Back pain has a way of creeping into everything you do—how you work, how you sleep, even how you enjoy time with the people you love. When back pain lingers or starts to change, it is reasonable to wonder if something more serious is going on. Dr. Todd Lanman has spent decades helping patients sort out what back pain is regular aging, what needs closer attention, and when specialized neurosurgical care is the best path forward.
What Does a Neurosurgeon Do?
A neurosurgeon is a physician who specializes in diagnosing and treating conditions that affect the brain, spinal cord, and peripheral nerves. This training allows neurosurgeons to evaluate complex neurologic symptoms and determine when non-surgical care is appropriate versus when surgery offers meaningful benefit.
In spine care, neurosurgeons focus on disorders that involve the spinal cord, nerve roots, spinal bones and discs, and the supporting structures that protect them. These conditions range from nerve compression to spinal stenosis (narrowing of the spinal canal). The clinical priority is to relieve pressure on neural structures, preserve neurologic function, and restore stability without unnecessary loss of motion.
Importantly, neurosurgeons do not treat every spine problem with surgery. Many patients improve with conservative measures such as targeted medications, structured physical therapy, activity modification, or image-guided injections. Surgical treatment enters the discussion when symptoms persist despite appropriate care, when neurologic deficits emerge, or when structural instability places long-term function at risk.
Dr. Todd H. Lanman centers his practice on advanced, motion-preserving treatment of cervical and lumbar spine disorders. When surgery becomes necessary, he prioritizes techniques such as artificial disc replacement and other modern approaches that maintain natural movement, limit disruption to surrounding tissues, and support durable function over time.
Common Causes of Back Pain That May Need a Neurosurgeon
- Herniated Discs: A herniated disc occurs when the soft inner portion of a spinal disc pushes out through a tear in the outer layer and presses on a nearby nerve root. This can cause sharp, shooting pain, numbness, tingling, or weakness in the arm or leg, and may require neurosurgical evaluation if symptoms are significant or persistent.
- Spinal Stenosis: Spinal stenosis is a narrowing of the space around the spinal cord and nerves, often due to arthritis, bone spurs, or thickened ligaments. When the canal becomes too tight, it can cause pain, cramping, or heaviness in the legs, especially with walking or standing, and sometimes problems with balance.
- Degenerative Disc Disease: Degenerative disc disease refers to age-related wear and tear of the spinal discs that can lead to loss of disc height, small tears, and inflammation. In some people this process also causes abnormal motion between vertebrae (instability), which can produce ongoing pain and may require specialized evaluation.
- Sciatica: Sciatica is a pattern of pain that travels from the lower back into the buttock and down the leg, usually due to compression or irritation of a lumbar nerve root. When sciatica is severe, long-lasting, or associated with weakness, a neurosurgeon may be needed to determine whether relieving pressure on the nerve could prevent lasting damage.
- Nerve Root Compression: Nerve root compression happens when one of the nerves leaving the spinal canal is pinched or irritated as it exits between two vertebrae. This pressure can come from a herniated disc, bone spur, thickened ligament, or spinal misalignment and often causes sharp, shooting pain, numbness, tingling, or weakness in the area the nerve supplies. When symptoms are intense, persistent, or associated with muscle weakness or trouble walking, it may signal a more serious problem that deserves evaluation by a spine-focused neurosurgeon.
- Spondylolisthesis (Vertebra Slipping): Spondylolisthesis occurs when one vertebra slips forward over the one below it, which can narrow nerve spaces and strain supporting joints and ligaments. This slippage can cause back pain, leg pain, or nerve symptoms, and in more advanced cases may need surgical stabilization.
- Spinal Tumors or Cysts: Abnormal growths such as tumors or cysts can develop within the spinal canal, in the vertebrae, or around the nerves. These can compress the spinal cord or nerve roots, leading to pain, weakness, numbness, or changes in bowel or bladder function, and are typically managed by a neurosurgeon.
- Failed back surgery or Pseudarthrosis: Failed back surgery syndrome refers to persistent or recurrent pain after a prior spine operation, while pseudarthrosis describes a failure of the bones to fuse properly after a fusion procedure. Both situations can lead to ongoing instability or nerve compression that sometimes require complex revision surgery.
- Spinal fractures or Traumatic Injuries: Spinal fractures and high-energy injuries can damage the vertebrae, discs, ligaments, or the spinal cord itself. Depending on the pattern of injury, a neurosurgeon may be needed urgently to stabilize the spine, decompress the nerves, and protect or restore neurologic function.
7 Signs It’s Time to See a Neurosurgeon for Back Pain
1. Back Pain That Radiates to Your Arm or Leg
When back pain shoots into your arm or leg, it often means a nerve is irritated or compressed, a pattern called radiculopathy. This can signal a disc problem or nerve root compression that deserves a specialist’s evaluation.
2. Numbness, Tingling, or Weakness
New or worsening numbness, “pins and needles,” or weakness in an arm or leg are signs that the nerves or spinal cord may be affected. These neurological changes should be taken seriously and assessed promptly.
3. Pain That Doesn’t Improve with Conservative Treatment
If you have tried appropriate non-surgical care such as medications, physical therapy, and activity modification for six weeks without meaningful relief, it may be time to consider a neurosurgical opinion. Ongoing pain despite these measures can point to a structural issue that needs more advanced treatment. Importantly, if pain gets considerably worse despite conservative treatments, six weeks may be too long to wait for a neurosurgical evaluation.
