How do I know if I need surgery or if there's another option first?

Most spine and joint pain doesn't require surgery as a first step. Surgery moves up the list when one of a specific set of findings is present — not simply because pain is severe or has lasted a long time.

Signs that typically point toward surgery:

• Progressive neurological deficit — weakness that is measurably getting worse over days to weeks, not just pain that persists.
• Loss of bowel or bladder control, or saddle numbness — these are signs of cauda equina syndrome, a surgical emergency that needs same-day evaluation, not a trial of conservative care.
• Confirmed structural instability or a complete tear — findings like ongoing spondylolisthesis slippage or a full tendon or ligament tear that mechanically won't heal without repair.
• A reasonable trial of conservative and interventional care that hasn't worked — physical therapy, medications, and a treatment matched to the confirmed pain generator (an injection, ablation, or similar procedure) that hasn't produced meaningful, lasting improvement.

Signs that typically point toward trying another option first:

• Pain without progressive weakness or any of the red-flag neurological symptoms above.
• Imaging findings — disc bulges, arthritis, general degeneration — without confirmed instability or a structural tear requiring mechanical repair.
• A targeted interventional option matched to the specific pain generator hasn't been tried yet.

When one of the surgery markers is present, Dr. Foster refers promptly rather than working through less invasive options first — delaying wouldn't help. Otherwise, the standard path is conservative care, then a diagnosis-matched interventional option, with surgery reserved for when it's genuinely the right tool.