Patients usually are pretty good about realizing that surgery is a last resort, is it should be a last resort.
In our practice, we are very big on making sure the patients have tried everything else before we identify them as surgery, unless of course they are showing neurological deficits on exam.
Once patients are identified surgically, they do however sometimes continue to wait it out. If after failing conservative management and with a positive MRI indicating that the patient needs surgery, waiting for surgery really is determined by the patient according to their pain and worsening of symptoms. Dr. Roger always tells the patients if you feel that you can wait, then you should. You'll always know when its the right time to come back for surgery.
There are a few instances in which waiting it out it's a very bad idea, specifically patients who have cervical myelopathy. Those patients often don't come with complaints of pain, they usually come with complaints of difficulty with balance. Those patients need surgery right away as they have spinal cord compression. If left untreated, the condition will only get worse . The bad thing about this patient when we see them in the office, because they don't have a lot of pain, they prefer to wait it out sometimes. The surgery that was performed on these patients actually cannot bring them back to their original state. The surgery only can prevent the progression so any damage that has been done or neurological loss that the patient has will actually be permanent . The patient will continue to deteriorate until the patient decides to have surgery.