|Dr. Leon J. Grobler|
Sun City, AZ
Pain in and of itself does not inflict permanent damage, nor is it necessarily a sign that permanent damage to the nerves has occurred. The critical issue, however, is that of neurological deficit (impingement or pressure on the nerve roots in the spine or the spinal cord). If a patient continues to experience back- or neck-related pain, especially if the pain radiates below the knee and is accompanied by numbness or muscle weakness, there is a very distinct possibility that irreversible damage has occurred and will remain even after the pressure on the nerve is relieved. Recent bowel or bladder problems are also a potential sign of severe nerve damage. The patient’s outcome also will depend on how long the nerve has been pinched or compressed. Anyone who wishes to delay surgery should thoroughly discuss the potential for permanent damage with his or her spinal surgeon.
|Dr. Sebastian Lattuga|
Rockville Centre, NY
In general, cervical disc disease does not cause irreversible nerve damage. However in the rare instances where patients are developing worsening neurological injury, then early surgery is recommended.
|Dr. Jeffrey Goldstein|
New York, NY
It's certainly possible. People who have weakness or significant numbness for a prolonged period of time may not get complete recovery of function with or without surgery. Often there is significant recovery and pain can resolve completely but there is certainly a possibility that there could be some permanent loss of function. That is certainly the exception rather than the rule but it is a possibility.
|Dr. W. Christopher Urban|
Glen Burnie, MD
Most often, a period of non-operative therapy is recommended prior to considering surgery. A majority a patients experience relief of their symptoms after a few weeks and can avoid surgery. However, when the spinal cord is severely compressed, the pressure on the nerves may cause irreversible damage. I sometimes use the analogy of a heavy brick placed on top of a garden hose causing it to be compressed. If the brick is removed after a few hours or days, it is unlikely to cause permanent kinking of the hose. However, if the brick is left on the hose for several months, the hose may never regain its original shape after the brick is finally removed. In cases of myelopathy or severe radiculopathy, where there is significant spinal cord or root compression, delaying surgery may cause irreversible damage.
|Dr. Dennis G. Crandall|
Only in cases of significant spinal cord or nerve compression with functional deficits is surgery emergent or urgent. If significant weakness is present, waiting longer than 3 months for surgery is associated with a poorer return of muscle strength. In general, nerves that have been chronically and severely pinched do not respond as well as nerves that have been pinched a short time.
|Dr. Theodore A. Belanger|
There are some specific situations where this is true, such as in the case of spinal cord compression and worsening paralysis, but, in most cases, delaying surgery will not cause a worse final outcome.
|Dr. Joseph Alexander|
If pressure on a nerve or the spinal cord lasts for a long period of time, it is possible that the changes in the nerve or spinal cord can become permanent. This would generally be the case in someone who had significant weakness or clumsiness as symptoms of their spinal degeneration. For patients who primarily have neck region pain, there is probably little chance of permanent damage if surgery is delayed, as long as their problem is related to simple degeneration. Of course, patients with cancer, infections, fractures, or instability involving the spine may need much more urgent attention.
|Dr. Moe R. Lim|
Chapel Hill, NC
In certain serious conditions such as when the spinal cord is becoming damaged, delaying surgery too long can lead to irreversible damage.
|Dr. Rick Sasso|
That's a very good question. Most of the time people do not have a significant neurologic deficit. They don't have significant weakness or numbness and tingling, and so then it's basically a lifestyle issue: whether you can do your activities that you want to do or need to do, your hobbies, and your job. On the other hand, if a significant neurologic deficit is present, either spinal cord changes or nerve changes, and they are progressive, basically they are getting worse, that's when we get more concerned, and taking pressure off the neural structures is important. The problem is, if we wait too long, there is very, very good data to show that if you press on a nerve and that nerve is pressed on for a long period of time, that we have less of a chance of having return of function to that nerve after we take the pressure off the nerve.
|Dr. Mark Testaiuti|
It depends on how badly the nerve(s) is pinched. If profound weakness is present there may be more irreversible injury. Some muscles in the arm are more dependent on a single nerve than others, i.e., C5. Also, if the spinal cord is being pushed on and there are exam findings showing this is occurring, this may be stopped by surgery but not always reversed.
