Do I Need Back Surgery? Questions to Ask

Decision Guide · Salisbury, MA

Told You Might Need Back Surgery? The Questions to Ask Before You Decide

By Dr. Jeff Newman, Newman Chiropractic, Salisbury, MA

What this is and is not. This is general information about how a spine surgery decision gets made and what to ask the people advising you. It is not medical advice, it is not a diagnosis, and it cannot tell you whether you need surgery. Only a clinician who has examined you and reviewed your imaging can answer that. If any of the urgent symptoms below apply to you, seek emergency care rather than reading on.

Somebody has used the word surgery, and now you are sitting with an imaging report full of terms you did not know last week. This will not tell you what to do. What it will do is give you the questions that make the decision a real one, for whichever direction you end up going.

We are a non-surgical clinic, so you should know our bias going in. That is part of why this is written as questions rather than answers. The same questions work on us.

What this covers

• The symptoms that mean stop reading and get emergency care
• Why nobody can answer this from a search result
• What to ask a surgeon
• What to ask a non-surgical provider, including us
• What to ask yourself
• What a second opinion is actually for

First: which symptoms need emergency care?

These are the symptoms every provider is trained to treat as urgent, whatever their profession. They are standard emergency guidance, not our opinion, and they come first because nothing else on this page matters if one of them applies to you.

Go to an emergency room if you have any of these:

• Loss of bladder or bowel control, or sudden difficulty starting or stopping urination
• Numbness through the groin, buttocks or inner thighs, the area that would touch a saddle
• Weakness in both legs at once, or legs that are giving way
• Weakness in a leg or foot that is getting worse quickly, such as a foot that has started catching or dragging
• Back pain with a fever, or after a significant fall or crash

Do not wait for an appointment with anybody, and that includes us. Back pain with a history of cancer or unexplained weight loss also needs prompt medical evaluation rather than a conservative-care appointment.

Do I need back surgery?

Nobody can tell you from the internet, and anyone who does is guessing.

The reason is that the answer depends on findings, and findings come from an examination plus imaging read together. Two people can have nearly identical reports and belong in completely different places, because a report describes anatomy and it does not describe what you feel or what you can no longer do.

So the useful move is not to search for the answer. It is to make sure whoever is advising you can show their work. That is what the rest of this is for.

A report describes anatomy. It does not by itself describe your pain.

What should you ask a surgeon?

Bring these to the consultation and write the answers down. A good surgeon will answer all of them directly.

1. Which specific finding on my imaging do you believe is causing my symptoms, and how do you know? This is the most important question on the page. Ask them to connect the finding to the symptom, including which side and how far down the limb it travels.
2. Is this operation aimed at my leg pain or my back pain, and what are your expectations for each? Ask them to answer the two separately.
3. What happens if I do nothing for three months? Does waiting change my outcome? The answer tells you whether this is a now decision or a when decision.
4. What are the odds I need another spine operation in the next ten years?
5. What does recovery look like week by week, and what will I not be able to do? Ask for specifics about work, driving and lifting.
6. Have I had a real course of conservative care, and would you want me to try one first? Ask what "real" means to them, and for how long.
7. What would make you tell me I am not a good candidate for this?

What should you ask a non-surgical provider, including us?

Apply the same scrutiny in this direction. The questions are deliberately the same shape.

1. What did you find on examination, and does it match my imaging?
2. What specifically are you expecting to change, and what will not change? Ask for the second half explicitly. Any provider should be able to name the limits of what they do.
3. How will we know whether it worked, and what are you measuring? If the only measure is how you feel on the day, that is a soft measure and worth saying so.
4. How long before we should see something measurable?
5. At what point would you tell me this is not working and send me somewhere else? This is the one that separates a clinical opinion from a sales pitch. Anyone who cannot describe the conditions under which they would stop is not making a prediction.
6. Have you worked with cases like mine, including ones that ended in surgery?
7. Are there findings in my history or imaging that would make your approach a bad idea for me? Prior surgery, hardware in the spine, bone density results and a cancer history all belong in this conversation.

Ask both sides the same questions. If one provider answers them specifically and the other answers them with reassurance, that difference is information. It does not tell you which direction to go, but it tells you whose reasoning you can actually inspect.

What should you ask yourself?

These are the ones people skip, and they usually turn out to matter most a year later. Write the answers down before either appointment so you are not composing them under pressure.

• What have I stopped doing because of this? Be specific. Not "exercise," but which thing, and when you last did it.
• What would better actually look like? A number on a pain scale is a weak goal. Getting through a workday, sleeping through the night, picking up a grandchild, those are goals you can tell whether you hit.
• How long has this really been going on? Including the earlier episodes you did not think counted.
• What have I genuinely tried, and for how long? Two weeks of something is not a trial of it. Neither is doing the exercises when it hurts and stopping when it does not.
• What am I most afraid of here? For some people it is the operation. For others it is being told nothing can be done, or being sold something that goes on forever. Naming it changes which questions you push on.
• Who is going to help me for the six weeks after an operation? Worth answering before you need the answer.

The questions you ask on both sides of the decision should be the same shape.

What is a second opinion actually for?

Not to find someone who tells you what you want to hear. It is to find out whether two people looking at the same information reach the same conclusion, and if they do not, where exactly they diverge.

Getting both a surgical and a non-surgical opinion is reasonable for most people facing this. They are looking at your case through different training, and the place where their reasoning splits is usually the thing you actually need to understand.

Bring your imaging to both. Bring your written answers to both. And bring the question about what would make each of them refer you elsewhere, because the honest ones have an answer ready.

What happens if you come to us

The first visit is a consultation and assessment with the doctor. You talk through your story and what the pain has taken away from you. Then there is an examination covering posture, range of motion, and orthopedic and neurological testing, with motion X-rays when they are indicated. If you have prior imaging, we go through it with you rather than glancing at the report.

Then you get told what we found and whether we think we can help. Sometimes that answer is that you need a surgical opinion, and we say so. Progress gets tracked with a Spinal Health Score covering posture, range of motion and nerve function, so there is something measurable to look at rather than a judgement call about how a given week felt.

Where non-surgical care fits, it usually draws on some combination of non-surgical spinal decompression, chiropractic care, Class IV laser therapy and focused shockwave therapy, along with specific work to do at home. What that mix looks like comes from your findings. More on the conditions this applies to on our herniated disc care and sciatica treatment pages.

The short version

A handful of symptoms mean emergency care rather than an appointment, and they override everything else here. Beyond those, no article can tell you whether you need surgery, because the answer comes from findings that have to be produced by examining you. What you can do is arrive with questions that make both sides show their reasoning: which finding explains my symptoms and how do you know, what are you expecting to change and what will not, how will we measure it, and what would make you send me somewhere else. Ask yourself what you have stopped doing and what better would look like, because that is the goal both conversations should be aimed at.

Get a clear read on your case

The New Patient Special is a consultation and assessment with the doctor, including a review of any imaging you already have. You leave knowing what we found and whether we can help, including if that means a surgical opinion. We see patients from Salisbury, Newburyport, Amesbury, Seabrook and across the North Shore.

Book New Patient Special

Or call or text the clinic at (978) 961-9099. Insurance questions? Every plan is different, so we do a free benefit check at your first visit. Financing available.

This article is general information, not medical advice, and it is not a substitute for evaluation by a qualified clinician who has examined you. It does not recommend or discourage any particular treatment. If any of the urgent symptoms listed above apply to you, seek emergency care. Learn more about non-surgical spinal decompression or browse the full list of conditions we treat. Patients travelling from across the river can find details on our chiropractor in Newburyport page.