Most spine complaints settle without surgery: around 90% of my patients recover with targeted conservative treatment. Surgery is not the first step. It is what remains once the conservative options have been exhausted. This page does not tell you whether you need an operation. It helps you see where you stand in the decision, and where it is worth going next.
A surgical recommendation does not follow from the severity of the scan. It follows from what the complaint, the physical examination and the imaging show together, and from where the conservative path has got to. There are three situations in which a surgical solution comes into question at all.
Four groups cover most of my spine surgery practice. Here I set out only the essentials, so that you can orient yourself; each has a detailed page covering the symptoms, the patient journeys and the recovery.
Surgery for a disc herniation removes the fragment pressing on the nerve: with discectomy in the lumbar spine, and usually with ACDF in the neck. It comes into question when radiating pain or weakness does not settle with conservative treatment. Around 70% of disc herniations heal without surgery.
Disc herniation in detailIn spinal stenosis the aim is to relieve the narrowed segment, so that the nerves regain room. It arises for those whose walking distance gradually shortens and whose complaint eases on leaning forward or sitting down. Fixing the vertebrae is not needed in every case.
Spinal stenosis in detailWhen the connection between the vertebrae becomes unstable, fixing and fusing the segment can be the solution. MI-TLIF does this through a muscle-preserving approach, and it is the technique in which I have built the deepest experience over the years. The choice of technique always depends on the case.
Stabilization surgery in detailSpine tumour surgery requires an institutional, multidisciplinary setting, and it was the subject of my PhD. Benign and malignant primary tumours, spinal metastases and en bloc resections belong here. This field is mostly not delivered within the private practice.
Spine tumour surgery in detailThese four groups cover the most common procedures, but the range of spine surgical options is considerably wider. Which one applies in your case is something we discuss at the consultation, knowing the scan and the physical examination. The same scan can allow more than one professionally defensible solution, and the choice always depends on the individual situation.
With one exception: neurosurgical procedures affecting the spine do not belong here. Lesions inside the dural sac, meaning those lying within the tough membrane covering the spinal cord, belong to the field of neurosurgery.
This word is used often and explained rarely. It is worth knowing what it covers, because it is part of understanding a surgical recommendation.
Minimally invasive does not refer to the significance of the operation, but to the way the surgeon reaches the target. In a traditional approach the muscles have to be detached from the vertebra so that the spine is exposed. In a muscle-preserving approach we pass between the muscle fibres instead, working through smaller incisions and with tubular instruments.
This has practical consequences: less blood loss, less post-operative muscle pain, and mobilisation that can begin earlier. The goal throughout is the same as in open surgery; the difference is the route taken to reach it.
With the following signs the task is not to weigh up surgery. These are rare but time-critical, and they need immediate care.
When should you see a doctor immediately for back pain? A detailed guide
Once the decision has been made, the question is no longer whether surgery is needed, but what lies ahead of you. A separate page answers that.
A description and your own situation rarely match exactly. The cases show how the decision went for other people, and in which of them it led to surgery.
If you have received a surgical recommendation elsewhere, or you have arrived at the thought of surgery on your own, the next logical step is an independent specialist opinion. Not a refutation of the earlier recommendation, but a way for the decision to become your own, informed one.
Second opinion consultation