When Spine Surgery Is the Right Answer, and When It Isn’t

I refer patients to surgeons.

There are situations where spine surgery is not only reasonable, but necessary.

That needs to be said clearly because conversations about “avoiding back surgery” can become just as misleading as conversations that make surgery sound inevitable.

The goal should never be:

Avoid surgery at all costs.

The better question is:

What problem is the surgery being asked to solve?

An Abnormal MRI Is Not the Same as a Surgical Indication

Spines change with age.

Discs degenerate. Facet joints develop arthritis. Stenosis can appear. Disc herniations can show up on imaging.

The important question is whether those findings explain your symptoms, neurologic examination, loss of function, and mechanical problem.

Sometimes they do.

Sometimes they do not.

Current spine recommendations emphasize that diagnosis and treatment decisions should integrate the history, neurologic examination, and imaging rather than relying on an imaging finding alone.

That distinction becomes particularly important before a permanent procedure such as fusion.

🎥 Continue Learning

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In this video, I discuss when surgery deserves serious consideration and when a more complete nonoperative evaluation may still be appropriate.

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Why Treating the Spine One Structure at a Time Is Not a Treatment Plan

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The spine does not function as a collection of unrelated parts. The disc, facet joints, ligaments, stabilizing muscles, neurologic structures, and adjacent mechanics continuously influence one another.

That is why a procedure history and a treatment plan are not the same thing.

Three Things I Want You to Remember

1. Do not be afraid of surgery simply because it is surgery.

If a structural or neurologic problem requires surgical correction, delaying the right treatment is not a victory.

2. Do not let the MRI make the decision by itself.

Imaging is part of the diagnosis.
It is not the entire diagnosis.

3. Before an irreversible procedure, understand the indication.

Ask what structure is being corrected.
Ask why the proposed operation addresses it.
Ask whether your examination and symptoms support the imaging.
And ask what realistic alternatives still exist, if any.

Recovery Still Matters, Whatever Path You Choose

This is why I often discuss high-quality supplements with patients who are working to improve their overall health and create a more favorable environment for healing.

If you’re not already using a structured approach, I’ve created a Fullscript dispensary with formulations I trust and use in practice.

Featured This Issue: Magnesium Glycinate

Whether the eventual treatment is rehabilitation, regenerative care, or surgery, there is one variable I do not ignore:

Recovery.

Sleep is part of that.

Magnesium participates in normal muscle and nerve function and in hundreds of enzymatic reactions throughout the body.

Magnesium glycinate is one form I may consider when supplementation is appropriate, particularly when sleep and recovery are part of the larger conversation.

A 2025 randomized, double-blind, placebo-controlled trial studied adults reporting poor sleep who received magnesium bisglycinate or placebo for four weeks. The magnesium group had a statistically greater improvement in insomnia severity, but the effect was small.

That is exactly the kind of finding I think should be communicated accurately rather than turned into a miracle-supplement claim.

Magnesium is not a treatment for spinal stenosis, disc disease, nerve compression, back pain, or a substitute for surgery.

It is one possible tool for supporting a recovery environment when it fits the individual.

And if you have a medical procedure planned, always follow your physician’s specific instructions regarding supplements rather than assuming that something labeled “natural” should automatically be continued.

This is not a treatment for back pain, nerve compression, or a substitute for surgery.
It is part of supporting the recovery environment around whatever treatment path is appropriate.

📘 Before You Make an Irreversible Decision

If you are trying to decide between regenerative care, continued conservative treatment, and surgery, you need more than a list of procedures.

You need a framework for asking better questions.

That is why I created The Patient’s Guide to Ethical Regenerative Medicine.

It explains where regenerative care may fit, where its limitations are, what responsible care should look like, and how to recognize when a different category of treatment may be more appropriate.

The Bottom Line

Do not choose surgery simply because an MRI looks bad.
Do not reject surgery simply because you want to avoid it.

Ask what problem the surgery is being asked to solve.
Ask whether your symptoms, examination, imaging, and neurologic findings support that diagnosis.
Ask whether fusion is actually necessary to correct it.

And then choose the treatment that fits the problem.
Sometimes that answer will be rehabilitation.
In selected patients, regenerative care may have a role.
And sometimes the correct answer will be surgery.

Precision means knowing the difference.

To better movement,

Tammy J. Penhollow, DO
Architect of Spine and Joint Health
Precision Regenerative Medicine
Structure First. Precision Always.

If this helped you think about your symptoms more clearly, feel free to pass it along to someone dealing with something similar.