Who should have invasive therapy or surgery for neck and back pain?

In severe cases, where at least four weeks of conservative, noninvasive treatments have failed to relieve constant referred or radiating patterns of neck and back pain, more aggressive treatments may be necessary. These procedures carry the higher risks that are associated with anesthesia and infections. Generally speaking, you should not consider invasive therapies unless you have significant pain or weakness in one or both arms or legs.

Additional symptoms that warrant the investigation of aggressive therapies include stabbing or shooting pain, tingling, a sensation that the extremity is falling asleep, loss of function, or an inability to easily move your limbs. Progressive weakness, numbness, decreased reflexes, or increased pain with movement are all signs of direct nerve involvement that is not being relieved by the conservative therapies. Conversely, if you don't have these signs and symptoms, it usually indicates that aggressive or invasive treatments are not warranted.

Because severe neck or back pain can have multiple causes, you want to make sure you have explored every possible conservative approach before starting aggressive treatments. If the cause of pain in an arm or leg is severe regional or referred neck or back pain, then treating the source of the pain conservatively should relieve the extremity pain as well. However, when you have arm or leg pain that continues even though your neck or back is no longer painful, then in all likelihood the pain is caused by direct spinal cord or nerve root compression that will have to be treated invasively.

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