When should you consider surgery for your back or neck?   The old “rule of thumb” was that surgery for your back should be the very last thing you consider – when everything else has failed! Like most “rules of thumb” though, that’s only good advice some of the time.  In certain situations, putting off surgery can lead to problems down the road, or be down-right dangerous.  Here are FIVE CONDITIONS that need surgery earlier rather than later: 

1. Spinal instability 
2. Conditions that are destroying bone 
3. Worsening spinal deformity 
4. Nerve or spinal cord compression 
5. Disc disease when motion preserving surgery is an option 

Conditions causing spinal instability range from severe degenerative disc disease to traumatic injuries after falls or motor vehicle accidents.  If the structures that keep your spine in good alignment get disrupted, progressive instability can lead to deformity, pain, and neurological injury. Early surgery stabilizes the spine while it is still in good alignment and can prevent a more challenging operation later. 
 
Conditions that destroy bone are usually more serious medical conditions, like tumors or infections, and require your Medical Specialists and your Spine Surgeon to work together. While the medical management is often the key to controlling the underlying disease, delaying surgery can lead to bone collapse and cause a much greater problem.  Modern surgical techniques can provide stability with an overnight stay, keeping patients on their feet and minimizing pain during medical management. 

Spinal deformities should not be allowed to progress.  A curvature of the spine or a slip of one vertebra relative to another that progresses in adulthood is most likely going to keep progressing! Early treatment will be less difficult and more successful than surgical reconstruction when the problem is severe. 

Nerve compression or spinal cord compression may be observed by your doctor for a while, but if symptoms of arm or leg pain are severe and persistent, or if any symptoms of spinal cord compression develop, there is no role for continued physical therapy or pain management.  Spinal cord or nerve injury may become permanent, and surgery then - as a “last option” - may not do much good. 

Finally, there are some options available to patients with neck and back pain that just didn’t exist 20 years ago.  Disc replacement, or disc arthroplasty surgeries lead to fewer re-operations and complications than traditional fusion procedures, and they protect the adjacent levels from degeneration often seen after fusion.  However: total disc replacement operations PRESERVE MOTION, meaning that earlier surgery, while the spine is still mobile, is crucial.  Waiting until the “last option” may mean there’s no motion left to preserve. 

And then, fusion is the right thing to consider. 

People usually don’t worry about aches and pains that come on after a fall or moving a piano. 
It’s pretty typical to be sore, so… no worries, right?  But, when pain sticks around longer than you’d expect, it’s also pretty natural to start worrying – ‘could this be something worse?’.  That thought comes on even quicker if you’ve ever known someone who did have pain due to cancer or another serious problem. And while we try to look cool and very calm, your healthcare providers – doctors, nurses, physical therapists – are the quickest to come in for a check-up if their pain lasts too long! They worry about the same things you do.

The important thing for you to know is that, while 80-90% of EVERYBODY will have an episode of persistent back or neck pain at some point of their life, almost all of those episodes will result from muscle strain, disc degeneration, or other manageable causes of back injury. Almost all of these episodes will start to improve after 3 -4 weeks of rest, and some appropriate anti-inflammatory's.  If your pain persists for more than 6 – 8 weeks, bothers worse at night than when you are up and active, is causing numbness, weakness, or pain in your arm or leg, however, it’s probably time for a check-up.

To be honest, my own Grandfather was an exception to this rule.  At age 65, a 3 pack-per-day smoker, his mid-thoracic back pain had none of the symptoms of a back strain and he had all the risk factors for trouble.  So, if you:

- have a history of cancer,
- are at high risk for cancer because of heredity or heavy smoking,
- have been losing weight, or
- are running fevers

along with your symptoms of back or neck pain, then you shouldn’t put off that visit to your doctor. A careful examination and appropriate imaging will either identify the problem or help put your mind at ease.
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For the rest of us, it’s worth knowing that a muscular back or neck injury can take several weeks to completely calm down.  That’s NORMAL.  The best treatment remains – rest, ice and heat, anti-inflammatory medications, time, and exercise, once you start getting back to normal.  A visit to your primary doctor, physical therapist, or chiropractor can help get you back on track in most cases.  And if it doesn’t, well…that’s where I come in.