Dr. Theodore A. Belanger Charlotte, NC The most appropriate time to perform surgery for spinal problems is only after all reasonable conservative measures have been tried. If symptoms are not controlled adequately with medications, physical therapy and injections, then surgery can be considered, depending on the specific situation.

Dr. Thomas Zdeblick Madison, WI Surgery is necessary for patients with spine problems when their symptoms become disabling. Most spinal conditions can be treated initially with nonsurgical methods. However, when symptoms become overriding and a patient is unable to continue to perform their daily activities of work, play, and hobbies, then spinal surgery may be indicated.

Dr. Sebastian Lattuga Rockville Centre, NY Surgery for conditions associated with disc disease is necessary when patients continue to be symptomatic despite all conservative treatments. Generally, patients try conservative treatments for between 2 and 6 months. If after this trial of conservative treatment patients continue to have severe pain, surgery is an excellent option. Surgery becomes "necessary" when patients develop signs and symptoms of progressive nerve damage ie, increasing muscle weakness or worsening nerve damage.

Dr. Paul Saiz Mesa, AZ Surgery is typically a dish best served last. Surgery is a last option when all conservative measures have failed.

Dr. Rick Sasso Indianapolis, IN Success of surgery depends upon what the source of the spine problem is. For some spine problems, surgery is highly successful (disc herniations in the neck or back causing nerve problems, spinal cord compression). For other problems, surgery is less successful (back pain).

Dr. George Frey Englewood, CO Surgery is necessary for patients when nonsurgical methods do not give the patient adequate relief from their pain. The individual must decide if they are willing to live with their current level of comfort and function, or if they require more. Progressive neurologic changes are also an indication for surgery. This progressive numbness or weakness of the extremities, as well as changes in bowel or bladder functions. My spinal fusion is performed, so that particular segment of the spine can no longer move. It must be remembered, however, that all of the adjacent vertebrae and discs still allow for motion in the spine, as does the pelvis. For most patients, therefore, a fusion does not mean significant loss of overall range of motion. The remaining disc and vertebrae, which continue to move, can compensate for the loss at their fused levels. Many individuals can return to nearly all-normal activities after a spinal fusion has been preformed.

Dr. Thomas Kleeman Bedford, NH Surgery is indicated when adequate conservative measures have failed, the source for the pain has been clearly identified, and a surgical procedure exists that can improve the condition with a high percentage of success and an acceptably low complication rate. The patient must understand clearly the goals of the surgery as well as the alternatives. Some procedures such as disc excision often have a success rate over 90% with a complication rate of 2% or less. Other procedures such as lumbar fusions have a more variable success rate and serious complications are more common. As such, the decision for performing a lumbar fusion requires a longer trial of conservative treatment than a disc excision.

Dr. Paul J. Slosar Daly City, CA Surgery is necessary if a patient has a progressive nerve loss, spinal infection, tumor, or unstable fracture. Luckily, these conditions are rare. More commonly patients elect to proceed with surgery after a thorough work-up and diagnostic evaluation, by a spine specialist surgeon, for conditions that have become unmanageable with non-surgical treatment.

Dr. Jeffrey C. Wang Los Angeles, CA There are certain situations where surgery is absolutely necessary. These are urgent situations where the nerves are extremely compressed to the point they are becoming damaged and surgery is necessary to alleviate the pressure to prevent paralysis. Other situations where surgery is necessary include instability of the spine where the structure of the spine is unstable and surgery is necessary to protect the nerves. Besides these rare and urgent situations, surgery is typically necessary for patients who have failed conservative treatment and are still having significant symptoms, which inhibit their lifestyle. I believe surgery is warranted in these elective situations where the patient is very unhappy with the quality of his or her life and experiencing significant amounts of pain, which can be alleviated with spine surgery.

Dr. Sylvain Palmer Mission Viejo, CA Surgery is necessary when nonsurgical therapy fails to adequately control the symptoms of pain or nerve disfunction.

Dr. Sean Salehi Chicago, IL Surgery is recommended when a patient's pain doesn't respond to conservative treatment or if they have neurological deficits.

Dr. Ezriel E. Kornel White Plains, NY Surgery is necessary when all the conservative treatments have been ineffective and the symptoms persist or when there is a significant neurologic impairment such as profound weakness resulting in a foot drop or when there is bowel or bladder dysfunction. In these cases of neurological impairment, in order to recover neurologic function, it may become urgent or even emergent to have surgical intervention.

