Spine surgery: when it helps, and how to choose the right surgeon

Spine surgery is recommended for specific, well-defined problems: a nerve compressed by a herniated disc or stenosis, spinal instability, deformity, or spinal cord compression. It follows failed non-surgical care, or comes sooner when nerve function is at risk. Most back pain never needs surgery. When surgery is indicated, randomized trials show meaningful relief for the right patient.

Who is a candidate for spine surgery?

Surgery makes sense when three things line up:

• A specific structural problem appears on imaging.
• That problem explains your symptoms and exam findings.
• The problem has not responded to an adequate course of non-surgical care, or it threatens nerve or spinal cord function.

Common indications include persistent sciatica from a herniated disc, spinal stenosis that limits walking, degenerative spondylolisthesis, cervical radiculopathy with arm pain or weakness, spinal cord compression (myelopathy), and deformity.

Back pain without nerve compression or instability is different. Long-term follow-up of three randomized trials found no difference in patient-rated outcomes between fusion and intensive rehabilitation after an average of 11 years¹. We tell patients this directly, because the best spine surgeons are defined as much by the operations they advise against as by the ones they perform.

When to get help right away Some spine problems need urgent surgical evaluation. Go to the emergency department for any of the following2,3: Numbness in the groin or saddle area, or new bladder or bowel dysfunction. Rapidly progressive arm or leg weakness. New clumsiness of the hands, trouble with balance or walking, or frequent dropping of objects (possible spinal cord compression). Spine pain with fever, or after significant trauma.

Common spine procedures and what they treat

Procedure	What it does	Typical condition
Microdiscectomy	Removes the disc fragment pressing on a nerve	Lumbar disc herniation with sciatica
Laminectomy / decompression	Enlarges the spinal canal to free compressed nerves	Lumbar spinal stenosis
Foraminotomy	Widens the opening where a nerve exits the spine	Foraminal stenosis, radiculopathy
Lumbar fusion	Joins vertebrae to stabilize a segment	Instability, spondylolisthesis, deformity
ACDF	Removes a neck disc from the front and fuses the level	Cervical radiculopathy, myelopathy
Deformity correction	Realigns the spine over multiple levels	Adult scoliosis, kyphosis

Does spine surgery work? The evidence by condition

• Herniated disc with sciatica: early surgery gives faster leg-pain relief than prolonged conservative care⁴. For sciatica lasting 4 to 12 months, microdiscectomy reduced leg pain substantially more than continued non-surgical care at six months⁵.
• Spinal stenosis: in SPORT, patients who had decompression improved significantly more in pain and function than those treated non-surgically, through two years⁶.
• Stenosis with spondylolisthesis: decompression alone is non-inferior to decompression with fusion for many patients^7,8. Fusion adds benefit in selected stable grade I slips⁹.
• Cervical myelopathy: international guidelines recommend surgery for moderate and severe degenerative cervical myelopathy. Surgery is also an option for mild disease, to prevent further neurological decline³.
• Cervical radiculopathy: most patients improve without surgery. Surgery is considered for persistent arm pain or weakness¹⁰.

Spine surgery risks: what affects them

The single biggest driver of risk is how extensive the operation is. In a national study of older adults with stenosis, life-threatening complications rose from 2.3% after decompression alone to 5.6% after complex fusion. Rehospitalization within 30 days rose from 7.8% to 13.0%¹¹.

That is why we favor the least extensive operation that will reliably solve the problem. Other risk factors you can influence before surgery include smoking, blood-sugar control, weight, bone density, and conditioning.

Recovery and enhanced-recovery care

Recovery depends on the procedure. A microdiscectomy or single-level decompression often means going home the same day or the next, and returning to desk work within weeks. A fusion requires a longer recovery while the bone heals.

The ERAS Society’s consensus for lumbar fusion lays out evidence-based perioperative care: patient education, multimodal pain control that limits opioids, early mobilization, and early return to eating and normal function¹². Our in-house physical therapy team then guides your return to activity.

How to choose a spine surgeon

Ask these questions of any surgeon you are considering:

• Fellowship training: is the surgeon fellowship-trained in spine surgery? Dr. Kanwarpaul Grewal, DO, completed the UCSF Complex Spine & Deformity Fellowship.
• The alternative: what happens if I don’t have surgery? A good surgeon can explain the natural history of your condition.
• The goal: what specifically will this operation fix, and how likely is it to help my leg pain versus my back pain?
• The scope: is fusion necessary, or would decompression alone work?
• The risks: what are the risks for someone with my health profile?

Second opinions are welcome and encouraged. Bring your imaging and prior reports.

