What to Ask Your Spine Surgeon Before Agreeing to Surgery

Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University

Spine surgery is a major decision, and a good surgeon expects to be asked hard questions. If a recommendation for surgery doesn’t hold up under a few direct questions, that itself is useful information. Here are the questions worth asking at any consultation, before agreeing to a procedure.

1. What happens if I don’t have surgery?

This is the single most useful question in any surgical consultation. For some conditions — progressive cervical myelopathy, cauda equina syndrome — delaying surgery carries real risk of permanent neurological loss. For others, like most disc herniations or mild degenerative changes, the natural history is improvement over weeks to months without any intervention at all. A surgeon who can clearly explain the natural history of your specific condition, and not just the procedure they’re offering, is giving you the information you actually need to decide.

2. Have all reasonable non-surgical options been tried?

Physical therapy, activity modification, injections, and time itself resolve the large majority of spine complaints. Ask specifically what has been tried, for how long, and what response it produced. If the answer is “nothing yet,” that’s worth understanding before agreeing to an operation.

3. How many of these procedures do you perform, and how often?

This matters more for complex procedures — deformity correction, revision surgery, multilevel reconstruction — than for routine ones. Surgical volume is one of the most consistently reproduced predictors of outcome in the orthopedic and neurosurgical literature. A surgeon confident in their experience will answer this plainly.

4. What specifically will this surgery fix, and what will it not fix?

Surgery is very good at correcting structural problems — a compressed nerve, an unstable segment, a severe curve. It is much less reliable at eliminating pain that doesn’t clearly correlate with a structural finding on imaging. Ask your surgeon to connect your specific symptoms to your specific imaging findings, and to be honest about which of your symptoms surgery is and isn’t likely to address.

5. What does recovery actually look like, week by week?

Ask for specifics: hospital stay, return to driving, return to work, restrictions on lifting or bending, and when fusion (if applicable) is expected to be solid. Recovery timelines that sound too easy relative to the size of the procedure are worth questioning further.

6. What happens if the surgery doesn’t fully work?

No procedure has a 100% success rate. Ask what the plan would be if your symptoms persist or partially recur — this tells you whether your surgeon has thought past the operation itself to your longer-term care.

7. Is a second opinion reasonable here?

For elective, non-urgent procedures — especially anything involving fusion of multiple levels, deformity correction, or revision of prior surgery — a second opinion is always reasonable, and a surgeon who is confident in their recommendation should welcome it rather than discourage it.

This article is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your specific condition.

To schedule a consultation with Dr. Sardar, call 212-932-5187 or visit the contact page.