Diagnostic tests such as  x-ray, arthrography, CAT scan or MRI are performed before deciding on surgery. Sometimes injections are used as diagnostic tests before deciding on surgery (e.g., discography, selective nerve root injection).

Because surgery carries certain risks, a physician may perform a surgical risk assessment before operating on the spine. Facts about the patient’s health (e.g., pre-existing conditions, allergies) that may increase surgical risk are considered. Findings from diagnostic tests and a patient’s medical history may be reviewed. A physical and/or neurological examination may be given, and a patient may be referred for consultation with additional specialists prior to surgery.

In addition, a physician may give instructions to patients who require spine surgery before the procedure begins. These may include references to:

• Medications. Anticoagulants (medications that reduce the ability of blood to clot) may complicate surgery in some instances. Patients may be required to stop taking anticoagulants several days prior to surgery. Intake of certain other daily medications may need to be temporarily discontinued as well in some instances. 
  
  
• Food and drink intake. Food and liquid are typically restricted prior to surgery. Guidelines will be given prior to surgery.
  
  
• Smoking. Patients who smoke will be advised to quit several days or weeks prior to spine surgery.
  
  
• Transportation. Arrangements to and from the hospital should be made well in advance. Patients are not usually allowed to drive immediately after surgery, even if it is an outpatient procedure.
  
  
• Assistance. Some spine surgeries may require home assistance. Arrangements may be necessary if assistance is required for an extended period of time (e.g., home health aide).

The patient’s experience during spine surgery will vary according to the type of procedure. Some arthroscopic or other minimally invasive surgeries can be performed at a physician's office under a local anesthetic, but more serious procedures may require a general anesthetic during surgery and an extended hospital stay.

During the surgery, one or several incisions may be made in the back or neck. Incisions may be made on the front or back of the body, depending on the portion of the spine involved. Special instruments are used to remove growths or sections of vertebrae. Other procedures may reposition or realign portions of the spine or the nerves that run through the spinal column. Bone grafts, cements or devices such as bone screws may be inserted to strengthen the spine.