How to Choose a Spine Surgeon: 10 Questions to Ask Before Surgery

Choosing a spine surgeon is less about finding one “best” name and more about testing whether a recommendation makes sense for you. A useful consultation should connect your symptoms, examination, and actual imaging; explain whether an operation is needed; and define what the proposed treatment is—and is not—expected to improve.

Bring this page to a Fort Wayne spine surgery consultation and use the ten questions below as a conversation guide. The goal is not to force every surgeon toward the same answer. It is to make the reasoning, alternatives, tradeoffs, and next step understandable before you decide.

Red flags that need urgent evaluation

New loss of bladder or bowel control or saddle numbness requires emergency assessment: go to the nearest emergency department or call emergency services now. Rapidly progressive weakness or a severe new gait or balance decline also requires prompt assessment and should not wait for a routine spine surgery consultation. These symptoms can have causes other than cauda equina or spinal-cord compression, but they require timely evaluation; the World Federation of Neurosurgical Societies consensus recommendations address the urgency of suspected cauda equina syndrome.

Watch: 10 principles behind a careful spine surgery decision

Clinical context for the short video

The video uses memorable shorthand, not universal medical rules. A systematic review and meta-analysis of symptomatic lumbar disc herniation found that regression can occur with nonsurgical treatment, but the course and relevance to an individual patient vary. A discectomy is generally intended to relieve symptoms from a compressed nerve and often targets concordant radiating leg pain more directly than nonspecific low back pain; long-term SPORT follow-up compared surgical and nonoperative outcomes in carefully selected patients rather than establishing a universal treatment rule. New or progressive weakness may make evaluation more time-sensitive, while severe pain alone can still require prompt care when it cannot be managed safely. Open, minimally invasive, and endoscopic techniques can each be appropriate; the anatomy and the operation’s goal should determine the approach.

Exact on-screen transcript

10 SPINE SURGERY HILLS I’LL DIE ON

from an endoscopic spine surgeon

1. Try a real nonsurgical plan first.

2. A surgeon visit isn’t a surgery.

3. A herniated disc can shrink on its own.

4. I don’t treat MRIs. I treat people.

5. Start with the function you want back.

6. Discectomy is for leg pain, not back pain.

7. Pain gets time. Weakness doesn’t.

8. Pick the right operation, then go small.

9. Endoscopic and open can both work.

10. If you don’t need surgery, I’ll tell you first.

Educational content, not medical advice.

10 questions to ask before spine surgery

1. What is my diagnosis, and which symptoms does it explain?

Ask the surgeon to name the condition in plain language and show you the relevant finding on the actual MRI, CT, or X-ray. Then ask how that finding connects to your pain pattern, numbness, weakness, balance, or walking limitation. Degenerative changes are common, so an abnormal scan alone does not prove that a particular level is causing your symptoms; a systematic review of asymptomatic populations found that several degenerative imaging findings become more prevalent with age even in people without pain.

2. Do I need surgery now, later, or possibly not at all?

A consultation with a surgeon is not a commitment to surgery. Ask whether a real nonsurgical plan is medically reasonable and how improvement will be measured. Depending on the diagnosis, that plan may include time, activity changes, medication, physical therapy, or a targeted injection. Progressive neurologic loss, spinal-cord dysfunction, instability, infection, fracture, or cauda equina symptoms can change the timing and may not fit a routine treatment sequence. The WFNS cauda equina recommendations are one example of diagnosis-specific guidance; they do not determine the urgency of every back or leg symptom.

3. What function are we trying to restore?

Start with the activity that matters to you: walking through a grocery store, sleeping, working, using your hands, exercising, or caring for family. A specific functional goal makes it easier to judge whether the likely benefit of treatment is meaningful. It also helps separate what an operation may improve from symptoms that may persist for another reason.

4. What happens if I wait?

Ask about the expected natural history and the risk of delay. Some disc herniations shrink over time, as summarized in a systematic review and meta-analysis of nonsurgically treated symptomatic lumbar disc herniation, and symptoms can improve before—or without—the scan returning to normal. Other problems can threaten strength, coordination, stability, or spinal-cord function. The important question is not simply whether waiting hurts; it is whether waiting changes the chance of recovery or creates a safety risk in your specific case.

5. Which symptom is the operation most likely to improve?

Ask for a symptom-by-symptom forecast. For example, a lumbar discectomy is designed to remove pressure from a nerve and commonly aims to improve concordant radiating leg pain. It is not a general cure for every source of low back pain. A Canadian Spine Outcomes and Research Network registry analysis specifically examined low-back pain after lumbar discectomy and found that improvement varied, reinforcing the need for an individualized forecast. Long-term SPORT results describe outcomes in patients who met specific eligibility criteria, so they should inform—not replace—an individual prognosis. A responsible discussion should identify the primary target, what may improve less reliably, and what the operation is not designed to treat.

6. Why this operation—and why not a smaller or motion-preserving option?

The operation should be selected before the incision size. Ask whether decompression alone could address the problem, whether a fusion is necessary for stability or alignment, and whether motion preservation is reasonable. For lumbar stenosis, published WFNS fusion recommendations and a randomized decompression-versus-fusion trial with two-year MRI follow-up illustrate why fusion is not a one-size-fits-all addition; neither source determines the correct operation for an individual patient. A smaller approach is valuable only when it can accomplish the complete surgical goal safely.

7. Would an open, minimally invasive, or endoscopic approach fit my anatomy?

Each approach can work well in the right setting. Ask what exposure is needed, what the surgeon must see or remove, and how the approach affects muscle disruption, blood loss, recovery, and the ability to complete the operation. The answer should be tied to your anatomy and diagnosis rather than to a technique used for every patient.

