What is a spine consultation?
A spine consultation is an appointment with a spine specialist to assess what may be causing your back or neck symptoms and discuss next steps. At Alter Health, your consultation is led by a US board-certified neurosurgeon. The plan is based on your history, examination, relevant imaging and treatment already tried.
It is a conversation as much as an examination. Many people arrive worried that surgery is inevitable. Often it is not - and a careful assessment is the only way to know for sure.
What to expect
Your visit usually begins with your history: how the pain feels, where it travels, when it started, what makes it better or worse, and what you have already tried. Sharing associated symptoms - such as numbness, tingling, or weakness - helps point to the nerve involved.
Next comes a structured physical and neurological examination. Imaging shows structure; the examination shows function, and matching the two is what tells us which nerve is involved and how severely. It looks at several things in turn:
- Movement and posture - how your spine bends, and where movement reproduces your pain.
- Muscle strength - including walking on your heels and toes to test the lower legs.
- Sensation - whether light touch feels normal across the areas each nerve supplies.
- Reflexes - at the knee and ankle, which can be reduced when a nerve root is compressed.
For leg pain, your specialist may use the straight leg raise test, gently lifting the affected leg while you lie on your back to see whether it reproduces radiating pain - a useful sign of a pinched lumbar nerve. None of this should be painful beyond briefly recreating your familiar symptoms, and you can ask to pause at any time.
If you have had an MRI, CT or X-ray, bring the images and reports so they can be reviewed alongside your symptoms rather than in isolation. If further imaging or nerve testing would help, we will explain why.
If further tests are needed
Nothing is booked in advance. Whether you need imaging or nerve testing - and which - is decided during the consultation, from what your history and examination show. Many people need neither.
- Imaging - an MRI, CT or X-ray, each answering a different question. An MRI shows discs, nerves and soft tissue; a CT shows bone in detail; an X-ray shows alignment and stability under load. If you already have recent images, they are reviewed alongside your symptoms rather than repeated.
- Nerve studies - EMG and nerve conduction studies measure how well a nerve and the muscles it supplies are actually working. They can confirm which nerve is involved and how severely, which is useful when the examination and the scan do not agree.
Anything requested is explained first - what it will show, and what would change depending on the result.
What happens next
We match the examination to any imaging to identify the true source of your symptoms - because scans in healthy, pain-free people often show changes that are not the cause of the problem. You will leave with a clear explanation of what we found and a plan in plain language.
For most people that plan begins without surgery - activity guidance, physiotherapy, or a targeted injection. If an operation is worth considering, we will talk it through honestly, including whether a minimally invasive approach may suit you. You are always free to take the information away and decide in your own time.
How we approach your care
- 01
Find the true source
We begin with a thorough history and examination, supported by imaging where appropriate, to pinpoint the precise source of the problem.
- 02
Consider appropriate options
Where clinically appropriate, we consider established non-surgical options before surgery. The plan depends on the diagnosis, symptoms, health and priorities of the individual patient.
- 03
A plan built around you
Every step is explained clearly, so you always understand your options and what comes next.
This may help if
- You have new or ongoing back or neck pain and want a clear diagnosis
- Pain, numbness, or weakness is spreading into an arm or leg
- You have been offered surgery and want to understand every option first
- Previous treatment has not settled your symptoms
- Your MRI findings do not seem to match how you feel
- You simply want an honest opinion on what is - and is not - needed
Suitability can only be assessed after reviewing your symptoms, examination, relevant imaging and previous treatment.
Common questions
What happens during a spine consultation?
A spine consultation combines a detailed conversation about your symptoms with a focused physical and neurological examination. Your specialist reviews any existing scans alongside your history, explains the likely cause of your pain, and outlines the options - starting with the least invasive that could work for you.
Do I need to bring my scans?
Yes, if you have them. Bringing your MRI, CT, or X-ray images and the written reports lets your specialist review them directly rather than rely on a summary. If you do not have recent imaging, or your scans are older, we will advise whether a new study would add anything useful.
Why examine me if I already have an MRI?
Because a scan shows structure, not symptoms. Disc changes and wear appear on the MRIs of many people with no pain at all, so a finding only matters if it matches your examination. The physical examination is what confirms whether an abnormality on the scan is genuinely the source of your problem.
Does the examination hurt?
It should not, beyond briefly reproducing symptoms you already have - for example, a movement or leg raise that recreates your familiar pain, which actually helps with diagnosis. Nothing is forced, everything is explained as it happens, and you can ask your specialist to pause or stop at any point.
Will I be told I need surgery?
Not usually. Most spine problems improve without an operation, and our approach treats surgery as a last resort. If surgery is worth considering, we explain honestly why, what it would involve, and whether a less invasive option could work first. The decision always stays with you.
Do I need a referral to book a consultation?
In most cases you can book directly without a referral, though some insurers ask for one before they will cover the visit - it is worth checking your policy. If you have already seen another doctor, bringing their notes and any scans helps us build a complete picture more quickly.