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Originally published August 4, 2026
Last updated August 4, 2026
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If you’ve been diagnosed with a spinal condition, the prospect of surgery can feel frightening. You may want to know whether you can wait, or even avoid, an operation. However, delaying spine surgery carries its own set of risks.
To help understand the stakes, we spoke with Michael Safaee, MD, a neurosurgeon specializing in spine surgery at the USC Spine Center, part of Keck Medicine of USC.
The answer depends on what kind of problem you have. Dr. Safaee explains that the spine has two distinct parts: the structural system (bones, discs and ligaments) and the neurologic system (the spinal cord and nerve roots).
“If there is a true neurologic problem — for example, weakness in a particular muscle group, difficulty using your arms and legs, being clumsy or having any difficulty controlling your ability to urinate or have bowel movements — those can sometimes be surgical emergencies,” Dr. Safaee says.
For common degenerative conditions like spinal stenosis or a herniated disc, surgery can often be delayed safely if there are no neurologic symptoms. “For most common degenerative spinal conditions, I encourage all of my patients to make a very earnest effort at nonoperative care,” Dr. Safaee says.
The most critical factor in timing spine surgery is preventing permanent nerve damage. “We can’t undo damage that’s been done to the spinal cord or the nerve roots, but we can prevent it from getting worse,” Dr. Safaee explains.
That’s why the type and duration of symptoms matter so much.
“If someone has had symptoms for a long period of time, we would still discuss surgery, but we’re not going to rush into it,” Dr. Safaee says. “Whereas if someone has a sudden onset of weakness in the foot or hand, that’s someone who I typically would recommend consider surgery much quicker — sometimes even emergently, depending on the severity.”
Symptoms that should be considered “red flags” include arm or leg weakness, unsteadiness when walking, clumsiness with the hands, or inability to control your bowel or bladder. “Those are concerning and warrant evaluation by a spine specialist, sometimes even an emergency room visit,” Dr. Safaee emphasizes, noting that such symptoms are sometimes misunderstood by primary care physicians.
One reason decisions about delaying surgery can be so complicated is that imaging doesn’t always match how a patient feels. “It is not always easy to correlate the severity of the symptoms with the severity of the X-rays, MRI or CT scan,” Dr. Safaee says. “Someone can have a horrible-looking X-ray or MRI but feel totally fine. The way the body perceives pain is different from person to person.”
Dr. Safaee cites the example of a patient with a severe scoliosis curve who experienced no discomfort, while another with a minor slippage of the vertebrae was in “horrific pain.”
Dr. Safaee takes a symptoms-based approach. If a patient has no symptoms, “My philosophy is to typically leave them alone,” he says. “If you’re managing and doing well, I’m not going to try to make you any better than you already are.”
Scoliosis, when stable, is one condition where delaying surgery is often appropriate. “A young adult with scoliosis that has been stable for many years certainly needs to be followed, but that’s very different than a young person who has scoliosis that is rapidly progressing,” Dr. Safaee says. Similarly, lumbar spinal stenosis without neurologic symptoms can often be managed conservatively.
The key is a proportionate approach to treatment. Dr. Safaee uses a ladder analogy: start with lifestyle modifications, then medications and physical therapy, then interventional procedures like injections, and finally surgery, if needed.
“You think of the interventions in terms of their risk and how that is proportionate to your symptoms,” he says. “The lowest-risk, safest interventions are often very simple, like lifestyle modification or rest.”
Certain conditions demand urgent attention. Spinal infections, rapidly growing tumors, fractures and anything causing rapid neurologic decline fall into this category.
“If someone says, ‘I can’t move my legs for the past 12 hours,’ that’s an emergency,” Dr. Safaee says. “That’s where we’ve got to do something very quickly.”
If you’re considering delaying spine surgery, the most important step is understanding whether your spine is being compressed for any reason. When in doubt, seeking evaluation from a spine specialist is critical. As Dr. Safaee advises, “It’s never wrong to get a second opinion.”
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