When you ask, "Is surgery my only option?"

What follows combines several people's visits into one reconstructed account. It is not any one person's story, and anything that could identify someone has been removed.

What we often hear

• "They told me there's no option but surgery."
• "They looked at my MRI and said it's on the serious side."
• "At my age, surgery scares me."

How do we answer that question?

First, we sort it out. There are clearly conditions where surgery comes first, and conditions where it doesn't. Our job is to check with you which one you're in now.

We don't tell you not to have surgery. That decision is made by the doctors who perform surgery; we tell you what we can see.

What are the signs that surgery comes first?

When your legs are so weak that your foot drags, you're having trouble controlling your bladder or bowels, the area of dulled sensation is spreading, or symptoms are getting worse quickly.

If you have these signs, that care comes before visits to us. We tell you this first, at your first visit.

If not, what do we look at?

We sort out whether your current pain is explained by age-related changes alone, or whether something has been added on top as your body's center collapsed.

We look at your scans together. When the spine can't hold its center and curves to the side, the starting point is often the pelvis. When the pelvis twists, the lower back, back and neck above it collapse in turn, and the space the nerves pass through narrows further.

We compare it to a kinked hose: even if you turn the water up full, not much comes out. That's why, if you leave the kink as it is and only increase the medication, the relief doesn't last.

How do we treat it?

Rather than forcing the narrowed space open, we work on re-establishing the body's central axis to create conditions where the spine can straighten out on its own.

We correct the twisted pelvis and work on the rotated segments one by one. What matters here isn't speed but stability. We go slowly, within the range your body can accept.

We also use herbal medicine because the stiff muscles and ligaments need to loosen for the correction to hold. And the legs need to get stronger for it to last.

What are the limits of this approach?

We don't say everyone gets through without surgery. If we don't find a direction after a few visits, we tell you so plainly and recommend other care.

If the distance you can walk keeps getting shorter or weakness appears, it means things are progressing, and we'll guide you to get tested again.

If you're facing the same worry

1. There are clearly conditions where surgery comes first — we sort that out first.
2. Weakness, bladder or bowel changes, or a quick worsening mean that care comes first.
3. We don't tell you not to have surgery.
4. Sometimes, if the kink is left alone and only medication is increased, the relief doesn't last.
5. If we don't find a direction after a few visits, we tell you plainly.

We start by measuring how far you can walk and how strong your legs are. We show you whether you're improving with numbers, not just feelings.

If you can't walk as far as you used to, come in and get measured. Just knowing how far you can walk right now changes the next decision.

Because there are many possible causes, progress differs from person to person, even with the same care.