When Should I Consider Spine Surgery for Neck or Back Pain?

You Have Exhausted Non-Surgical Treatments

If you have had ongoing, debilitating pain for months despite trying multiple non-operative treatments, you may be a candidate for spine surgery. Imaging studies like MRIs can identify pathology such as herniated discs, spinal stenosis, or degenerative disc diseases that may be the source of your pain. If your daily activities and ability to work or enjoy life are limited, spine surgery may be an option for relief.

After You Have Given Your Injury or Condition Time 

A significant portion of back and neck pain will resolve on its own over a few weeks to few months time frame with conservative treatment. Spine surgery is typically only considered if non-surgical options like lifestyle modifications, physical therapy, medications, and injections, fail to provide adequate relief. Being patient is often difficult when you are in pain, but it is often needed to fully heal from many spinal conditions and injuries. Surgery can be considered for persistent, severe pain or disability that significantly impacts your quality of life. Only you know how bad your pain is, and the decision to proceed with surgery should be yours. There are times when spine surgery is absolutely essential to prevent further injury or permanent damage, however most spine surgery is elective. 

You Have a Potential Surgical Diagnosis 

You have exhausted non-surgical treatments and given adequate time for healing. You have not achieved relief and have a diagnosis that may benefit from surgical intervention. The most common spinal pathologies that can potentially benefit from surgery include: 

• • Herniated, bulging, or ruptured discs pressing on nerves or your spinal cord
  • Spinal stenosis (narrowing of the space for nerves or spinal cord) 
  • Degenerative disc disease
  • Spondylolisthesis (vertebral slipping)
  • Spinal instability 
  • Scoliosis
  • Vertebral factures
  • Spinal tumors

The type of surgical procedure that is recommended depends on your specific condition and symptoms. Surgical spine procedures aim to decompress pinched nerves, stabilize the spine or both.

Am I a Candidate for Spine Surgery?  

Symptoms Persist Despite Conservative Treatments

Spine surgery is typically only recommended after non-surgical treatments have been exhausted without providing adequate relief. Conservative approaches like physical therapy, medications, lifestyle modifications, and epidural steroid injections, and or facet injections are usually attempted first for a minimum of six to twelve weeks. If your symptoms persist or worsen despite these efforts, then you may be a candidate for spine surgery. Common indications include chronic neck or back pain, radiating arm or leg pain, numbness, weakness, or loss of function that severely impacts your daily activities and quality of life. 

Diagnostic Imaging Confirms Need for Surgery

Imaging studies such as an MRI, or CT are essential for diagnosing the underlying spinal condition or pathology causing your symptoms. Conditions that may warrant surgery may include spinal stenosis, herniated discs, degenerative disc disease, spondylolisthesis, spinal instability, bone spurs, or spinal deformities. Dr. Kalra will review images, your symptoms and neurological examination to determine what is generating your pains. Dr. Kalra will then present his opinion and your potential treatment options. Together you will decide if and when to proceed with surgery. 

You Have Realistic Expectations and Are Motivated

Spine surgery outcomes are optimized when patients have a clear understanding of the risks, benefits, recovery process, and realistic goals. You may be a good candidate if you are motivated to improve your situation, can comply with post operative restrictions, and have the ability and support system for rehabilitation. Dr. Kalra will ensure you understand the procedure, have reasonable expectations about reducing pain and symptoms, and are mentally prepared for the road ahead. A positive mindset greatly improves outcomes. 

What Spinal Conditions May Require Surgery? 

Herniated Discs

One of the most common reasons patients consider spine surgery is a herniated disc. Your spinal discs act as cushions between the vertebrae, but injury or degeneration can cause them to bulge out and press on nerves or your spinal cord. This compression leads to pain, numbness, tingling, and weakness in the affected areas. Surgery aims to remove or repair the damaged material to relieve pressure on the nerves and spinal cord. A microdiscectomy is a minimally invasive procedure to access and remove the the portion of herniated disc.   

