This is the question that patients routinely ask me during the initial consultation at my office. The answer to this question is multifactorial and will be different for each patient. A comprehensive history and thorough exam usually gives clues as to if surgery is needed or not.
I learned early on in Chiropractic school, and this has been the case after practicing for over 25 years, in general you know after taking the history if care will help an individual. I do not start care with a patient unless I am fairly certain that I can help them via conservative care, and I tell them this upfront to avoid wasting time and money.
The list below is not an exhaustive list, but a good starting point in ascertaining if someone needs surgery for a spinal or extremity complaint:
1. The pain has been there for more than 6-12 months and is steadily worsening.
2. Upper or lower extremity weakness
3. Difficulty walking, poor balance, or instability while standing or moving.
4. Urgency with going to the bathroom along with back or neck pain.
5. Condition has been treated by multiple providers and continues to not respond or worsen.
6. Progressive loss of ability to perform daily tasks with pain or weakness.
7. History of Cancer
8. Signs of instability in a knee, shoulder, or hip i.e., clicking, popping, or sharp pain upon movement
9. Pain worsens with in clinic treatment or home care given to the patient.
10. Documented spinal or extremity fracture.
A caveat to the above list is that patients sometimes present to my office with imaging that shows severe degenerative changes to their joints and discs and have chronic pain. More times than not Chiropractic, Physical therapy, or massage therapy can help patients get out of pain and start functioning better in a non-operative way. Just because the images look horrible, doesn’t mean a person’s body isn’t compensating in some way to allow them to be pain free and function just fine.
Most adults over the age of 40 already have arthritis and discal narrowing of some kind, but degenerative changes and arthritis don’t automatically mean surgery, and any good surgeon will tell you that. Surgery is the last thing most quality surgeons want to do.