Vice Chairman & Head - Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi
Part 18 of 18 in Spinal Surgery: Advances in Techniques & Technology for Excellent Patient Outcomes
When to See a Spine Specialist: Warning Signs You Shouldn't Ignore
August 5, 2026
Patients with back or leg pain should see a spine specialist if four to six weeks of medical treatment brings no improvement, or sooner if numbness, weakness, gait problems or worsening pain develop before six weeks are up. Recognising these warning signs early, rather than waiting, leads to better surgical outcomes.
The four to six week rule
Patients who have completed four to six weeks of medical management, such as painkillers and physiotherapy, without any improvement should be referred to a spine specialist. Patients should be referred even earlier than six weeks if they develop advancing symptoms such as numbness, weakness, gait disturbance or pain they cannot tolerate.
A case that shows why timing matters
A 60-year-old man with radiating leg pain, an inability to walk more than a few metres, and numbness in the foot took six months of treatment, including physiotherapy and pain injections, before being referred, and kept worsening throughout that time. Many patients go on to develop foot drop if intervention is delayed too long, though the goal is always to intervene before foot drop occurs.
When imaging is needed to check spinal stability
If back pain is severe, rated more than six or seven out of ten, and the MRI shows changes, lateral X-rays taken bending forward and bending backward can reveal whether the spine is unstable. Backache is one of the most common symptoms across every area of medicine, and patients not responding to conservative treatment for spinal instability or stenosis should be referred for spine surgery rather than continuing indefinitely with medication alone.
← Biportal Endoscopic Spine Surgery: What It Is and How It Works | Series index | Minimally Invasive Spinal Fusion: Treating Spinal Instability Without Open Surgery →
This article is based on a Jivo Masterclass session conducted by Dr. Puneet Girdhar, Chairman, Max Institute of Robotics and Minimal Invasive Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass — Dr. Puneet Girdhar taught doctors across Africa on August 10, 2025.
FROM THE LIVE Q&A
Dr. Frank, referring physician, Ghana
I'm also trying to go into orthopedic surgery myself, and I'm really happy learning more about it and seeing the advances in the surgery you're doing. Out of curiosity — how many of your own fellows go on to specialize in spine surgery after training under you?
Dr. Puneet Girdhar
I always joke about this with my orthopedic fellows. I've had an orthopedic training program for the last 13 or 14 years, and not even one of them has opted for spine surgery as a career — they're very happy doing a knee replacement, arthroscopy, or a fracture nail instead. Spine surgery has evolved so much that the moment they look into the scope, everything is very tiny, and that can be discouraging — it looks very uphill. It takes a little while to enter the system and understand what's going on through keyholes; one has to be patient, because it has a steep learning curve and the margin of error is not there. So for the last four years I've run a dedicated fellowship national training program for spine fellows — once they're selected and come to me, they don't have the option to go to any other theatre, because they're now committed to spine surgery for the rest of their life.
Book a Consultation with Dr. Puneet Girdhar
Book on WhatsAppOr message us on WhatsApp: +91 98182 98669
Frequently Asked Questions
I wanted to share how Paulina has been doing since her surgery with you — honestly speaking, I was really impressed by her recovery time. She's come back to Ghana and she's always praising your team, and now I have even more patients lining up who also want to come and have a consultation, and possibly the surgery, after hearing about her experience.▼
We feel privileged to be treating your patient, and I hope we have done justice to you, your practice and of course the patient. I think at the end of the day we all have one common goal — we want to see our patients happy. Otherwise you, me and Jivo would not be here on a Sunday evening, leaving our families aside, if we did not have this goal.
I'm also trying to go into orthopedic surgery myself, and I'm really happy learning more about it and seeing the advances in the surgery you're doing. Out of curiosity — how many of your own fellows go on to specialize in spine surgery after training under you?▼
I always joke about this with my orthopedic fellows. I've had an orthopedic training program for the last 13 or 14 years, and not even one of them has opted for spine surgery as a career — they're very happy doing a knee replacement, arthroscopy, or a fracture nail instead. Spine surgery has evolved so much that the moment they look into the scope, everything is very tiny, and that can be discouraging — it looks very uphill. It takes a little while to enter the system and understand what's going on through keyholes; one has to be patient, because it has a steep learning curve and the margin of error is not there. So for the last four years I've run a dedicated fellowship national training program for spine fellows — once they're selected and come to me, they don't have the option to go to any other theatre, because they're now committed to spine surgery for the rest of their life.
How long should you try medical treatment before seeing a spine specialist?▼
Patients who have completed four to six weeks of medical management, such as painkillers and physiotherapy, without improvement should be referred to a spine specialist.
What symptoms mean you shouldn't wait the full six weeks before referral?▼
Developing advancing symptoms such as numbness, weakness, gait disturbance or pain that cannot be tolerated means a patient should be referred earlier than six weeks.
What can happen if referral to a spine specialist is delayed too long?▼
One 60-year-old patient with radiating leg pain and foot numbness took six months of treatment before being referred and kept worsening throughout that period. Many patients who are delayed too long go on to develop foot drop.
What imaging helps determine if the spine is unstable?▼
When back pain is severe, rated more than six or seven out of ten, and the MRI shows changes, lateral X-rays taken bending forward and bending backward can reveal whether the spine is unstable.
In This Series: Spinal Surgery: Advances in Techniques & Technology for Excellent Patient Outcomes
- 1.Advances in Spinal Surgery
- 2.Biportal Endoscopic Spine Surgery: What It Is and How It Works
- 3.Cervical Disc Replacement: Treating Neck Disc Herniation While Preserving Motion
- 4.Growth Rods for Early-Onset Scoliosis in Young Children
- 5.Hemivertebra: Why Early Surgery Prevents Severe Spinal Deformity
- 6.Herniated Disc Surgery: Biportal Endoscopic Discectomy Explained
- 7.Kyphoplasty for Osteoporotic Spinal Fractures: A Same-Day Procedure
- 8.Lumbar Canal Stenosis: Symptoms and Modern Minimally Invasive Treatment
- 9.Minimally Invasive Spinal Fusion: Treating Spinal Instability Without Open Surgery
- 10.Minimally Invasive vs Open Spine Surgery: How Techniques Have Evolved
- 11.Navigation and Robotics in Spine Surgery: Why They Improve Accuracy and Safety
- 12.Prolonged Sitting and Disc Degeneration: Why Desk Jobs Are a Spine Risk
- 13.Recovery After Minimally Invasive Spine Surgery: What Patients Can Expect
- 14.Robotic Spine Surgery for Complex and Revision Cases
- 15.Scoliosis and Kyphosis in Children: Types and Warning Signs
- 16.Scoliosis Treatment: When Observation, Bracing or Surgery Is Needed
- 17.Vertebral Column Resection: Correcting Severe Spinal Deformity From Neglected Tuberculosis
- 18.When to See a Spine Specialist: Warning Signs You Shouldn't Ignore