Spinal Stenosis

Spinal stenosis refers to the narrowing of spaces in the spine that put pressure on the spinal cord and nerve roots. It can occur in the neck (cervical stenosis) or lower back (lumbar stenosis). Causes include overgrowth of bone causing bone spurs, herniated discs, or thickened ligaments. Symptoms like numbness, weakness, and cramping pain in the legs or arms may not respond well to conservative treatments. Surgical options aim to decompress the area by removing bone, disc material, overgrowth of bone, herniated discs, or thickened ligaments. Surgical options to relieve spinal stenosis may include laminectomies, foraminoties, or facetectomies. 

Degenerative Disc Disease 

The discs between your vertebrae can degenerate and break down overtime due to injury and age related changes. As your discs lose hydration and height, it can lead to instability, compression, and irritation of the nearby nerves. Along with pain, it can cause numbness, tingling, and muscle weakness. Surgical options like spinal fusion are considered to treat degenerative disc disease when conservative treatments fail to provide relief. During the fusion the damaged discus is removed and the adjacent vertebra are fused together with bone grafts or implants. This eliminates motion and prevents nerve compression at that level. 

Spondylolisthesis 

Sondylolisthesis occurs when one vertebra slips forward over the one below it. It can be caused by a defect present at birth or degeneration and arthritis over time. The displaced bone can pinch nerves, causing lower back pain that radiates down the legs. Laminectomies and spinal fusions are common surgical treatments to stabilize the slipped vertebra and decompress the pinched nerves. More severe slips may require more complex reconstructive surgery. Determining if spine surgery is appropriate depends on various factors like symptom severity, condition progression, and failure of conservative care. Careful evaluation by an experienced spine surgeon is essential to understand all treatment options. 

What Are The Most Common Types of Spine Surgery? 

Microdiscectomy, Discectomy

One of the most commonly performed spinal procedures is a microdiscectomy or discectomy. This surgery aims to relieve pressure on the nerve roots caused by a herniated disc in your spinal column. During the minimally invasive microdiscectomy, a small portion of the damaged disc is removed through a small incision to decompress the nerves. 

Laminectomy, Laminotomy 

If you suffer from spinal stenosis, a narrowing of the spinal canal that compresses nerves, your surgeon may recommend a laminectomy or laminotomy. These procedures create more space for the spinal cord by removing portions of the lamina, the bony arch protecting the spinal canal. A laminotomy is less invasive, only removing a small part. 

Foraminotomy, Facetectomy

Procedures like foraminotomies and facetectomies enlarge the opening of the foramen where nerve roots exit the spinal column. This alleviates compression caused by bones spurs, arthritis, or herniated discs that are pinching nerves. During a foraminotomy, your surgeon will remove bone of soft tissue that is obstructing the foramen. A facetectomy involves removing part of the facet joint. 

Spinal Fusion  

For more severe spinal conditions or instability, spinal fusion surgery may be recommended to permanently connect two or more vertebrae. This immobilizes the fused section to prevent painful movement and further degeneration. Metal implants are used to hold the vertebra together as the bone grafts fuse over time. 

Disc Replacement 

An artificial disc replacement surgery removes a damaged spinal disc and replaces it with a artificial disc implant. This preserves flexibility and movement at that level compared to a fusion. Disc replacements are most commonly performed in the neck (cervical) and currently indicated for up to two levels or discs. 

How Do I Find the Right Spine Surgeon? 

When considering spine surgery it is critical to choose an experienced, reputable spine surgeon you feel comfortable with. The right surgeon will throughly answers all your questions and educates you on what to expect before, during, and after surgery. Here are a few other items to consider when selecting the right surgeon for you:

• • Experience and specialty training
  • Patient satisfaction ratings and outcomes
  • Perspective on non-surgical versus surgical treatments
  • Communication style explaining procedures and recovery

Should I See a Neurosurgeon or Orthopedic Surgeon For Spine Surgery? What is the Difference Between Each Surgeon? 

