Comparing Treatment Options
Treatment Selection Flowchart
Step 1: Assess the Severity of Your Symptoms
| Symptom severity | Next step |
|---|---|
| Mild (daily life is not greatly affected) | Continue conservative treatment |
| Moderate (life is affected but you can walk) | Try conservative treatment for 3-6 months; if no improvement, go to Step 2 |
| Severe / Urgent (cauda equina syndrome, progressive muscle weakness) | Consider surgery immediately |
Step 2: When Conservative Treatment Has Not Helped -- Three Directions
When conservative treatment has not provided sufficient improvement, consider these three directions. Rather than a simple choice between "can surgery fix it or not," the scale and risk of the surgery should also be part of the decision.
| Direction | When this applies | Specific situation |
|---|---|---|
| A. Surgery is the best option | The compression site is clear, and a relatively small surgery can help | Stenosis at a single level, decompression alone is sufficient, overall health is good |
| B. SCS should be considered first | Pain is difficult to fix with surgery, or the scale and risk of surgery are high | Imaging does not match symptoms, degeneration at multiple levels, neuropathic pain is the main problem, multi-level fusion is needed but surgical risk is high (age, health conditions), younger patient wishing to avoid major fusion |
| C. Consider SCS after surgery | Surgery was performed but pain remains | Chronic pain persists after surgery, reoperation carries high risk |
Key point: Consider not just "whether surgery is possible," but also "how extensive the surgery would need to be" and "whether the expected benefit justifies the risk." For example, when multi-level fusion is needed, the surgery may be technically possible, but the burden on the body is substantial, and SCS may be the safer choice.