When do I need surgery

Dr. Kevin Yoo
Escondido, CA
You need surgery for your neck if you have the following two conditions. One, you have tried conservative treatments (e.g., physical therapy, massage, chiropractic, acupuncture, prolotherapy; and spinal injections) over the course of 3 to 6 months and continue to have symptoms that are difficult to tolerate, particularly if one of your symptoms is weakness that persists or is getting worse. And, two, diagnostic tests (e.g., X-rays, CT scan, MRI, and EMG studies) show abnormalities that explain your symptoms.
Dr. Dennis G. Crandall
Mesa, AZ
Surgery is appropriate when conservative care has not helped and you decide that you are tired of living with your pain.
Dr. Randy Davis
Glen Burnie, MD
Surgery should best be performed in patients who have had adequate periods of non-operative treatment over a minimum period of several months. If the patient still has significant weakness and/or persistent pain, then surgery may be a satisfactory alternative for most patients.
Dr. Timothy C. Ryken
Iowa City, IA
You may elect surgery when you and your surgeon feel you have exhausted your non-surgical options and it has been determined that your symptoms have a good chance of responding to surgical treatment.
Dr. Joseph Alexander
Winston-Salem, NC
Surgery for degenerative problems involving the neck generally comes down to a life-style decision. If someone is coping with the discomfort with a reasonable regimen of medication and limitation of activities, then there may be no reason to consider surgery. Surgery is generally recommended if a patient has persistent or worsening weakness, numbness or clumsiness. These problems generally indicate more serious pressure on the cervical nerves or the spinal cord. If a patient's pain is intolerable and a structurally correctable problem has been identified in the spine, that is another reason to consider surgical intervention.
Dr. Jeffrey Goldstein
New York, NY
Certainly if there is compression of the spinal cord with what we call a myelopathy. With clear impairment of spinal cord function surgery is necessary to decompress the spinal cord because the risk or permanent spinal cord injury is quite high without it. In patients with pain or numbness and weakness surgery should be considered when conservative or nonoperative treatment measures fail. We often talk of about 6 weeks of conservative care but that certainly is not the shortest period of time that one can go through therapy. You can try to control your pain as long as possible as long as there's no progressive loss of neurologic function. With loss of function one should consider surgery when the other treatment measures fail. It needs to be individualized for every patient.
Dr. Robert S. Pashman
Los Angeles, CA
Surgery is only indicated if conservative therapy fails, the patient becomes dysfunctional, or the patient experiences progressive neurological problems.
Dr. John Peloza
Dallas, TX
Surgery is a reasonable alternative for pure mechanical neck pain that does not respond to appropriate conservative treatment and has a specific diagnosis that would predictably improve with surgery.
Dr. Allan Levi
Miami, FL
Surgery is indicated when there is a failure of conservative treatment and/or the patient has significant symptoms of radiculopathy or nerve root compression and/or spinal cord compression.
Dr. Theodore A. Belanger
Charlotte, NC
Initially, most problems can be treated without surgery. If non-surgical measures fail to control symptoms after several months, then surgery can be considered. Some specific situations require surgery, initially, as non-surgical treatment is known to be ineffective, but this is the exception to the rule.
Dr. David S. Baskin
Houston, TX
This decision should be made by you and your doctor, and depends upon the precise anatomy of your problem. In general, surgery is indicated when conservative therapy fails and the discomfort is sufficient to prevent you from going on with your life. Surgery is often indicated early in the course of the problem when there is nerve compression present, with or without neurological deficit.
Dr. Paul Saiz
Mesa, AZ
The need for surgery is an individual decision. It typically should be a decision made as a last resort when all conservative measures have failed to improve pain and fail to restore quality of life.
Dr. Moe R. Lim
Chapel Hill, NC
Surgery is necessary when the spinal cord and nerves are being damaged. Surgery can also be an option when non-operative treatments have failed to provide pain relief.
Dr. Brett Taylor
St. Louis, MO
Patients consider surgery for neck problems when they develop persistent symptoms of pain and/or weakness that have failed nonoperative treatment. Other circumstances requiring surgical intervention include tumors of the spine and fractures of the spine that result in instability or threatened instability.
