some mild muscle relaxants. 

Surgery and Recovery  

The very last option for patients would be spinal surgery. Surgery is reserved for patients who cannot manage their pain with medication or injections and have failed multiple attempts at physical therapy. Before surgery, the patient should get a second and even sometimes a third opinion. These other opinions will either contradict or support the surgical plan as well as the recovery plan. After getting the second opinion, the patient will come back into the office and have a discussion on the course of treatment.  

The recovery timeline is different for every patient but in most cases the recovery is not months but a matter of days or weeks. Physical therapy is the most important part of recovery and allows for resumption of regular activities to be very quick.