4. Loss of Balance or Coordination
Trouble with balance, clumsiness, or feeling unsteady on your feet can indicate pressure on the spinal cord, especially in the neck. Because spinal cord problems can progress over time, this symptom should be evaluated without delay.
5. Bowel or Bladder Changes
Difficulty starting or stopping urination, loss of control, or new bowel problems along with back pain can signal a serious condition called cauda equina syndrome. This is a medical emergency and requires immediate medical evaluation.
6. History of Cancer or Sudden Onset of Severe Pain
If you have a history of cancer and develop new back pain, or you experience a sudden, severe spike in pain after minimal strain, it could indicate a tumor or spinal fracture. In these situations, urgent imaging and specialist review are important to rule out serious causes.
7. Prior Spine Surgery with Recurring or Worsening Symptoms
When pain, numbness, or weakness return or worsen after spine surgery, it may suggest issues such as failed fusion, hardware problems, or adjacent segment disease. A neurosurgeon can determine whether revision surgery or another targeted treatment is appropriate.
How a Neurosurgeon Like Dr. Lanman Can Help
Dr. Todd Lanman starts by making sure the diagnosis is correct and complete. This includes a careful neurologic examination, a detailed review of your symptoms and medical history, and advanced imaging studies such as magnetic resonance imaging (MRI), computed tomography (CT), or specialized X‑rays when needed. The goal is to pinpoint exactly which structure in the spine is causing your pain or neurologic symptoms so treatment can be tailored rather than generic.
Whenever possible, Dr. Lanman uses minimally invasive and motion-preserving techniques designed to treat the problem while protecting healthy tissue. These may include artificial disc replacement (ADR) to maintain movement at the treated level, microdiscectomy to remove the portion of a herniated disc pressing on a nerve through a small incision, and cervical or lumbar decompression procedures to relieve pressure on the spinal cord or nerve roots. For patients who have had prior surgery that did not fully succeed, Dr. Lanman also performs complex revision operations to address failed fusions, hardware issues, or adjacent segment disease in a targeted way.
Throughout care, Dr. Lanman emphasizes preserving motion, minimizing downtime, and supporting a full return to normal activities. That means choosing strategies that reduce muscle disruption, shorten recovery when possible, and lower the risk of future breakdown at nearby levels of the spine. The overall focus is not just on relieving pain, but on restoring and maintaining quality of life so you can move, work, and live with confidence.
Dr. Lanman’s Unique Approach to Spine Care
With more than 30 years of experience as a board-certified spinal neurosurgeon, Todd H. Lanman, MD, brings a depth of judgment that only comes from decades of treating complex spine problems. Over that time, he has become a trusted resource for patients whose careers and lifestyles demand the highest level of performance, including global executives, professional athletes, and A-list performers.
Dr. Lanman is also known for innovation. He developed the 4D Health™ optimization approach, which looks beyond static imaging to consider how your spine functions over time and how to keep it healthy as you age. In keeping with this philosophy, he was among the first surgeons in the United States to perform multi-level artificial disc replacement (ADR) and has served as a lead investigator in United States Food and Drug Administration (FDA) studies of advanced disc devices, helping to bring motion-preserving technologies into mainstream spine care.
FAQs: Back Pain and Neurosurgery
Is seeing a neurosurgeon only for serious conditions?
No. Seeing a neurosurgeon is not only for emergencies or severe disease. Many people see a neurosurgeon for common problems like disc herniations, spinal stenosis, and chronic neck or back pain—often to explore non-surgical options early.
Should I see a neurosurgeon or orthopedic spine surgeon?
Both neurosurgeons and orthopedic spine surgeons treat spine conditions, but their training is different. A neurosurgeon’s background focuses on the brain, spinal cord, and nerves, which is especially important when you have neurologic symptoms such as weakness, numbness, or balance changes. The most important qualification is to choose a surgeon with a dedicated spine fellowship and extensive hands-on experience in spine surgery and spine care.
How do I know if I need spine surgery?
You may need spine surgery when your symptoms, physical examination, and imaging all point to a specific structural problem that has not improved with appropriate non-surgical treatment. Pain alone does not mean surgery is required, and an imaging “abnormality” by itself does not guarantee that surgery will help. Dr. Lanman works with you to decide if surgery offers a clear benefit over continued conservative care.
What questions should I ask my neurosurgeon?
Ask about the exact cause of your symptoms, all reasonable non-surgical options, and what the proposed surgery is designed to change. It is also important to understand expected recovery time, possible risks, and realistic long-term outcomes. A good neurosurgeon welcomes direct questions and explains trade-offs in plain language.
Does a neurosurgeon always recommend surgery?
No. A neurosurgeon does not automatically recommend surgery. In many cases, the most appropriate plan involves observation, physical therapy, medications, or injections, with surgery reserved for situations where clear benefit outweighs risk.
Conclusion: Don’t Ignore the Warning Signs
Seeing a spine-focused neurosurgeon like Dr. Todd Lanman early can help identify the true source of the problem, prevent long-term nerve damage, and open the door to treatments that relieve pain while protecting motion and function. With the right plan in place, many patients can get back to work, family life, and the activities that matter most to them.
Concerned your back pain might be more than muscle strain? Your next step matters. Reach out to Dr. Todd Lanman’s Beverly Hills office today to schedule a thorough, personalized spine evaluation. Your spine supports every part of your life—trust it to a recognized leader in neurosurgery and motion-preserving care.