Dr. Sebastian Lattuga
Rockville Centre, NY
Surgery for conditions associated with cervical disc disease is necessary when patients continue to be symptomatic despite all conservative treatments. Generally, patients try conservative treatments for between two and six 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, i.e., increasing muscle weakness or worsening nerve damage.
Dr. B. Theo Mellion
Carbondale, IL
Certainly if there is compression of the spinal cord causing myelopathy. With clear impairment of spinal cord function, surgery is necessary to decompress the spinal cord because the risk of permanent spinal cord injury is quite high without it. In patients with pain or numbness, even mild weakness, surgery should be considered when conservative treatment measures fail. Six weeks is a reasonable period of time to use as a guide for physical therapy, but that certainly is not the shortest or longest period of time that one can go through physical therapy. Conservative measures can be employed as long as one feels necessary, providing there is no progressive loss of neurologic function. One should consider surgery when the other treatment measures fail, but it needs to be individualized for every patient.
Dr. Mark R. McLaughlin
Princeton, NJ
I always try to emphasize to my patients that if it is only pain they are experiencing and not spinal cord or nerve dysfunction, they should try to live with the pain. If the pain is severe, debilitating, or ruining their life, then I think surgery is a good option.
Dr. Kambiz Hannani
Los Angeles, CA
Surgery is usually optional unless there is pressure on the spinal cord. In this case, there may be progressive weakness or bowel and bladder problems. In patients who continue to experience severe pain, and conservative management, such as physical therapy and medications, have failed, surgery is a reasonable option.
Dr. Mark Testaiuti
Haddonfield, NJ
When the pain is intractable. Activities of daily living (work) have been affected, or if weakness is progressing.
Dr. Sean Salehi
Chicago, IL
Indications for surgery are any or a combination of: weakness, significant numbness, intractable pain unresponsive to maximal medical management, spinal cord compression, cervical instability.
Dr. Daniel Resnick
Madison, WI
Surgery is indicated only in patients who have clear radiographic and clinical signs of disc disease which correlate, which do not improve with an adequate trial of conservative treatment, and who do not have other contraindications to surgery. Surgery is generally considered earlier in patients who have neurological deficits such as weakness or significant numbness.
Dr. Rick Sasso
Indianapolis, IN
Surgery is done in someone who does have significant symptoms, have objective neurologic findings - usually those who have significant arm pain, weakness, numbness and tingling in the arm - that doesn't get better with non-operative treatment, including steroids and giving it some time, and have a lesion on the MRI scan that matches the symptoms, basically a disc herniation that is in the appropriate place [and] that matches the distribution of the numbness, tingling, and pain. And, in those patients, it is reasonable to consider surgery.
Dr. W. Christopher Urban
Glen Burnie, MD
Surgery is reserved for patients who have failed non-operative forms of treatment. These types of therapy are usually recommended for at least six weeks prior to considering surgical intervention. Disabling pain, weakness, or numbness that persists beyond this time frame may be evaluated for surgical treatment. It is essential to correlate each patient’s symptoms with their imaging studies (x-ray, MRI) to determine if surgery is likely to relieve their problem. There are other less common scenarios, such as severe spinal cord compression or spinal instability, where surgery should be considered earlier.
Dr. Brian Subach
Atlanta, GA
If the pain is progressive, severe, and disabling, I would strongly consider surgery. Numbness, tingling, and weakness are all possible signs of nerve compression and may indicate a need for surgery.
Dr. Douglas Slaughter
Mesa, AZ
Surgery is needed mainly in three instances: paralysis or other neurologic dysfunction; infection of the bone; or instability of the cervical spine.
Dr. Jeffrey C. Wang
Los Angeles, CA
There are certain conditions that are urgent that involve the spinal cord nerve elements becoming damaged, and in these situations, surgery is necessary. Other reasons for surgery include patients with significant pain and those who have failed conservative treatment and surgery appears to be the only option.

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.

Published: May 04, 2007
Updated: April 19, 2010