Neurosurgeons and orthopedics surgeons both perform many types of spine surgery. Spine surgery is often associated with orthopedic surgeons due to the bony spinal column. Neurosurgeons perform brain, spine, and peripheral nerve surgeries. They regularly operate on the spine and in and around the delicate structures that your spinal column protect, such as your spinal cord and nerve roots. Although both are qualified to perform spine surgery, each surgeon’s training is different:

Orthopedic surgeons are trained on the bone, muscles, and ligaments. Their medical training typically consists of all aspects of orthopedic surgery including: sports medicine, joint replacement, fractures, and spine. Their medical training consists of: 

• • Four (4) years of medical school
  • Five (5) years of residency
  • One (1) year in spine fellowship to become orthopedic spine surgeon

Neurosurgeons are trained on the brain, spinal cord, and nervous system. Their training consists of brain, spine, peripheral nerve pathology and surgical treatment. Roughly fifty (50%) of a neurosurgeon’s surgical training is spent on spine surgery, so some neurosurgeons do not pursue a fellowship. Neurosurgeons medical training consists of:

• • Four (4) years of medical school
  • Five to seven (5-7) years of residency
  • One to two (1-2) year fellowship in spine or brain surgery, typically focusing on advanced, complex, or specific surgical skill sets 

Which Type of Spine Surgeon is Right For Me? 

Surgeon training is a component of determining which spine surgeon is right for you. Some additional questions to consider when selecting your spine surgeon are: 

• • Are they board certified?
  • Did they complete a fellowship? 
  • How many spine surgeries have they done? 
  • How many spine surgeries have they done for your specific condition?
  • How much of their practice is dedicated to your specific condition? 
  • Do they educate and assist with your decision making on treatment?
  • Are they open to you seeking a second opinion?
  • Have they offered and exhausted conservative treatments? 
  • Do they put you at ease with their thoroughness and confidence? 
  • Do they have good bedside manner?
  • Has their staff been helpful and their follow up timely?

How Should I Prepare for My Upcoming Spine Surgery? 

If you have decided spine surgery is your best treatment option you most likely are experiencing mixed emotions, excited for relief but also nervous. These are completely normal emotions when preparing for spine surgery. But there are things you can do to get your body optimally ready for the surgery and set yourself up for the best recovery. The months or weeks leading up to your surgery are crucial preparation time. From specific exercises to quitting smoking, the steps you take now can make a huge difference in healing and preventing potential complications down the road. Refer to our previous blog article “Preoperative Optimization: Preparing for Spine Surgery” for detailed information to help you prepare for your upcoming spine surgery. 

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board-certified spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physician colleagues from 2017-2023. If you have unanswered questions about a recommended spine surgery, need a second opinion, or would like to obtain the neurosurgical treatment you need call Kalra Brain & Spine at (972) 905-9226 or request an appointment on our website.

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At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified, spine fellowship trained neurosurgeon who specializes in conservative treatment, minimally invasive spine surgery, and complex spinal deformity. During Dr. Kalra’s fellowship training he completed an additional six months of training in Germany to learn advanced spine procedures and new technologies coming out of Europe. Dr. Kalra also has been recognized as a D Best Neurosurgeon in Dallas by his physicians colleagues from 2017-2023. 

Does Dr. Kalra See Patients for Second Opinions?

Yes, Dr. Kalra sees patients for second opinions and also encourages his patients to seek a second opinion. Dr. Kalra wants to ensure you make an informed decision that is best for you, your health, and your recovery, regardless if it is with him or another surgeon. Remember, statistics show that roughly 80% of Americans will experience some form of spine pain in their lifetime, however only 10% of spine pain truly requires surgery. If you have been told you need spine surgery a second opinion may also help you find treatment options you were unaware of, or never considered. Two of Dr. Kalra’s patients share their experience on how a second opinion made all the difference:

“Life Changing!! I have had a great experience with Dr. Kalra! He was my second opinion and gave me options that I did not realize I had. He really cares for his patients and will spend as much time with you as you need to answer all your questions. His team worked extremely hard with my difficult insurance to get the surgery approved that was best for me. I am a young mom who could no longer spend time with or take care of my kids due to pain. Now I am pain free and can do all the fun things with my kids again! I have my quality of life back!!” Bailey W.

