Orthopedic Surgeon vs. Neurosurgeon for Spine Surgery

When patients are considering having spine surgery, one of the most common questions they have is, “Which is better, a neurosurgeon or an orthopedic spine surgeon?” The quick answer is that for most types of spine surgery, both specially trained orthopedic surgeons and neurosurgeons may be considered.

Neurosurgeons and Orthopedic Surgeons can Specialize in Spine Surgery

Many years ago, neurosurgeons were primarily responsible for spine surgery, but in the past 20 to 25 years spine surgery has evolved so that both neurosurgeons and orthopedic surgeons specialize in spine surgery, and for most of the typical spine operations both types of surgeons are equally well qualified.

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In both specialties, the surgeons may subspecialize, such as in the case of surgeons who specialize in pediatrics, cervical spine, lumbar spine, hand and wrist surgery, plastic surgery, or in other areas or procedures.

Neurosurgeons

Neurosurgeons may be Medical Doctors or Doctors of Osteopathic Medicine, and complete a five to six year residency focused on the surgical treatment of neurological conditions. Neurosurgeons are trained in the diagnosis and treatment of disorders involving:

• Brain
• Spine and spinal cord
• Nerves
• Intracranial and intraspinal vasculature

Some neurosurgeons specialize exclusively on brain surgery, some on spine surgery, and some split their practice between the two.

Orthopedic Surgeons

Orthopedic surgeons may be Medical Doctors (MD) or Doctors of Osteopathic Medicine (DO) who have completed a five-year surgical residency focused on the treatment of musculoskeletal conditions. Orthopedists specialize in the diagnosis and treatment of almost all bone and joint disorders, such as:

• Spinal disorders
• Arthritis
• Sports injuries
• Trauma
• Bone tumors
• Hand injuries and deformities
• Total joint replacement

Some orthopedic surgeons focus their practice exclusively on spine surgery, some on other types of joints (e.g. hips, knees, shoulders), and some split their practice among two or more areas.

Both neurosurgeons and orthopedic surgeons may complete fellowship training to do most types of spine surgery, but there are a few types of spine surgery in which one specialty tends to be more qualified than the other, such as:

• In the past, orthopedic surgeons tended to be better qualified to do spinal deformity surgery, such as scoliosis , other types of spinal deformity. Today many neurosurgeons have been trained in deformity surgery.
• Neurosurgeons tend to be more qualified to perform intradural surgery (surgery inside of the dura in the spinal cord), such as thecal sac tumors.

Spine Fellowships

Both orthopedic surgeons and neurosurgeons may extend their training after residency by completing a spine fellowship program. These fellowships provide additional, specialized training for orthopedic surgeons and neurosurgeons that have successfully completed their residency training and earned their board certification or eligibility in their specialty.

Completing a spine fellowship is a marker of a surgeon who has chosen to specialize in spine surgery and is willing to make the extra investment in training to become more skilled.

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This was not always the case. Before spine surgery was a recognized subspecialty—15 to 20 years ago—it was not common, and often not an option, for orthopedic surgeons or neurosurgeons to do a spine fellowship program. For surgeons who have been in practice with this length of tenure, if they have specialized their practice in spine surgery, then they have likely earned their additional training in their practice and may not be fellowship trained.