Treatment for a spinal disorder involves both rehabilitation and possibly surgery. There are three absolute indications for surgery. Progressive motor weakness is one. If compression of a nerve root causes weakness of the muscles attached to the nerve, surgery is indicated sooner than later. The compression of a nerve root normally causes pain, numbness and paresthesias (pins and needles). If the compression is great enough to involve the motor portion of the nerve, the chance of recovery of good useful motor strength is limited. Decompression of the nerve gives the greatest chance of recovery and the faster surgery can take place, the better the chance of recovery.

Surgery is indicated if spinal cord compression causes spinal cord dysfunction (myelopathy). Injury from cord compression is not generally recoverable. Surgery should be performed as soon as feasible.

Surgery is necessary if the spinal problem can be predicted to continue to cause problems and will be more difficult to treat if the problem is allowed to advance. An example is a grade 2 isthmic spondylolysthesis in an adolescent which is well know to advance without surgical stabilization.

Surgery is also necessary if the patient has undergone rehabilitation but still has symptoms that are not livable. Of course, the problem has to be surgically correctable which many times requires a thorough work-up.
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Mechanical Lower Back Disorders

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