Dr. Dennis G. Crandall Mesa, AZ Urgent indications for spinal surgery are limited to patients with loss of bowel or bladder control as the result of nerve compression. Surgery happens when you decide you are tired of living with your pain and there is a surgical solution for it.

Dr. Jorge E. Isaza Baton Rouge, LA Surgery is indicated for multiple problems of the spine, including, but not limited to, disc herniations, spinal stenosis, deformity, instability, tumors, compression fractures, and osteoporosis. All these problems may be treated surgically if the patient has intractable pain or progressive neurological deficits.

Dr. Mark Rosenthal Baltimore, MD Surgery should be done right away if there is a profound neurologic deficit caused by nerve compression. For example- a large disc herniation causing loss of bladder function. Otherwise, surgery is indicated if the patient has failed non-operative care, the pain is severe enough to warrant invasive treatment, and the patient has a problem that surgery will fix.

Dr. Jeffrey Goldstein New York, NY Surgery is considered when nonsurgical therapy fails to adequately control the symptoms of pain, weakness or nerve dysfunction. The need for emergent spinal surgery exists but is infrequent. Emergency surgery may be indicated if there are progressive or severe neurologic deficits or bowel or bladder difficulties. Generally the need for surgery is a quality of life decision and not a life and death decision. Spinal surgeons do not treat MRIs and X-Rays but rather treat patients. The same MRI findings may be found in both patients with severe pain or patients with little to no pain. There is no such thing as a "magic bullet" for patients with spinal problems. Your surgeon will work with you to customize a treatment plan. There are also some situations where spinal surgery is still not appropriate even after poor response nonoperative treatments.

Dr. Kenneth A. Pettine Loveland, CO The only specific indications for spine surgery include the occasional patient who has a neurologic deficit who is becoming paralyzed because of nerve pressure and a patient who develops such severe pressure on their spine that they lose control of their bowel and bladder. Other indications would include someone who has an infection in their spine or cancer that requires removal of the affected area in order to cure their patient of their disease. The only other indication for spine surgery is pain relief. As stated, pain is a subjective complaint only experienced by the patient. Any surgery performed is an elective procedure done after the patient decides non-operative treatments have failed and their pain is such that surgery is the only alternative to living with their pain.

Dr. Leon J. Grobler Sun City, AZ Surgery is recommended: if there has been no improvement in the patient’s condition after three to six months of conservative, or non-surgical, treatment; and if nerve pain persists despite treatment, and/or if there has been neurological compromise, especially if it’s progressive.

Dr. Douglas Slaughter Mesa, AZ Surgery is truly necessary for only three main conditions: bone infection of the spine, instability of the spine, and neurological dysfunction of the spinal cord or nerve roots.

Dr. Randy Davis Glen Burnie, MD Surgery should always be reserved for patients who fail non-operative treatment. The only emergency indications for surgery would be increasing paralysis of the extremities, pain which is not controlled with conservative means, and a condition known as cauda equina syndrome where bowel and bladder functions can be affected. There are two basic types of surgery. One type of spinal surgery involves decompression or the removal of bone and/or disc material from around the spinal cord and the exiting nerve roots. The second type of spinal surgery in general is known as fusion which is an attempt to weld the vertebral segments together to presumably stop painful motion and avoid further nerve damage.

Dr. John S. Shiau Staten Island, NY I think you should always try to consider the treatment if you can avoid surgery, that is always the best option. But in terms of surgery, in my opinion, when all other options have been used, surgery should be considered.

Dr. Donald D. Dietze Jr. Covington, LA Surgery is only necessary when a patient has progressive motor weakness or bladder incontinence. However, surgery is performed the majority of time to improve a patient's quality of life by increasing activity level and decreasing pain. Surgery should only be considered after a trial of conservative non-surgical treatment has failed to achieve specific goals that surgery might address.

Dr. Andrew Glass Someras Pt., NJ Surgery is only necessary in a small percentage of patients with spinal problems. Factors that may result in decision in favor of surgery include response to prior treatment, severity of pain, severity of loss of function, severity of neurological problem, degree of spinal damage, degree of neurological threat and prognosis without surgery. Ultimately, the decision to proceed with surgery is a careful and thoughtful decision made between the patient and his or her physician after fully weighing the potential risks and benefits.

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