When Is It Time to See a Spinal Neurosurgeon?Symptoms not to ignore, what to expect from your consultation and Fabio Tresoldi’s upcoming consultation dates in Italy
Having back pain, neck pain, a disc herniation or spinal stenosis does not automatically mean that you need surgery. However, when pain persists, tingling, loss of sensation or reduced strength develop, or treatment is not producing the expected results, a spinal neurosurgical assessment can help determine what is happening and which course of treatment may be most appropriate.
One of the questions I am asked most frequently is:
“Doctor, do you think it is already time for me to see a neurosurgeon?”
This question often stems from an understandable misconception.
Many people associate seeing a neurosurgeon directly with having surgery.
They therefore assume that consulting a specialist means they have already reached the point where an operation is necessary.
That is not the case.
A spinal neurosurgical consultation is first and foremost about understanding the problem.
It means listening to the patient's symptoms, carrying out a neurological assessment, reviewing any diagnostic investigations already performed and establishing whether what we see on the scans actually corresponds to what the patient is experiencing.
This is also the idea behind the series “What Is Happening to Me?”: when spinal symptoms require a neurosurgical assessment, which focuses on the signs that can help patients understand when it may be appropriate to seek specialist assessment.
And very often, the conclusion may be that there is no indication for surgery at that time.
IN BRIEF: Seeing a spinal neurosurgeon does not necessarily mean that you will need surgery. The consultation is intended to establish whether your symptoms are actually related to a spinal condition, whether neurological structures are involved, and which treatment pathway may be most appropriate.
I Have Back Pain: Should I See a Neurosurgeon?
Not necessarily.
Back pain is extremely common and, in most cases, does not require an immediate neurosurgical assessment.
However, there are situations in which specialist assessment may be appropriate.
For example, when the pain:
persists despite treatment;
radiates down a leg or into an arm;
is associated with tingling or changes in sensation;
is accompanied by reduced strength;
progressively worsens;
returns after previous spine surgery.
In these cases, it becomes important to understand whether the pain is related to compression of a nerve root, the spinal cord or other structures of the spine.
The purpose of the consultation is precisely to bring all these elements together.
WHEN DOES BACK PAIN REQUIRE A NEUROSURGICAL ASSESSMENT? When pain persists, radiates into the limbs, or is associated with tingling, loss of sensation or reduced strength, it may be appropriate to assess whether neurological structures are involved.
I Have Had an MRI and It Shows a Disc Herniation: Should I See a Specialist?
This is another very common situation.
A patient has an MRI scan and finds terms such as the following in the report:
disc herniation, disc protrusion, spinal stenosis, disc degeneration, compression.
These terms can understandably cause concern.
However, an imaging finding alone does not establish either the severity of the condition or whether surgery is necessary.
Two people can have very similar MRI findings and completely different symptoms.
This is why the important question is not simply:
“What does my MRI show?”
but:
“Do the findings on my MRI explain my symptoms?”
It is precisely this relationship between symptoms, neurological examination and imaging findings that allows us to reach a more complete clinical assessment.
In the case of a disc herniation, I have explored this issue in more detail in the article “Disc Herniation: When Is Surgery Necessary? The Value of a Second Neurosurgical Opinion”, because the presence of a disc herniation on an MRI scan does not automatically mean that surgery is indicated.
MY MRI SHOWS A DISC HERNIATION: DOES THIS MEAN I NEED SURGERY? No. A disc herniation or protrusion visible on an MRI scan does not automatically mean that surgery is indicated. It is necessary to establish whether the finding is consistent with the symptoms and whether there is any significant neurological involvement.
When Tingling and Loss of Strength Deserve Closer Attention
Pain and stiffness are important symptoms, but the situation changes when neurological symptoms appear.
Persistent tingling, loss of sensation and, above all, reduced strength may indicate that a neurological structure is involved.
This is particularly important in the cervical spine.
Compression of the spinal cord can, in fact, cause symptoms that may not initially be associated with a cervical spine condition.
Difficulty buttoning a shirt.
Objects being dropped from the hands more frequently.
Handwriting becoming less precise.
Difficulty with fine finger movements.
A feeling of weakness.
I have discussed this in more detail in the article about when the hands begin to lose strength and the possible cervical cause of this symptom.
When neurological symptoms are progressively worsening, simply waiting for the pain to go away may not be the most appropriate course of action.
WHEN DO CERVICAL SPINE SYMPTOMS REQUIRE A NEUROSURGICAL ASSESSMENT? When neck pain is associated with loss of strength, changes in sensation, difficulty with hand movements or other neurological signs, it is important to assess whether the spinal cord or nerve roots are involved.What If I Have Already Been Told That I Need Surgery?
Being told that surgery is recommended inevitably raises questions.
Is surgery really necessary?
Why this particular operation?
Are there any alternatives?
Why does that specific level need to be treated?
Is spinal stabilisation necessary?
Could a minimally invasive or endoscopic technique be used?
These are all legitimate questions.
As I have explained when discussing how to choose the most appropriate procedure in spinal neurosurgery, there is no single technique that is best in every situation.
