Most back and neck pain gets better on its own
Back pain is one of the most common reasons adults see a doctor. The good news is that most episodes settle down within a few weeks, and many people are close to normal within a month or two. Neck pain tends to follow the same pattern. Staying gently active, short courses of over-the-counter medicine, heat and a few weeks of physical therapy are usually the right first steps.
So a new backache on its own is not a reason to rush to a surgeon. What matters more is the pattern of symptoms, how long they last, and whether the nerves are involved.
Seeing a surgeon does not mean having surgery
Many people put off a spine visit because they worry the surgeon will push them toward an operation. In practice, a large share of the patients a spine surgeon sees do not need surgery at all. A good visit gives you a clear diagnosis, tells you what your MRI actually shows, and lays out every reasonable option, including the ones that do not involve an operating room.
A spine surgeon is also the doctor who can tell you when surgery is not a good idea. That answer can be just as useful as a yes, because it lets you commit to therapy or other care with confidence.
Signs it may be time to make an appointment
These symptoms are not emergencies, but they are good reasons to have a spine specialist take a look:
- Leg or arm pain that has lasted six weeks or more despite rest, medicine and therapy. Pain that travels below the knee or down into the hand often means a nerve root is pinched. Our guide to sciatica versus ordinary back pain explains the difference.
- Numbness, tingling or weakness in a leg, foot, arm or hand, especially if it is slowly getting worse.
- Legs that get heavy, tired or painful when you walk or stand and feel better when you sit or lean forward on a shopping cart. This is a classic pattern of lumbar spinal stenosis.
- Clumsy hands or trouble with balance, such as dropping things, trouble with buttons, or feeling unsteady on your feet. These can be signs of pressure on the spinal cord in the neck and should be checked promptly.
- A curve or posture change you or your family have noticed, such as leaning forward or to one side, losing height, or a rib hump. Our page on spinal deformity in adults covers this.
- An MRI report with words you do not understand, or a report that mentions severe narrowing or a compressed nerve. Our guide to common MRI terms can help you read it first.
- Injections or therapy that helped for a while and then stopped helping, and pain that still limits work, sleep or daily life.
Symptoms that need emergency care now
A small number of spine problems cannot wait for an office visit. Go to the nearest emergency room or call 911 if you have back pain along with any of the following:
- New trouble controlling your bladder or bowels, or being unable to pass urine
- Numbness in the groin, genitals, buttocks or inner thighs (the area that would touch a saddle)
- Weakness in one or both legs that is quickly getting worse
- Fever or chills with new back pain, especially after a recent infection, surgery or IV drug use
- Back or neck pain after a serious fall, car crash or other injury
- New back pain with a history of cancer, or with weight loss you cannot explain
The first two items can be signs of cauda equina syndrome, a rare condition where the nerves at the bottom of the spinal canal are squeezed. It is treated as an emergency because delays can lead to lasting problems with bladder, bowel and leg function.
Who does what in spine care
Spine care is a team effort, and it helps to know the roles:
- Your primary care doctor is usually the first stop. They check for warning signs, start basic treatment and order imaging when it is needed.
- A physical therapist works on strength, flexibility and how you move. For many people this is the treatment that makes the biggest difference.
- A pain management or physical medicine doctor may offer medicines and spinal injections, such as epidural steroid injections.
- A spine surgeon, either an orthopedic spine surgeon or a neurosurgeon, diagnoses structural problems and decides whether surgery could help. Many spine surgeons also guide nonsurgical care.
You do not have to go through every step in order. If you have weakness, a worsening nerve problem or a clear structural issue, it is reasonable to see a surgeon early. More on the first-line options is in our guide to nonsurgical care for back pain.
Do you need a referral?
It depends on your health plan. Many PPO plans let you book with a specialist directly. HMO plans and some Medi-Cal plans usually need a referral from your primary care doctor first. When you call, have your insurance card handy and our staff can talk through what your plan may require.
What to bring to your first visit
- A list of your symptoms: where the pain is, where it travels, what makes it better or worse, and when it started
- Any MRI, CT or X-ray images on a disc or through an online link, plus the written reports
- Notes from physical therapy, injections or other doctors you have seen for this problem
- Your medicine list, including blood thinners and supplements
- A family member or friend, if you would like a second set of ears
What happens at the visit
At Central Valley Advanced Spine, Dr. Devan Higginbotham starts with your story. He will ask how the pain began, how it has changed and what you have tried. A hands-on exam checks strength, reflexes, sensation and how you walk. Then he reviews your images with you on the screen, so you can see what he sees.
You should leave with a plain explanation of the likely cause, what the options are, and what the next step looks like. For some people that is therapy or an injection. For others it may be a conversation about a procedure such as endoscopic spine surgery for a pinched nerve in the low back.
When to call us
Call the office if leg or arm pain has lasted more than six weeks, if you notice new numbness or weakness, or if walking has become harder because of your legs. We can help you figure out whether a visit makes sense now. For bladder or bowel changes, saddle numbness or fast-worsening weakness, skip the phone call and go to the emergency room.
Common questions
How long should I wait before seeing a spine surgeon?
For plain back or neck pain without nerve symptoms, many doctors suggest four to six weeks of basic care first. If you have weakness, numbness that is spreading, or trouble walking, it is reasonable to be seen sooner.
Should I get an MRI before my appointment?
Not always. An MRI is most useful when symptoms have lasted several weeks, when there are nerve findings on exam, or when surgery is being considered. If you already have one, bring it. If not, the surgeon can decide whether you need one.
Is an orthopedic spine surgeon different from a neurosurgeon?
Both can be fully trained to operate on the spine. Orthopedic spine surgeons come from orthopedic surgery training and neurosurgeons from neurosurgery training, and many of each complete a spine fellowship. Dr. Higginbotham is fellowship-trained in orthopedic spine surgery.
What if I am told I am not a surgical candidate?
That usually means the surgeon does not expect an operation to help more than other care would. Ask what is causing your pain and what the most sensible next treatment is. It can also be fine to get a second opinion.
Sources
- Low Back Pain, American Academy of Orthopaedic Surgeons, OrthoInfo
- Cauda Equina Syndrome, AAOS OrthoInfo
- Back Pain, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH)
- Qaseem A, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017.