There are two categories if sources of pain in the human body:

Structural (Type I):

  • An anatomic abnormality is visible on an imaging study; and
  • The symptoms (pain or neurological deficits, or both) correspond to the abnormality.

Non-structural (Type II):

  • No anatomical abnormality is identified on an imaging test; or
  • The symptoms don’t match the anatomic findings or are too vague to trace to a specific origin.

Spine surgery is an option only if your problem is structural and originates from the spine. There are treatment options for non-structural sources of pain, but they do not include spine surgery. Once you understand the principles that distinguish structural from non-structural sources of symptoms, you will be closer to making an informed decision about surgery and other treatment options.



Structural Anatomy (Type I)

Anatomical characteristics that are likely to cause symptoms include:

  • Instability: Abnormal or excessive motion (generally more than 3 or 4 millimeters in the lumbar spine and 2 to 3 mm in the neck) between vertebrae when you bend forward or backward.
  • Compression:
    • A pinched nerve, with pain and/or neurological deficit in the pattern of that nerve (radiculopathy). The pressure can be from a bone spur or soft tissue within the spinal canal.
    • A compressed spinal cord that causes symptoms within the spinal cord (myelopathy). Cord symptoms are usually diffuse and more serious than pinched nerves. The spinal cord is more subject to injury and less likely to recover.
  • A spinal deformity (curve) that is:
    • Decompensated (head not centered over the pelvis)
      • Forward (kyphosis)
      • Sideways (scoliosis)
      • Both (kyphoscoliosis)
    • Collapsing (worse while upright compared to lying flat)
    • Progressive (more than 10 degrees)
  • A spinal fracture that has not healed after four months, diagnosed by an MRI with a STIR (short inversion time recovery) sequence that reveals bleeding or hematomas. Factors that interfere with healing are:
    • Medications such as prednisone, anti-inflammatories, and others
    • Smoking
    • Obesity
    • Kidney failure
    • Severe osteoporosis

Non-structural Anatomy (Type II)

The following characteristics make an anatomic problem less likely to cause pain or neurological symptoms:

  • Stability:The segment of the spine is stable. The disc space may be completely collapsed, and the vertebrae essentially fused; but a disc that has minimal or no motion is not a source of pain, so surgery on that area would not be expected to alleviate any symptoms.
  • Narrowingaround a nerve or the spinal cord withoutpain or neurological deficit in the pattern of that nerve or that level of the spinal cord. If there is fat or cerebrospinal fluid around the area in question, it is even less likely to cause symptoms.
  • A spinal deformity that:
    • Is balanced (your head is centered over your pelvis)
    • Remains stable between the lying down and upright positions
    • Has not changed for several years
  • A spine fracture that has healed, as indicated by repeat x-rays or an MRI with STIR images that show no fluid inside the vertebrae.

Do You Really Need Spine Surgery? Take Control with a Surgeon’s Advice will provide you with enough information to have a productive conversation with your surgeon.