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Before Your Spine Appointment: What to Bring and What to Ask

By Mr Ahmed-Ramadan Sadek, Neurosurgeon · 6 min read

Key points

  • A little preparation helps you get the most from a short appointment with a spine specialist.
  • Bring a written summary of your symptoms, a list of your medicines, and any scan reports or letters.
  • Write down your two or three most important questions and ask those first.
  • You can ask about every option, including not having surgery and what happens if you wait.
  • If new warning signs appear while you are waiting, do not wait for the appointment.

How referrals to a spine specialist work

In the NHS, the usual route to a hospital spine specialist is through your GP. You generally cannot refer yourself to a hospital specialist. Your GP decides whether a referral is needed, and will often suggest trying other tests or treatments first.[1]

In most of England you can also refer yourself to a community musculoskeletal (MSK) service, such as physiotherapy, for back pain or sciatica. You do not need a diagnosis first. These services can assess you, offer treatment and, where needed, arrange scans or refer you on to other specialists. They do not deal with urgent problems, and self-referral is not yet available everywhere.[2]

When your GP refers you, you can often choose which hospital you go to. For a problem that is not urgent, the NHS Constitution gives you the right to start specialist-led treatment within 18 weeks of referral, unless you choose to wait longer or waiting is the right thing medically.[1]

Private appointments

If you plan to see a specialist privately, NHS advice is still to get a referral letter from your GP, although people paying for themselves can sometimes be seen without one.[1] The letter gives the specialist useful background about your health. If you have health insurance, speak to your insurer before you book. Insurers have their own rules, for example about referrals and which specialists and hospitals they cover.

What to bring

Appointments can feel rushed. Having the key facts written down saves time and means nothing important is forgotten. NHS advice is to make notes before you go and tick each point off during the appointment.[3]

  • Your symptoms and when they started. Where the pain is, whether it spreads into an arm or leg, and any numbness, tingling or weakness. A rough timeline is very helpful.
  • What makes it better or worse. For example sitting, standing, walking, bending, lying down or coughing.
  • How it affects your life. Your work, sleep, caring for others, exercise and hobbies. This tells the specialist what matters most to you.
  • Treatments you have tried. Physiotherapy, exercise programmes, injections or earlier operations, and whether each one helped and for how long.
  • A list of all your medicines. Include anything you buy yourself, plus vitamins and supplements. Photos of the packets work well.[3]
  • Scan reports and images. If you had an MRI, CT scan or X-ray somewhere else, bring the report, or the images if you have them. If not, note the name of the hospital or clinic and roughly when the scan was done, so the team can ask for it.
  • Letters from your GP, physiotherapist or other doctors.
  • Insurance details and any authorisation number, if you are being seen privately.

How to prepare

Write down your two or three most important questions, as well as details of your symptoms.[3] Put your top three questions at the start of your list, so they get answered even if time runs short.

You are welcome to bring a family member or friend. They can help you remember what was said, take notes, or ask something you forget.[3][4] Taking your own notes is fine too. If you would like to record the conversation, ask the doctor first. GMC guidance asks doctors to support a patient who wishes to record a discussion or to have someone with them.[5]

If you need an interpreter or other communication support, ask the hospital or surgery before the day.[3]

Useful questions to ask

You do not need to ask all of these. Choose the ones that matter most to you.

  1. What is causing my symptoms, and how sure are you?
  2. What are all my options, including not having surgery?
  3. What are the likely benefits and risks of each option, and what would recovery involve?
  4. What is likely to happen if I wait, or do nothing for now?
  5. If surgery is suggested, who would do it, and how many of these procedures does the team carry out?
  6. What support is there afterwards, such as physiotherapy or follow-up appointments?
  7. Which symptoms mean I should seek urgent help, and who should I contact?

The NHS suggests similar questions before any operation, including what happens if nothing is done.[4]

Shared decision making

Shared decision making means you and your doctor reach a decision together. The doctor brings knowledge of the condition and the evidence. You bring knowledge of your own life, your priorities and the risks you are willing to accept.

