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When Is Spine Surgery Needed

Many patients are lost when they start developing back pain and or sciatica (pain going down a leg). Oftentimes back pain, neck pain, and sciatica can be severe. However, this does not necessarily mean surgery is necessary. 


Where does a patient go when they experience new neck pain, back pain, sciatica and/or upper extremity pain that’s coming from the spine? I’ve always said that when someone has a toothache, they go to the dentist. Where does somebody go when they have back or neck pain? Well, it’s all over the map. Some patients will go to the urgent care, ER, their primary care doctor, the general orthopedist, or even a spine surgeon. Although we have many fine spine surgeons in our community, it is not appropriate to run to the spine surgeon as the first option with new-onset back pain or neck pain. Most people will not require spine surgery.


Going straight to a spine surgeon is like somebody with a little bit of chest discomfort, going to the cardiothoracic surgeon, thinking that they might need heart surgery. What patients with new-onset back and neck pain need is a comprehensive workup and a treatment plan to be established. What most patients don’t realize is that most new-onset back pain, sciatica, and upper extremity and neck pain resolves in six to eight weeks with conservative treatment, including physical therapy and anti-inflammatory medications. Sometimes these patients are helped along with epidural steroid injections or injections into joints known as Fossette joints in the back and neck. This could help to speed the recovery process. 


Only when a patient fails conservative management and continues to have back or neck pain and associated symptoms that are severe and/or has neurological dysfunction should they ever consider surgical intervention. 


It is rare for someone to become paralyzed or have serious sequelae by not having spine surgery. Spine surgery should always be the last resort. The excellent spine surgeons in our community know this and are extremely conservative and advocate more minimally invasive treatments provided by my specialty of interventional pain management prior to considering surgical intervention. 

When Should Patients Worry about Symptoms Caused by Back or Neck Pain? 

Patients should worry when they have upper or lower extremity, numbness, weakness, bowel/bladder dysfunction, or a foot drop.  A foot drop is when the foot doesn’t lift up and drags when you walk. When someone loses control of their bowel/bladder this can be a sign of cauda equina syndrome. This is a rare condition, but can be serious and often requires emergency surgical intervention. Most importantly, a patient with back or neck pain and associated symptoms, such as sciatica and or upper extremity pain should see a board-certified interventional pain management physician to obtain a comprehensive workup. This workup often includes x-rays and perhaps even MRIs or CAT scans of the spine to further evaluate the situation. 


Sometimes we perform a test known as an electromyogram nerve conduction study (EMG/NCS) to be able to assess whether or not there’s any nerve damage. The important takeaway is that spine surgery is rarely needed no matter how bad one’s back pain, neck pain, sciatica, or upper extremity pain symptoms may be unless they persist and have a neurological component.

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