When Do You Need Spine Surgery? 

If you're experiencing back or neck pain, you're likely wondering: Do I need surgery?

“Almost everyone will have back or neck pain at some point in their life, really,” said Bryan Schatmeyer, MD, a neurosurgeon at Franciscan Health Indianapolis. “But the most important thing to know is that most of these cases do not require surgery themselves.”

Understanding when spine surgery is truly necessary—and when it's not—can help you make informed decisions about your health and avoid unnecessary procedures.

Key Takeaways: Spine Surgery

• Most back and neck pain does not require surgery—surgery is only considered when there's a clear structural problem matching your symptoms that hasn't improved with conservative care.
• Surgery becomes urgent when you experience progressive weakness in your arms or legs, or sudden loss of bowel or bladder control—these neurological symptoms should be evaluated immediately.
• The decision to have elective spine surgery is a shared process between you and your surgeon, weighing risks, benefits and whether surgery aligns with your goals and quality of life.
• Abnormal MRI findings don't automatically mean you need surgery. Surgeons evaluate your symptoms, physical exam findings and imaging results together to determine the best treatment.

The Most Common Spinal Conditions

"The most common problems in the spine we actually see are degenerative conditions," said Dr. Schatmeyer. These include disc herniations, spinal stenosis, and general wear and tear from aging.

While these conditions can cause real discomfort, they don't automatically mean you need an operation.

Daniel Spomar, MD, an independent neurosurgeon specializing in spine surgery who practices at Franciscan Health Indianapolis, said, "Most people with back pain don't need surgery."

Many spine conditions respond well to non-surgical treatments. For more information on conservative treatment options, see our article on back pain relief without surgery.

Structural Problems That May Require Spine Surgery

Surgeons evaluate your symptoms, physical exam findings and imaging results to determine treatment. They consider spine surgery only if it’s the best way to treat your condition, such as if you have nerve compression or spinal instability.

Spine problems that may require surgery include:

Herniated Discs

The cartilaginous discs in your spine are closely associated with nerves.

“Any time there is a herniation of that disc, it could either push on a nerve or it could narrow the spinal canal," Dr. Schatmeyer said. “That could cause the patient to have symptoms, that may or may not need surgery.”

If other treatments do not help herniated disc pain, surgical treatment like a microdiscectomy may be needed.

Spinal Stenosis

Spinal stenosis involves narrowing of the spinal canal or nerve roots, which can lead to radiating pain, numbness, or weakness. Surgery may stop this progression.

Spinal Fractures

Fractures can cause spinal instability and may require surgical stabilization.

Other Spinal Concerns

Other problems leading to spine surgery include:

• Spine joint abnormalities, such as sacroiliac or facet joint problems
• Scoliosis (irregular spine curvature)
• Spondylolisthesis (slipped vertebrae)
• Damage to nerve or spinal cord
• Spinal infections
• Tumors

“We always look for the least invasive surgery to correct the problem,” Dr. Spomar said.

These structural problems can contribute to more than just pain. They may cause numbness, tingling, weakness, or even difficulties walking.

Back Problems That May Not Need Surgery

"In contrast to structural problems in the spine, many people have pain that comes from other things such as the muscles, ligaments, your joints, or even general deconditioning, that can cause very real pain and be very limiting, but it doesn't have always a clear surgical solution," Dr. Schatmeyer said. “These kind of cases are usually better treated with certain things such as physical therapy, activity modification, and overall, just having time allow the body to heal itself rather than undergo any kind of specific operation on your spine.”

When Does a Spine Problem Require Surgery?

The key question isn't just "what's wrong with my spine?" but rather "does this problem require surgical intervention?"

Most people experience back or neck pain at some point, whether it’s a strained muscle or it develops over time. But if you have severe back pain; pain, numbness or weakness that extends into your arms or legs; or back pain along with bladder or bowel problems, these can signal a neurological problem that needs attention.

“A spine surgeon should evaluate these symptoms,” said Daniel Spomar, MD, an independent neurosurgeon specializing in spine surgery who chooses to practice at Franciscan Health Indianapolis. “For most people, over-the-counter pain medicines like ibuprofen or Tylenol, rest, and ice or heat packs relieve pain. But neurological symptoms like these should be evaluated.”

Dr. Schatmeyer notes that "as surgeons, we don't really make decisions based on imaging alone. A lot of people have abnormal MRIs, but they feel perfectly fine."