8. If fusion is recommended, why is stability or alignment part of the problem?

Fusion may be used when a segment is unstable, deformed, or likely to become unstable after the required decompression. It is not automatically required for every case of stenosis or every degenerative MRI finding. The WFNS consensus recommendations summarize scenarios considered in lumbar stenosis, while a randomized trial compared decompression alone with decompression plus fusion in a defined study population. Ask what evidence of instability or alignment problem is present, what a decompression-only option would leave unresolved, and which tradeoffs fusion adds.

9. What are the risks, recovery limits, and chance of another procedure?

Ask about risks that apply to the proposed operation and to your health, not just a generic list. Clarify expected time in the hospital, restrictions, therapy, return to driving or work, and the milestones that would trigger a call. Also ask what could cause symptoms to persist or recur and whether another operation might be needed later.

10. Would you tell me if surgery is not the right next step?

A surgeon’s role includes recommending against an operation when the diagnosis is unclear, the likely benefit is too small, or nonsurgical care remains more appropriate. Ask what evidence would change the recommendation in either direction. If the explanation remains unclear—or if a major fusion, multilevel operation, or revision is proposed—a second opinion can help you compare the reasoning without committing you to either plan.

A surgeon does not need to agree with your assumptions to be a good fit. The useful signal is whether the surgeon welcomes specific questions, explains uncertainty, and helps you understand the decision without pressure.

Training and focus matter

Evaluating a surgeon’s training background is one part of finding the right fit — not because more training automatically equals better outcomes, but because specialized training in spine surgery provides focused experience with the specific procedures and decision-making patterns relevant to your condition.

Training, fellowship, and credential verification

Review the surgeon’s residency and dedicated spine-fellowship training, then independently verify any certification the surgeon states. The American Board of Orthopaedic Surgery certification portal is one official verification source for orthopaedic surgeons. A credential confirms a defined training and examination pathway; it does not replace the need to understand the recommendation for your condition.

Dr. Greenberg earned his medical degree at Mayo Clinic, completed orthopedic surgery residency at Johns Hopkins, and completed spine surgery fellowship at Brown University.

Experience with the specific procedure you need

A spine surgeon’s practice focus matters. Some surgeons primarily perform fusions while others have deeper experience with decompression-only procedures, endoscopic techniques, or motion-preserving options like cervical disc replacement. Ask how the surgeon decides among the procedures relevant to your condition, what alternative they considered, and what would make them change the plan.

Signs you should get a second opinion

A second opinion is a standard part of medical decision-making for any significant surgery — it is not a sign of mistrust. Certain situations make a second opinion especially worthwhile:

• You have been told you need a fusion but want to understand whether a decompression-only or motion-preserving option might also be appropriate.
• The proposed surgery was explained quickly or felt rushed, and you left with unanswered questions.
• You were told surgery is the only option without a clear discussion of non-surgical alternatives or what happens without surgery.
• Your symptoms do not clearly match the imaging findings as they were explained to you.
• You want confirmation that the proposed surgical plan is appropriate for your specific anatomy and goals.

What to bring to a consultation

Bring the actual MRI or CT images when possible—not only the written report—plus related X-rays, radiology reports, prior operative reports, a medication list, and a short timeline of physical therapy, injections, medication, or other care already tried. Write down the function you most want back and your ten questions. A family member or friend can help listen and take notes.

Fort Wayne spine surgery resources

These pages provide deeper information to support your evaluation process — from understanding specific procedures to learning when surgery may not be the right path:

Spine surgery options in Fort Wayne

Comprehensive guide to procedures, conditions, and what to expect

Fort Wayne spine surgeon

Dr. Greenberg’s training, philosophy, and practice approach

When spine surgery may not be right

Understanding when conservative care is the better path forward

Decision-Making Hub

Framework for shared decision-making — when surgery is appropriate and when it is not

Choosing a Spine Surgeon in Indiana

State-wide guide to evaluating spine surgeons — training, experience, and approach across Indiana

Patient education library

In-depth condition guides covering herniated disc, stenosis, sciatica, and more

Question and verification frameworks

• MedlinePlus: Questions to ask your surgeon about spinal surgery
• American College of Surgeons: 10 Questions to Ask Before Having an Operation
• Agency for Healthcare Research and Quality: shared decision-making handout (PDF)
• American Board of Orthopaedic Surgery: Verify Certification

These resources provide general question and verification frameworks.

Clinical evidence cited

• Brinjikji et al.: Systematic review of spine imaging findings in asymptomatic populations
• Zhong et al.: Systematic review and meta-analysis of lumbar disc herniation regression
• Lurie et al.: Eight-year SPORT results for lumbar disc herniation
• Iorio-Morin et al.: Low-back pain after lumbar discectomy in the CSORN registry
• WFNS Spine Committee: Cauda equina and conus medullaris recommendations
• WFNS Spine Committee: Fusion recommendations for lumbar spinal stenosis
• Karlsson et al.: Randomized decompression-alone versus decompression-plus-fusion trial

Their inclusion does not imply that any organization endorses Dr. Greenberg or this practice.

Considering a spine surgery consultation?

To apply these questions to your own history and imaging, request an appointment or arrange a spine surgery second opinion in Fort Wayne. A consultation can clarify both surgical and non-surgical options without committing you to an operation.

Call Monday-Friday during office hours to discuss current availability.

Key points when evaluating a surgeon

• Fellowship training in spine surgery beyond residency
• Independent verification of any stated certification
• Personal review of your imaging, not just the report
• Discusses non-surgical and less invasive alternatives
• Clear, unhurried communication — answers all questions
• Welcomes second opinions — not threatened by them

Choosing from outside the Fort Wayne area? See spine surgeon in Indiana.