So, last slide. This is who needs spine surgery, finally. So cervical radiculopathy – not relieved for four weeks despite measures, epidural injections, medications.
Lumbar radiculopathy not relieved for four to six weeks. This should be debilitating. Patients should not be saying occasional pain or occasional tingling. It should be that they are disturbing their life. They are affecting their activities of daily living, work, recreation.
Worsening claudication, especially in older patients, Lumbar canal stenosis who are getting treatment conservatively, including epidurals, not getting better, having a worsening claudications, they need surgeries. Rapidly deteriorating neurological status. These are sort of emergencies. These also include cauda equina syndrome, which is a real emergency.
That’s the only emergency in spine. It’s like a compartment syndrome in which we have to do a surgery, ideally within 24 hours. Patients who get delayed surgery have suboptimal benefits out of it. We can reverse the neurological status in most cases with surgery within 24 hours. Severe worsening radiculopathy not controlled on maximum closes. Occasionally we can find one patient who has such presentation.
So in this list, there’s no back pain here. So patients with back pain, they don’t need surgeries, essentially. These are the patients – Only patients have debilitating back pain, pathological one or two discs, which have failed every rigorous conservative treatment for more than three months are a candidate, after very due diligent informed consent that this may not get better even after that.
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