"Surgery's really only considered when there's actually a clear structural problem, and it's matching the patient's symptoms and that haven't already improved with appropriate conservative or non-surgical care," Dr. Schatmeyer said. “Outside of emergencies, I'd say surgery is most commonly considered when someone has persistent nerve-related problems. Like that radiating arm or leg pain that hasn't improved after a reasonable trial of conservative treatment, and it really still affects their activity or their quality of life, as well as their ability to perform their activities of daily living.”

Dr. Spomar adds that surgeons evaluate three key factors together: "your symptoms, physical exam findings and imaging results to determine treatment."

Emergency Warning Signs: When Spine Surgery Can't Wait

There are certain symptoms that require immediate medical attention and potentially urgent spinal surgery.

"Progressive weakness in any extremity such as your arm or leg is definitely one urgent indication for surgery," said Dr. Schatmeyer.

Dr. Spomar echoes this concern: "Neurological symptoms like these should be evaluated. For most people, over-the-counter pain medicines like ibuprofen or Tylenol, rest, and ice or heat packs relieve pain. But neurological symptoms like these should be evaluated."

Perhaps most concerning is a rare but serious condition affecting bowel and bladder function. Dr. Schatmeyer said: "The nerves, you know, they not only innervate our arms and our legs, but they innervate our bladder as well as our bowels. And so, certain times there can be a medical condition that's an emergency where we have incontinence."

If you experience sudden lower back pain combined with leg pain and any of the following symptoms, seek immediate medical attention:

• Progressive weakness in arms or legs
• Loss of bowel or bladder control
• Numbness in the groin or inner thigh area

Other urgent situations include severe spinal instability from fractures, spinal infections, and in rare cases, tumors affecting the spine.

Dr. Spomar notes that "if someone has weakness or significant nerve damage, nonsurgical treatments may not help or may even worsen the pain," making surgical evaluation more urgent.

The Elective Surgery Decision: A Shared Process

For most people considering spine surgery, the decision isn't urgent.

"Surgery is usually more of an elective process, which means that there's time to think through the decision very carefully and think about the risks versus the benefits of the procedure," Dr. Schatmeyer notes.

What Goes Into the Decision?

When evaluating whether surgery is appropriate, Dr. Schatmeyer considers several factors:

• How long have symptoms been present?
• Are they improving or worsening over time?
• How significantly do they affect your quality of life and ability to perform daily activities?
• Have conservative treatments been tried appropriately?
• Is there a clear structural problem that matches your symptoms?

"It's very much a shared decision-making process," said Dr. Schatmeyer. "My role is to make sure that I explain the risks, benefits, and alternatives very clearly to the patient so they can make that informed decision whether surgery aligns with their goals and their expectations."

Dr. Spomar said the patient's role in this decision: "Ultimately, you have to decide if surgery is right for you. I tell my patients if they can live with their symptoms and they're tolerable, surgery might not be right. You should only have surgery if your symptoms significantly affect your quality of life."

Outside of emergencies, Dr. Schatmeyer notes that "surgery is most commonly considered when someone has persistent nerve related problems. Like I said, that radiating arm or leg pain that hasn't improved after a reasonable trial of conservative treatment and it really still affects their activity or their quality of life, as well as their ability to perform their activities of daily living."

The Conservative Treatment Trial

Dr. Spomar said that most people with back pain don’t need surgery. Often, physical therapy, spinal injections, exercise and other nonsurgical back pain treatments offer relief.

“We always consider nonsurgical treatments first,” Dr. Spomar said. “But if someone has weakness or significant nerve damage, nonsurgical treatments may not help or may even worsen the pain.”

For most non-emergent spinal conditions, Dr. Schatmeyer typically recommends "about six to 12 weeks of that very structured conservative treatment." Many conditions, including disc herniations causing severe pain, can resolve on their own during this timeframe as "the body very well can take care of itself."

However, this timeline isn't rigid. "If someone's getting worse, they develop any kind of weakness, they're unable to function despite these conservative treatments; that's when I would consider surgery sooner than later,” Dr. Schatmeyer said. “On the other hand, if their symptoms start to gradually improve, even if it's slow, slow improvement, then I would still consider non-surgical care the right choice for the patient."

Understanding Your Imaging: When "Abnormal" Doesn't Mean "Surgery"

One of the most important concepts to understand is that abnormal imaging doesn't automatically indicate a need for surgery.

Dr. Schatmeyer said that "pain doesn't always mean damage. Many spine changes seen on imaging are a normal part of your just aging process."

