Post by @stevencyrmd

Most patients ask me the same question: “If my neck and my lower back both need surgery… why do you start at the neck?” Because they are not the same problem. Your neck holds the spinal cord. Your lower back, below the end of the cord, mostly holds nerve roots. That difference changes the entire plan. Cervical compression can cause myelopathy — clumsy hands, dropping things, a gait that feels unsteady, legs that feel tight or spastic. That is the cord. Delay here can mean function that does not fully come back. Lumbar stenosis usually causes leg pain, numbness, heaviness with walking, and the need to sit or lean forward to get relief. It can destroy quality of life. It is still not the same as crushing the spinal cord. There is also an operating-room reality most people never hear. Lumbar surgery is typically done face-down. Intubation and positioning often put the neck in extension. If the cervical canal is already tight, that position can pinch the cord during the “other” surgery. I will not take that chance. When both levels are tight — what we call tandem stenosis — doing the neck first often improves gait, spasticity, and even some “leg” symptoms that were actually coming from the cord. A meaningful number of patients never need the second operation. Do the back first, and the neck can get worse quickly. This is not a rigid rule for every person. If there is no myelopathy and the legs are the only thing taking your life away, we talk through lumbar-first or staged options. But if both need surgery and the cord is in the story, I protect the cord first. Every time. I don’t start at the neck to ignore your back. I start at the neck to protect the one structure you cannot replace. Then we fix the rest — safely, in the right order. Your MRI can show two problems. Surgery still has to respect which one poses the greatest risk to your lifelong mobility. — Dr. Steven Cyr | Orthopaedic Spine Surgeon | 📍San Antonio & Houston #SpineSurgeon #NeckSurgery #BackSurgery #SpineHealth #PatientEducation