|Dr. Mark R. McLaughlin|
Waiting a few weeks or even 1-3 months to have surgery should not cause any irreversible damage unless there is progressive worsening during the observation period. If during the waiting period, you begin to experience worsening arm, leg, or bowel/bladder dysfunction, you should have a re-evaluation immediately.
|Dr. Jeffrey C. Wang|
Los Angeles, CA
The more serious conditions where the spinal cord or nerve elements are becoming damaged or already show signs of damage represent a more urgent situation and do require surgery within a reasonable amount of time. For elective conditions where the main symptoms do not involve signs of neurologic damage, but mainly significant pain, most likely will not result in irreversible damage if surgery is delayed. A great deal depends on the actual diagnosis and the root of the problem.
|Dr. Douglas Slaughter|
In some cases with nerve root injury or spinal cord injury, delay of surgery can cause permanent damage; however, surgeons cannot tell you exactly when that time of irreversible damage will occur.
|Dr. B. Theo Mellion|
It is certainly possible. People who have weakness or significant numbness for a prolonged period of time may not get complete recovery of function. Often there is significant recovery, and pain can resolve completely, but there is certainly a possibility that there could be some permanent loss of function. Although that is the exception rather than the rule, it is a possibility.
|Dr. Kevin Yoo|
It is hard to say if you will have irreversible damage if you delay surgery, but clinical experience shows that the longer your nerves or spinal cord are compressed, the less likely surgery will be successful. For nerves in the cervical spine (the neck), some clinicians report, and I happen to agree, that if you have significant pain, numbness or weakness at 3 months after the symptoms started, then you should seriously consider surgery.
|Dr. Robert S. Pashman|
Los Angeles, CA
Your physician will advise you based on your condition. In general, if there is severe spinal cord compression or a nerve is compressed over a period of time there may be irreversible damage. If a patient experiences an increase in weakness, weakness in the legs, loss of balance or loss of bladder or bowel control, they should be reevaluated by their spine specialist immediately.
|Dr. Allan Levi|
Irreversible damage to the spinal cord and to nerves can occur with prolonged compression.
|Dr. Sean Salehi|
If the compression is on the spinal cord, then a delay in surgery can cause significant damage. Compression on a nerve root emanating from the spinal cord is less of an issue, and a conservative treatment is recommended prior to a surgical decompression.
|Dr. Timothy C. Ryken|
Iowa City, IA
While there are situations in which delays in surgery may result in permanent injuries, most of the time patients improve. If you have a neurological condition defined, beyond pain alone, you should be followed closely by your surgeon.
|Dr. David S. Baskin|
This also depends on the exact anatomy of your problem, and is an important question to ask your doctor. This risk does exist when there is nerve pressure present and you have a neurological deficit.
|Dr. Brian Subach|
In general, the longer nerve compression or spinal cord compression exists, the less likely the chance of a complete recovery.
|Dr. Randy Davis|
Glen Burnie, MD
Although there are a small number of instances where a patient has a progressive paralysis, where delay in surgery can be damaging, it is much more common for the patient to benefit from a period of non-operative treatment since there is frequently a good chance that they will respond without surgery.
|Dr. Daniel Resnick|
In general, a delay of several weeks or even months does not influence ultimate outcome. If significant weakness does exist however I would recommend surgery earlier rather than later. If the problem is primarily pain or numbness which is not especially bothersome then there is no harm in waiting for a period of weeks or even months to try and avoid surgery.
|Dr. Paul Saiz|
Irreversible damage which correlates as nerve damage is more likely to occur the longer nerves are pinched. Fortunately, waiting on conservative measures to improve symptoms typically will not induce irreversible change.
|Dr. Kambiz Hannani|
Los Angeles, CA
If there is direct pressure on the spinal cord and you are experiencing progressive weakness or bowel and bladder problems, irreversible damage may occur. In these cases, surgery needs to be performed, depending on the extent of the cord compression.
The commentary above recounts the experiences of these physicians. Medtronic invited them to share their stories candidly. Keep in mind that results vary; not every patient's response is the same. Talk with your doctor to learn more about any products that are mentioned above.
It is important that you discuss the potential risks, complications and benefits of spinal surgery with your doctor prior to receiving treatment, and that you rely on your doctor's judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.