This is why evaluation from a qualified provider who examines the complete clinical picture—not just MRI findings—is so important. The imaging must correlate with your symptoms and your response to conservative treatment.

Choosing Your Surgeon And Hospital

Choose a surgeon trained through an accredited medical program who has plenty of experience with the procedure you’re having.

“Neurosurgeons do hundreds if not thousands of procedures during residency,” Dr. Spomar said. “Ask your surgeon about their experience with the surgery you need. Choose someone with a good reputation, significant experience and high-quality outcomes.”

• Learn as much as you can by asking:
• What is your expected success rate with this particular surgery?
• What are the possible complications and how likely are they?
• Are there other alternatives to consider, such as nonsurgical or minimally invasive approaches?

“Ultimately, you have to decide if surgery is right for you,” Dr. Spomar said. “I tell my patients if they can live with their symptoms and they’re tolerable, surgery might not be right. You should only have surgery if your symptoms significantly affect your quality of life.”

You should also consider the facility’s or health system’s reputation. Choose a surgeon with experience caring for spine surgery patients.

“At Franciscan Health, our nurses and surgical technologists are trained to assist and care for spine patients before, during and after surgery,” Dr. Spomar said. “Our experienced anesthesia providers ensure patients are safe and comfortable during surgery and their pain is well-managed after surgery. It takes a team – not just the surgeon.”

If you have questions or concerns about your care, get a second opinion from another spine surgeon and make sure they agree the treatment plan is the best one for you, he added.

Surgical Advancements

Spine surgery has evolved significantly with new technologies that improve safety and outcomes.

"During spine surgery, surgeons use equipment that offers real-time pictures of your spine," said Dr. Spomar. "Imaging guidance allows us to place devices – such as screws, rods or cages – in the spine with greater accuracy and consistency. This is one of the best surgical advancements."

Modern techniques also include expandable interbody cages. "The cage is compressed when we place it in the spine, and then it expands once it's in position," Dr. Spomar said. "This reduces the risk of damaging the spinal cord or nerves."

"These advancements allow surgeons to treat spine conditions in the safest manner possible," he adds.

Benefits and Risks of Spine Surgery

The Benefits

When spine surgery is the appropriate treatment—and performed by an experienced surgeon—most patients do very well.

The benefit of spine surgery is relieving symptoms – either they go away or they're significantly reduced, said Dr. Spomar.

When surgery is the well-accepted approach for a particular spine condition – and the surgery is done by an experienced surgeon – most patients do very well, he said.

"People return to an improved quality of life compared with how they felt before surgery,” Dr. Spomar said. “They can do things they couldn't do before."

Understanding Spine Surgery Risks

No surgery is without risks. With spine surgery, you may not feel better, or your symptoms could get worse. You may need another spine surgery to address a problem with the first surgery. Although rare, other potential complications can include:

• Bleeding
• Blood clots in the legs
• Infection, including pneumonia
• Spinal fluid leaks

"We take every precaution to ensure surgery is safe and effective," Dr. Spomar said. "If surgery is the best option, we want you as healthy as possible before surgery. For example, we have you lose weight if you’re overweight or quit smoking if you smoke. If you have diabetes, high blood pressure or another condition, we make sure it’s well-controlled beforehand to ensure the best possible outcome."

What If You're Uncertain?

If you're struggling with back pain and aren't sure whether you need surgical evaluation, Dr. Schatmeyer offers this advice: "First I would just recommend them to not panic overall. Most back pain improves with time and the appropriate care."

He recommends seeking evaluation from a qualified provider if:

• Pain persists despite conservative measures
• Symptoms are worsening
• You develop concerning symptoms like numbness or weakness
• Pain significantly impacts your quality of life and daily function

The key is finding a provider "who looks at the picture as a whole, not just the MRI findings or the imaging findings that you may be worked up for."

The Bottom Line

"The goal is not to rush into surgery, but it's to find the right treatment for the right problem," Dr. Schatmeyer said.

Surgery has an important place in treating spine conditions, but it's reserved for specific situations where there's a clear structural problem causing significant symptoms that haven't responded to appropriate conservative care.

As Dr. Schatmeyer said, "Surgery itself can be life-changing, but it's only when truly needed. The best outcomes happen when it's used thoughtfully at the right time and for the right reasons."

If you're experiencing back or neck pain, start with conservative treatments and give your body time to heal. But if you're experiencing red flag symptoms, or if your pain persists and significantly impacts your life despite appropriate non-surgical care, a surgical evaluation may help determine if surgery is the right next step for you.