Spine surgery consultations in Westbury and across Long Island

Our Westbury office is open Monday to Friday, 9 a.m. to 5 p.m., and Saturday, 9 a.m. to 3 p.m. It houses the practice’s fluoroscopy (C-arm) suite, where image-guided spine injections are performed. Spine evaluations are also available at our East Meadow main office, and at our Lindenhurst and Elmhurst/Queens satellite offices. When you need an MRI or CT scan, we arrange it at an outside imaging center and review the images with you in person.

The practice accepts New York workers’ compensation and no-fault (auto accident) claims. Translation in Spanish, Punjabi, Hindi, and Urdu is available at all four offices. To book, call (516) 743-9450.

Surgery is performed at accredited hospital and surgical-center partners. Your surgeon will discuss the setting that is safest for you.

Frequently asked questions

When is spine surgery necessary?

Spine surgery is necessary urgently for cauda equina syndrome, progressive neurological weakness, or spinal cord compression. It is recommended electively when a specific structural problem, such as a herniated disc, stenosis, or instability, explains disabling symptoms that have not improved with adequate non-surgical care.

What is the success rate of spine surgery?

It depends on the diagnosis. Surgery is most reliable for leg or arm pain caused by nerve compression, where randomized trials show substantial improvement. It is far less predictable for back pain without nerve compression or instability, where long-term trials show no advantage over intensive rehabilitation.

Is spine surgery safe?

Modern spine surgery is generally safe, but risk rises with the extent of surgery. In older adults with stenosis, life-threatening complications occurred in about 2.3% after decompression alone versus 5.6% after complex fusion. Choosing the least extensive effective operation lowers risk.

What is the difference between a laminectomy and a fusion?

A laminectomy removes bone and ligament to relieve pressure on nerves. A fusion permanently joins two or more vertebrae to stabilize the spine. Many patients need only decompression, and fusion is added when there is instability or deformity.

Is minimally invasive spine surgery better?

Minimally invasive techniques use smaller incisions and less muscle disruption, which can mean less pain and a faster early recovery for suitable cases. The best approach depends on your anatomy and diagnosis, and the right operation matters more than the incision size.

How long is recovery after spine surgery?

A microdiscectomy or single-level decompression often allows return to desk work within a few weeks. Fusion takes longer, often several months for full activity, while the bone heals. Your surgeon will give you a timeline specific to your procedure and job.

Should I get a second opinion before spine surgery?

Yes, especially for elective fusion or multi-level surgery. A second opinion helps confirm the diagnosis and that the proposed operation is the least extensive option likely to work.

What qualifications should a spine surgeon have?

Look for board certification and fellowship training in spine surgery. Dr. Kanwarpaul Grewal, DO, completed the UCSF Complex Spine & Deformity Fellowship and leads Grewal Orthopedic & Spine Care.

Do you accept workers’ compensation and no-fault for spine surgery?

Grewal Orthopedic & Spine Care accepts New York workers’ compensation and no-fault (auto accident) claims. Call (516) 743-9450 to review your coverage.

Where can I see a spine surgeon near Westbury, NY?

Grewal Orthopedic & Spine Care offers spine surgery consultations in Westbury and at offices in East Meadow, Lindenhurst, and Elmhurst/Queens. Call (516) 743-9450.

References

1. Mannion AF, Brox JI, Fairbank JC. Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials. Spine J. 2013;13(11):1438-1448. Link
2. Finucane LM, Downie A, Mercer C, et al. International framework for red flags for potential serious spinal pathologies. J Orthop Sports Phys Ther. 2020;50(7):350-372. Link
3. Fehlings MG, Tetreault LA, Riew KD, et al. A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression. Global Spine J. 2017;7(3 Suppl):70S-83S. Link
4. Peul WC, van Houwelingen HC, van den Hout WB, et al. Surgery versus prolonged conservative treatment for sciatica. N Engl J Med. 2007;356(22):2245-2256. Link
5. Bailey CS, Rasoulinejad P, Taylor D, et al. Surgery versus conservative care for persistent sciatica lasting 4 to 12 months. N Engl J Med. 2020;382(12):1093-1102. Link
6. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358(8):794-810. Link
7. Austevoll IM, Hermansen E, Fagerland MW, et al. Decompression with or without fusion in degenerative lumbar spondylolisthesis. N Engl J Med. 2021;385(6):526-538. Link
8. Forsth P, Olafsson G, Carlsson T, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016;374(15):1413-1423. Link
9. Ghogawala Z, Dziura J, Butler WE, et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med. 2016;374(15):1424-1434. Link
10. Bono CM, Ghiselli G, Gilbert TJ, et al. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J. 2011;11(1):64-72. Link
11. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA. 2010;303(13):1259-1265. Link
12. Debono B, Wainwright TW, Wang MY, et al. Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS) Society recommendations. Spine J. 2021;21(5):729-752. Link