“With little time remaining before my scheduled cervical fusion surgery I set out to find alternatives and discovered the Mobi-C. I found that Mobi-C patients generally have better outcomes, are less likely to need follow up surgery, are sent home the same day, do not need a neck brace, and most patients report returning back to work in one week. This sounded a lot different then my conversation with my first surgeon regarding a cervical fusion. We researched for a surgeon with advanced training on the Mobi-C and are so grateful to have found Dr. Kalra! With my surgery so close my expectations were low but Dr. Kalra and his staff went out of their way to be flexible and provide a thorough second opinion on my two level ACDF that was set to take place in less than a week. After meeting Dr. Kalra I cancelled the scheduled fusion and proceeded with his recommended C6-7 Mobi-C disc replacement. This was by far the best decision and outcome I could have hoped for. If you are looking for a neck or back surgeon, consider Dr. Kalra. He is genuinely interested in providing the best outcome and his staff is very friendly and helpful!” Jocelyn H.

What Diagnosis or Procedure Does Dr. Kalra See Most Frequently for Second Opinions? 

Patients often seek out Dr. Kalra’s experience and expertise in managing a wide variety of spinal conditions. One of the most common diagnosis Dr. Kalra sees second opinions for is patients who have cervical or neck pathology and have been recommended an anterior cervical discectomy and fusion (ACDF). ACDF has been considered the gold standard for many years in treating neck pathology however cervical disc replacement may be a superior  treatment option for certain patients. Many of these patients who see Dr. Kalra were unaware they had this option to avoid a fusion.

When Should I Seek a Second Opinion? 

You should seek a second opinion for spine surgery when:

• • You want to obtain additional information and knowledge on your diagnosis. 
  • No alternatives or options to a single procedure are presented.
  • Your surgeon recommends a second or confirming opinion.
  • You had previous spine surgery and require a revision surgery.
  • You are not completely comfortable or confident with your surgeon.
  • You experience difficulty in contacting or scheduling with your surgeon’s office.
  • Your surgeon refuses to perform your surgery in a hospital.
  • Your surgeon does not fully answer or address your questions regarding a recommended surgery.
  • You want to ensure you were not misdiagnosed.
  • If you feel pushed or rushed to make a decision on surgery right away.

What Should I Do After I Seek a Second Opinion? 

If you have done your due diligence and sought out a second opinion, what happens next depends on the information and recommendations you were given. If you consulted two surgeons with both confirming your pathology and surgical procedure you should have piece of mind in the recommendations. At this point you need to make the decision to proceed with surgery or continue managing your pain through physical therapy, lifestyle modifications, pain management, or medications. If you determine surgery is your preferred choice, go with your instincts and pick the surgeon who you had the best experience with. Which surgeon answered all your questions, had the best bedside manner, had the better or more helpful staff, and really put you at ease with their thoroughness and confidence. 

If you receive a second opinion that differs from your first opinion and you are not comfortable with either, it may make sense to seek a third opinion. If you find yourself in this situation make sure you do your research and know exact details of both previous surgical recommendations. You should think through each one logically, weigh pro and cons, and address your concerns or doubts with the previous recommendations. 

If you have been told you need a neck or back surgery Dr. Kalra advises you and his patients to seek a second opinion. There are many new ideas, techniques, and technologies that may help you avoid a complex spine surgery or unnecessary pain. Remember, less than ten percent of people that experience neck or back pain need spine surgery. If you are considering spine surgery and need a second opinion, call Kalra Brain & Spine at (972) 905-9226 or schedule an appointment on our website.   

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