How to Choose a Spine Surgeon (Without Regret)

Start with the "fit" problem

A common scenario I see is this: a patient comes in for a second opinion after being told they need a two-level fusion. The MRI shows some disc degeneration, sure. But their main symptom is leg pain from a herniated disc—not mechanical instability. The first surgeon wasn't wrong about the MRI findings. They were wrong about the operation.

This is where people get stuck. They assume all spine surgeons think the same way, use the same techniques, and recommend the same operations. They don't.

Some surgeons are trained primarily in fusion and approach most problems that way. Others focus on motion-preserving techniques (disc replacement, endoscopic decompression). Some use robotic navigation for precision. Some don't.

The goal isn't "more surgery"—it's the right decision. And that starts with finding a surgeon whose training, judgment, and communication style match what you need.

Training that actually matters (and why)

Here's what I'm listening for when patients ask about credentials:

Board certification

Your surgeon should be board-certified in orthopedic surgery or neurosurgery. This is baseline—it means they completed residency and passed rigorous exams. But it doesn't tell you if they specialize in spine.

Fellowship training in spine surgery

This is where it gets specific. After residency, many surgeons complete an additional year (or more) focused only on spine. Fellowship training is where you learn complex decision-making, not just technique.

It's where you see hundreds of cases, learn to handle complications, and—critically—learn when not to operate.

I completed my spine fellowship at Mayo Clinic after training at Johns Hopkins and Brown University. That's not to brag—it's to say that high-volume, complex training environments teach you pattern recognition. You see what works, what doesn't, and what happens when the wrong operation is chosen.

Case volume and focus

A surgeon who does 200 spine cases a year will have different pattern recognition than someone who does 20. Ask: "What percentage of your practice is spine?" and "How often do you perform this specific procedure?"

For newer or more complex techniques—endoscopic surgery, robotic navigation, cervical disc replacement—ask about their training and experience with that specific approach.

The most common mistake: treating the MRI, not the patient

Here's the honest part: your MRI is not your diagnosis.

Studies show that up to 40% of people with no back pain have disc bulges or herniations on MRI. The imaging finding doesn't automatically mean it's causing your symptoms.

What I'm listening for in clinic:

• Your symptom pattern: Is it leg-dominant nerve pain (sciatica) or mechanical back pain? Does it radiate in a nerve distribution or stay vague and achy?
• Your exam findings: Weakness? Reflex changes? Positive straight-leg raise? Sensory loss in a specific dermatome?
• Correlation: Does the MRI finding match your symptoms and exam? If you have right leg pain but the MRI shows a left-sided herniation, that's a mismatch.

A good surgeon will spend time on this. If they're recommending surgery based purely on imaging without a thorough exam and symptom discussion, that's a red flag.

What a good consultation feels like

You should leave the consultation with clarity, not more confusion.

Here's what I aim for in every first visit:

• Time for your story: I need to hear your symptom pattern, what makes it better or worse, what you've tried, and what your goals are.
• A thorough exam: Strength testing, reflexes, sensation, range of motion, provocative tests. This takes 10–15 minutes, not 2.
• Imaging review together: I'll show you your MRI or X-rays and explain what I see in plain language. You should understand what's causing your symptoms.
• Options, not just one path: Conservative care, injections, surgery—and the pros/cons of each. If surgery is recommended, why this operation and not another?
• Realistic expectations: What will surgery fix? What won't it fix? What's recovery like? What are the risks?
• Time for questions: You should never feel rushed. If you leave with unanswered questions, that's a problem.

Choosing the RIGHT surgery (or no surgery)

This is where training and judgment matter most.

Different problems need different solutions:

Leg-dominant nerve pain (sciatica, radiculopathy)

If your main symptom is nerve pain down the leg from a herniated disc or stenosis, you likely need decompression—removing pressure from the nerve. This can be done with microdiscectomy, endoscopic discectomy, or laminectomy, depending on the anatomy.

You probably don't need fusion unless there's instability or deformity.

Mechanical back pain without instability

If your pain is centered in the back, worse with certain movements, and there's no nerve involvement or instability, surgery often doesn't help much. Conservative care (PT, activity modification, sometimes injections) is usually the better path.

Fusion for pure mechanical back pain has mixed outcomes. A good surgeon will be honest about this.

Instability or deformity (spondylolisthesis, scoliosis)

If there's true instability (vertebra slipping forward) or progressive deformity, fusion may be necessary. But even here, the goal is to fuse only what needs to be fused—not more.

Cervical disc herniation or stenosis

In the neck, you have options: ACDF (fusion) or cervical disc replacement (motion-preserving). The right choice depends on your age, activity level, and anatomy. A surgeon who only offers one approach may not give you the full picture.

Conservative-first, but not "endless PT"

I'm a strong believer in trying conservative care first—when it's appropriate.

For most nerve pain (sciatica, radiculopathy), 6–12 weeks of structured conservative care is reasonable if you're not developing weakness or red flags. That includes:

• Activity modification (not bed rest, but avoiding aggravating movements)
• Physical therapy focused on nerve mobility and core stability
• Anti-inflammatory medications or nerve pain meds if appropriate
• Sometimes an epidural steroid injection to calm inflammation

But here's the key: reassess regularly. If you're improving, keep going. If you plateau or worsen, it's time to reconsider surgery.

I don't believe in "endless PT" when it's clearly not working. That's not conservative care—it's delaying a decision.

When a second opinion is smart

It's always reasonable to get a second opinion before major surgery, especially fusion or multi-level procedures.

Also smart if:

• The diagnosis feels unclear or doesn't match your symptoms
• You're being told "surgery is your only option" without trying conservative care first
• The surgeon seems rushed, dismissive, or doesn't answer your questions
• You're being offered a very aggressive operation (multi-level fusion, for example) and you want to know if there's a less invasive option
• You just don't feel confident in the plan

A good second opinion should clarify the diagnosis, confirm (or question) the surgical plan, and give you confidence in the path forward. If you're in the Fort Wayne or Northeast Indiana area and want a second opinion, I'm happy to help.

Red flags—seek urgent care

Most spine problems are not emergencies. But some are.

Seek urgent evaluation (same day or ER) if you develop:

• New weakness: foot drop, leg giving out, trouble walking
• Loss of bowel or bladder control
• Numbness in the saddle area (groin, buttocks, inner thighs)
• Severe pain after trauma (fall, car accident)
• Fever with back pain (possible infection)
• Cancer history and new severe back pain (possible metastasis)

These can signal cauda equina syndrome, spinal cord compression, infection, or fracture—all need immediate attention.

Simple decision pathway

Frequently Asked Questions