There is the technique that is most appropriate for that particular patient, that particular condition and that specific therapeutic objective.
This is why a specialist consultation should not simply be about telling the patient the name of the operation.
It should help them understand why it is being recommended.
I HAVE BEEN TOLD THAT I NEED SURGERY: WHAT QUESTIONS SHOULD I ASK? It is useful to ask what problem the operation is intended to address, why that particular technique is being recommended, which structures will be treated, what alternatives are available, and what results can reasonably be expected.
When Can a Second Opinion Be Helpful?
There are situations in which a patient has already received a diagnosis and a proposed treatment plan but still feels that some questions remain unanswered.
This is particularly common when complex surgery has been recommended, when several spinal levels are involved, when different surgical strategies are possible, or when the patient has already undergone surgery and the symptoms have persisted or returned.
In these cases, a Second Opinion in spinal neurosurgery can provide an additional assessment of the clinical records and diagnostic imaging.
Not necessarily to challenge what has already been recommended.
But to provide greater clarity in answering three important questions:
What is the problem?
Why is surgery necessary?
What is the most appropriate strategy?
DOES GETTING A SECOND OPINION MEAN STARTING ALL OVER AGAIN? No. It means having the diagnosis, imaging and proposed treatment plan reviewed by another specialist, particularly when the proposed surgery is complex or when there are questions about possible alternatives.
I Have Already Had Spine Surgery and I Am Still in Pain: Who Should I See?
Patients who have already undergone spine surgery may also need a new assessment.
The pain may never have completely resolved, or it may have returned after a period of improvement.
In these cases, we should not automatically conclude that the first operation “went wrong” or, conversely, that further surgery is necessary.
The important thing is to understand why the pain is present now.
The problem may involve the level that has already been treated, a different level, or it may have another cause.
Here too, the assessment begins… dalla storia del paziente, dall'esame neurologico e dalle nuove immagini diagnostiche.
A Consultation Is Not Only About Deciding Whether to Operate
For me, this is the most important point.
A spinal neurosurgical consultation should not necessarily end with a recommendation for surgery.
It may establish that surgery is not necessary.
It may indicate that conservative treatment should be continued.
It may suggest that further diagnostic investigations are needed.
It may identify the need to monitor the condition over time.
Or it may confirm that there is a problem for which surgery represents the most appropriate option.
Only in this last situation does the next question arise:
which operation?
This is where experience, knowledge of different surgical techniques and the ability to use traditional, minimally invasive or endoscopic approaches make it possible to develop a strategy tailored to the individual patient.
Because the aim is not to lead the patient towards surgery.
It is to understand which treatment pathway is most appropriate for them.
Bringing Specialist Consultations Closer to Patients
Not every patient who needs a neurosurgical assessment lives close to a major specialist centre.
And for those experiencing severe sciatica, disabling neck pain, difficulty walking or other neurological symptoms, travelling long distances can be even more challenging.
This is also why I hold specialist consultations in several cities across Italy.
I have discussed this in more detail in the article on the importance of access to specialist care in spinal neurosurgery.
Whenever possible, I believe that it should not always be the patient who has to travel to see the specialist.
Sometimes, the specialist can come closer to the patient.
Upcoming Spinal Neurosurgery Consultations – November and December 2026
Over the coming months, I will be available for specialist consultations for spinal conditions in the following cities:
For the consultation, it is useful to bring any available clinical documentation and diagnostic investigations already performed, including MRI scans, CT scans and previous specialist reports.
To find out about the other locations where I hold spinal neurosurgery consultations or to request information about appointments, please contact my office.
What Is Happening to Me? Patients’ Questions
When Should I See a Spinal Neurosurgeon?
A specialist assessment may be appropriate when neck or lower back pain persists, when pain radiates into the arms or legs, when tingling, changes in sensation or loss of strength develop, or when diagnostic imaging shows possible compression of neurological structures.
Does Seeing a Neurosurgeon Mean That I Will Need Surgery?
No. The consultation is first and foremost intended to establish a diagnosis and determine which treatment pathway is most appropriate. Many patients assessed by a neurosurgeon do not have an indication for surgery.
Do I Need an MRI Scan Before the Consultation?
Not necessarily. If recent investigations are already available, it is useful to bring them to the consultation, preferably the actual images as well as the report. Whether further investigations are needed will be assessed on an individual basis.
I Have a Cervical or Lumbar Disc Herniation: Do I Need Surgery?
Not necessarily. The presence of a disc herniation on imaging is not, by itself, sufficient to indicate surgery. Its relationship with the symptoms and any neurological involvement must be assessed.
I Have Already Been Advised to Have Surgery: Can I Ask for Another Assessment?
Yes. Particularly in complex cases, when surgery at several levels has been proposed or when you would like to understand the recommendation more clearly, it may be useful to request a Second Opinion in spinal neurosurgery.
Where Does Fabio Tresoldi Hold Consultations?
Specialist consultations are available in several cities across Italy. Availability changes throughout the year and is updated regularly on the website. Upcoming dates can be found in the schedule on this page and on the pages dedicated to each location.
Fabio TresoldiSenior Consultant Neurospine Surgeon
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