Treatment Options: The Big Picture

How Treatment Typically Progresses

The Typical Path

For most patients, treatment follows this general sequence:

1. Diagnosis — MRI, X-rays, and other imaging to identify the cause
2. Start conservative treatment (3-6 months) — Medications, physical therapy, injections, and other non-surgical approaches
3. Evaluate the results
   • If symptoms improve — Continue treatment and monitor
   • If symptoms don't improve — Move to the next step
4. Answer three key questions to guide the decision
   • 1. Can the source of pain be addressed surgically?
   • 2. How extensive would the surgery need to be?
   • 3. Can the patient safely tolerate that surgery?
5. Choose the right treatment
   • No clear surgical target — Consider SCS
   • Surgery possible but extensive fusion needed — Consider trying SCS first
   • Clear surgical target with manageable risk — Proceed with surgery
6. If pain persists after surgery — Consider SCS

When Urgent Action Is Needed

The following symptoms may require earlier surgical intervention:

• Loss of bladder or bowel control
• Sudden weakness in the legs
• Rapidly worsening symptoms

These are signs of serious nerve damage. Delaying treatment in these cases may make recovery more difficult.