The Right Timing in Spine Surgery

The decision for spine surgery is not always just a question of "to have surgery or not?" The right question is "when?" It is very important to distinguish between situations requiring early intervention and those where conservative treatment is the priority.

Situations Requiring Emergency Surgery

Cauda Equina Syndrome: Loss of bowel or bladder control, numbness in the saddle area. Surgical intervention within 24-48 hours is essential; delay leads to permanent damage.^1,2

Progressive Motor Deficit: If symptoms such as foot drop or difficulty walking are worsening rapidly, urgent evaluation is required.

Spinal Cord Compression: A tumour, abscess, or fracture compressing the spinal cord — emergency decompression is of vital importance.

Indications for Elective Surgery

Ongoing pain and loss of function despite conservative treatment (physical therapy, medication, injections) lasting longer than 6-8 weeks, pathology on imaging consistent with clinical findings, and significant restriction of daily living activities.^1,3

Progressive Motor Deficit: If symptoms such as foot drop or difficulty walking are worsening rapidly, urgent evaluation is required.

Situations Where Surgery Should Be Avoided

The Golden Rule

"There is a herniated disc on the MRI" is not an indication for surgery. "The patient's complaints are consistent with the MRI findings and have not responded to conservative treatment" is an indication for surgery.

→ Next page: S38 — Pre- and Post-Surgery Guide