Signs You May Need Back Surgery

Many patients wonder how to know when it’s time for back surgery. Below, one of Hoag Orthopedic Institute’s expert spine surgeons answers some of the most common questions we hear about signs you may need back surgery and what to expect next.

Q&A: Expert Advice on When Back Surgery Is Needed

How do I know if my back pain needs surgery?

If your back pain is intense enough to interfere with daily activities like standing, walking, dressing, or working — or if it’s linked to leg weakness, numbness, or changes in bladder or bowel control — these are signs you may need back surgery. Many conditions that cause these symptoms can be treated without surgery, but if imaging shows nerve compression or progressive damage, surgery may be required.

“Back surgery is never recommended unless more conservative treatments fail to relieve severe pain and dysfunction, or clear clinical results indicate progressive damage,” says Jeremy Smith, MD, Hoag Orthopedic Institute’s Division Chief of Spine Surgery and fellowship-trained spine surgeon.

What are the red flags for serious spine issues?

As our spine specialists evaluate when back surgery is necessary, they look for specific red flags that may indicate a serious spine condition. These include:

• Severe back pain that doesn’t improve with conservative care
• Numbness or weakness in the arms or legs
• Loss of coordination or balance
• Trouble walking or standing upright
• Changes in bladder or bowel control
• Unexplained weight loss
• History of cancer or recent infection

Symptoms like these may indicate nerve compression, spinal instability, infection, or other serious conditions — all potential signs you need back surgery.

When is minimally invasive surgery an option?

When back surgery is necessary, a minimally invasive approach is an option when your condition can be successfully treated without a large incision or extensive disruption of muscle and bone. It’s often used for herniated discs, spinal stenosis, some types of fractures, and certain degenerative spine conditions — especially when imaging shows clear, localized damage.

Not everyone is a candidate. The decision depends on your anatomy, the nature of the problem, and whether the surgical goal can be achieved safely with a less invasive approach. It’s important you select a spine surgeon who is highly experienced in evaluating whether a minimally invasive procedure is right for you, like the experts at Hoag Orthopedic Institute.

Can back pain get better without surgery?

Certainly — many causes of back pain can improve with nonsurgical spine treatments. Physical therapy, anti-inflammatory medications, activity modification, steroid injections, and other conservative options often relieve symptoms without the need for surgery.

The key is getting an accurate diagnosis. A spine specialist can review your imaging and symptoms for signs you need back surgery or a more conservative approach, and recommend the best course of treatment.

Dr. Smith adds, “Our job is to help you understand your diagnosis and what your options are for getting you back to you. We’ll make the decision together, based on what gives you the best chance to move freely and enjoy your life again.”

How long is recovery after back surgery?

Recovery after back surgery depends on the spine condition being treated, the type of procedure, and your overall health. Most patients return to light activity within weeks and gradually resume full function over several months. Physical therapy can play a key role in rebuilding your strength and mobility.

Procedures like spinal fusion may involve longer healing times. Others, like motion preservation and minimally invasive back surgery can shorten recovery time, with less pain, a lower risk of complications, and a quicker return to daily life. Your surgeon will advise you on which option is best for your specific condition.

Does back surgery help back pain?

In many cases, yes — back surgery can relieve pain by addressing the specific structural issue, like a compressed nerve, a herniated disc, or unstable vertebrae. When the source of the pain is clearly identifiable on imaging, and conservative treatments haven’t worked, surgery may offer meaningful, lasting relief.

Sometimes, back surgery is recommended not to alleviate pain but to stop progressive degeneration. Your surgeon will review your imaging and any signs you need back surgery to determine your best course of action and what you can expect.

“I know surgery sounds like the last thing you’d want when you’re already in pain — but in some cases, it’s the most effective way to stop what’s causing that pain in the first place,” shared Dr. Smith.

What happens if I delay spine surgery?

When back surgery is necessary but gets delayed, your symptoms may continue to worsen. With nerve compression or structural instability, waiting too long can increase your risk of permanent nerve damage, reduced mobility, or loss of function in your arms or legs. In some cases, delaying surgery can make the procedure more complex or reduce its chances of success.

If you’re anxious about the surgery you have scheduled or are considering delaying it, consult with your surgeon to monitor your symptoms and imaging results — so you can act before the damage becomes harder to reverse.

How do I choose the right spine surgeon?

When back surgery is needed, look for a board-certified, fellowship-trained surgeon who specializes specifically in spinal conditions, not just general orthopedics or general neurosurgery. Experience matters, so ask how often they treat your condition and perform the type of procedure you’re considering.

Hoag Orthopedic Institute’s Find a Doctor tool makes it easy to get started. Just click on the condition you’re dealing with or the procedure you need to see qualified surgeons in your area. You can learn more about their training, specialties, and patient approach — and find their contact information to schedule a consultation.

At Hoag Orthopedic Institute, our spine specialists work as part of a multidisciplinary team, offering both surgical and nonsurgical expertise. They’ll walk you through every step, help you recognize and manage the signs you need back surgery, and determine what approach offers the best chance of long-term relief.

Take the Next Step Toward Relief for Your Back

Don't let back pain continue to compromise your daily life. The board-certified, fellowship trained spine specialists at Hoag Orthopedic Institute are nationally recognized experts in diagnosing, treating, and relieving a full range of spine conditions. Our dedicated spine doctors will help you understand the signs you may need back surgery, when conservative care may be the wiser choice and work with you to create a personalized treatment plan focused on relief, recovery, and quality of life.

Schedule an appointment today and take the first step toward feeling like yourself again.