NICE guidance on shared decision making (NG197, 2021) asks health professionals to talk openly about the risks, benefits and likely results of each option, and to make clear that choosing no treatment is one of them. It also says people should have the time they need to decide, and can change their mind later.[6] The NHS Constitution for England gives you the right to information about your treatment options, including their risks and benefits, and the right to be involved in decisions about your care.[7]

An easy way to remember: BRAN. Choosing Wisely UK, a campaign from the Academy of Medical Royal Colleges, suggests four questions. What are the Benefits? What are the Risks? What are the Alternatives? What if I do Nothing?[8]

What happens at the appointment

Most spine appointments follow a similar pattern. The doctor asks about your symptoms and general health (this is called the history). You may be asked to fill in a questionnaire.[4] Then comes an examination. This usually means watching how you move and testing the strength, reflexes and feeling in your arms or legs.

The specialist will look at any scans you have already had. Sometimes a new or different scan is needed before a clear plan can be made. Seeing a surgeon does not mean you will be offered an operation. That decision comes only after a careful assessment and a look at all the options.[4]

After the appointment

Before you leave, check that you know what happens next and who to contact if you have questions.[3] NICE recommends that clinic letters are written to the patient, and that you are sent a copy unless you would rather not have one.[6] The NHS Constitution also pledges to share with you letters between clinicians about your care.[7] If a copy does not arrive, you can ask for one.[1]

If anything in the letter looks wrong, contact the clinic. If you are unsure about the advice, it is reasonable to ask for more time or more information. Our guide to getting a second opinion about your spine explains your options.

If things change while you wait

If your symptoms get worse while you wait, contact your GP or NHS 111; for warning signs such as numbness around the bottom or new bladder or bowel problems go to A&E.

Go to A&E or call 999 if you have:

  • Sciatica in both legs.
  • Numbness or weakness in both legs that is severe or getting worse.
  • Numbness around your bottom, back passage or genitals.
  • New difficulty starting to pass urine, being unable to pass urine, or not being able to control it.
  • Not noticing when you need to open your bowels, or losing control of your bowels.

Do not drive yourself. These can be signs of a serious nerve problem such as cauda equina syndrome, which needs treatment in hospital as soon as possible.[9]

Printable checklist

  • My symptoms, when they started, and what makes them better or worse
  • How the problem affects my work, sleep and daily life
  • Treatments I have tried and how they went
  • A full list of my medicines, including vitamins and supplements
  • Scan reports or images, or the name of the hospital and the date of the scan
  • Letters from my GP, physiotherapist or other doctors
  • Insurance details and authorisation number (if private)
  • My top three questions, written down
  • A pen and paper, and someone to come with me if I would like
  • The BRAN questions: Benefits, Risks, Alternatives, doing Nothing
Download the printable checklist (PDF)

Further reading

References

  1. NHS. Referrals for specialist care. NHS website. Page last reviewed 12 April 2023. Link
  2. NHS. Get NHS help for back or joint problems. NHS website. Page last reviewed 18 November 2025. Link
  3. NHS. What to ask your doctor or other healthcare professional. NHS website. Page last reviewed 12 January 2023. Link
  4. NHS. Having an operation (surgery): seeing a specialist. NHS website. Page last reviewed 9 July 2024. Link
  5. General Medical Council. Decision making and consent. Came into effect 9 November 2020; updated 13 December 2024 and 3 August 2026. Link
  6. National Institute for Health and Care Excellence. Shared decision making (NG197). Published 17 June 2021. Link
  7. Department of Health and Social Care. The NHS Constitution for England. Updated 17 August 2023. Link
  8. Academy of Medical Royal Colleges. Choosing Wisely UK: shared decision making using BRAN. Link
  9. NHS. Sciatica. NHS website. Page last reviewed 3 December 2024. Link

This page gives general information only and is not a substitute for advice about your own situation. If you are worried about your symptoms, contact your GP, call NHS 111, or in an emergency call 999.

Last checked: October 2026