Patients often ask whether avoiding surgery would be safer. I understand the concern. The spine supports the body, and the thought of surgery can be frightening. Treatment decisions require us to weigh risk alongside quality of life.

Much of my work as a spine surgeon involves deciding when surgery is not needed. If medication, rehabilitation, or changes in daily habits can keep symptoms stable, surgery is not my first choice. I do not recommend an operation simply because an image looks abnormal. What matters is how well a person can function and how much the condition disrupts daily life. After an evaluation, I often recommend monitoring symptoms rather than rushing into an invasive procedure.

Not having surgery can carry risks too. Prolonged nerve compression can cause lasting weakness, difficulty walking, and an increased risk of falls. Some of these changes may be irreversible. When nonsurgical treatment is no longer effective, surgery may be needed to prevent further loss of function and keep pain and disability from limiting daily life even more. Only after assessing the other options and finding them ineffective do I explain that, for that patient's situation, surgery is the remaining effective option for improving quality of life.

No choice is perfect. I cannot remove every uncertainty, but I can help patients understand the benefits and risks of each option. My aim is to find an approach with an acceptable level of risk and the least disruption to their lives, now and in the future. We make that decision together.