SPINE
Spine Surgery
Herniated disc, stenosis, low back and neck pain: when to treat without operating, and when surgery comes in.
Book an evaluationX-ray-style illustration of the spine seen from behind
Dr. Victor BatistelaNeurosurgeonCRM-PR 35044 · RQE 30580 (Brazilian medical registration)
What happens in the spine
Vertebrae, discs, canal and roots
The spine is made up of stacked vertebrae, separated by discs that work as shock absorbers. The spinal cord runs inside it, and from each level nerve roots exit, carrying movement and sensation to the arms and legs.
When a disc shifts (herniated disc), a canal narrows (stenosis) or a vertebra slips or moves too much (spondylolisthesis, instability), these structures can become compressed — and that is when pain, tingling or weakness appear.
"Spine surgery" is not a single procedure. It is a set of techniques for different problems, and none of them leads automatically to surgery.
Anatomy
Where each structure is
Hover over or tap the markers. The legend beside them explains each structure in one line.
- 1
Vertebra
The bone. Stacked, the vertebrae form the spine and protect the spinal cord.
- 2
Intervertebral disc
The cushion between two vertebrae. It is the part that can herniate.
- 3
Spinal canal
The tunnel the spinal cord passes through. When it narrows, it is called stenosis.
- 4
Nerve root
The nerve that exits the spine at each level, to the arms or legs.
- 5
Spinal cord
The main cable connecting the brain to the rest of the body.
Symptoms
Symptoms that lead to an evaluation
The most typical sign of nerve compression is radiating pain: it runs down the leg (so-called sciatica) or the arm, following a path. It often comes together with tingling or numbness in a specific region.
Weakness when lifting the foot, climbing stairs or holding objects, pain that worsens when sitting or coughing, and difficulty walking longer distances, with relief when sitting, also deserve evaluation — especially when they do not improve over time.
- Pain radiating to the leg or arm
- Tingling, numbness or weakness along a defined path
- Pain that does not improve after a few weeks
When not to wait
Signs that should not wait for an appointment
These signs call for the emergency room, not an elective appointment.
- progressive loss of strength in a leg or arm
- difficulty controlling urine or bowel
- numbness in the area between the legs
- very severe pain after a fall or trauma
How the evaluation is done
Four steps, in this order
The appointment begins with the conversation and the physical examination. Imaging comes afterwards — and is interpreted together with the symptoms, not on its own.
Step 01
Appointment and physical examination
When the pain started, where it goes, what makes it worse. Tests of strength, sensation and reflexes locate the affected nerve.
Step 02
Imaging tests
MRI for discs and nerves; CT scan for bone; dynamic X-ray for instability.
Step 03
Discussion of the plan
Conservative treatment, injection or surgery — and why. The decision is explained and made together with the patient.
Step 04
Follow-up
Reassessing after a few weeks shows whether the condition is evolving as expected or whether it is time to reconsider.
When surgery may be considered
Failure of conservative treatment, neurological deficit or instability
In general terms, spine surgery may be considered when pain or limitation does not improve with well-conducted conservative treatment over an adequate period; when there is progressive loss of strength; when there is instability or deformity that explains the symptoms and tends to progress; or in urgent situations, such as acute compression of the spinal cord or the roots.
Techniques vary according to the problem: microdiscectomy removes the part of the disc that compresses the nerve; decompression widens the space it passes through; spinal fusion (fixation with screws) stabilizes an unstable segment. In selected cases, minimally invasive, endoscopic or robot-assisted techniques may be considered.
Two paths
Conservative or surgery: the criterion is the condition, not preference
Conservative treatment
- Medication to control pain and inflammation in the acute phase
- Physical therapy focused on mobility and strengthening
- Adjustments to activity and posture at work
- Image-guided nerve blocks or injections, in selected cases, to allow rehabilitation
When surgery comes in
- Pain or limitation that does not improve with well-conducted conservative treatment
- Progressive loss of strength or neurological deficit that tends to worsen
- Instability or deformity that explains the symptoms and tends to progress
- Acute compression of the spinal cord or the roots (urgency)
For most people with spinal pain, the path is conservative. Those who undergo surgery also continue in follow-up: rehabilitation is what consolidates the outcome.
Frequently asked questions
- No. Most herniated discs improve with conservative treatment — medication, physical therapy and activity adjustments — over a period of weeks. Surgery may be considered when the pain does not subside, when there is progressive loss of strength or in specific situations evaluated at the appointment.
- It depends on the technique and the problem treated. In less invasive procedures, discharge is usually quick and the return to light activities happens within a few weeks; in larger surgeries, such as those using screws, the time is longer. The recovery plan is individual and defined before surgery.
- If you already have imaging tests (MRI, CT scan or X-ray) and reports, bring them. They help in understanding the condition, but the appointment begins with the conversation and the physical examination, not with the imaging.
- Most of the time, yes. Some less invasive techniques may use other types of anesthesia, depending on the case and the assessment of the anesthesia team.
- No. Low back pain is very common and, most of the time, has a muscular or postural cause and goes away on its own. What changes the evaluation is the presence of pain radiating to the leg, numbness, weakness or pain that does not improve over time.
Read also
Book an evaluation
The appointment serves to understand the condition and define the next step. Not every condition requires surgery.
This channel is not a substitute for emergency care. In an emergency, go to the nearest emergency room.
