When patients are considering having spine surgery, one of the most common questions they have is, “Which is better, a neurosurgeon or an orthopedic 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.
In both neurosurgery and orthopedic surgery the surgeons may further subspecialize in areas such as pediatric surgery, cervical spine surgery, lumbar spine surgery, hand and wrist surgery, plastic surgery, or in other areas or procedures.
Neurosurgeons
Neurosurgeons are specially trained in the diagnosis and treatment of disorders of the nerves, spinal cord and nervous system, including:
- Brain disorders
- Spine and spinal cord
- Nerves
- Intracranial and intraspinal vasculature
Some neurosurgeons specialize exclusively in brain surgery, some exclusively in spine surgery, and some split their practice between the two.
Neurosurgeons are either a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO). They complete a five-to-six-year residency focused on the surgical treatment of neurological conditions.
Orthopedic Surgeons
An orthopedic spine surgeon devotes all or most of their practice to spine surgery.
Following medical school, they complete 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 joints (e.g. hips, knees, shoulders), and some split their practice among two or more areas.
Orthopedic surgeons are either a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO). An orthopedic spine specialist who does not perform surgery is usually called a physiatrist, or physical medicine and rehabilitation doctor.
Spine Surgeon Training and Expertise
Both neurosurgeons and orthopedic surgeons typically complete fellowship training in 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. Neurosurgeons who are spine surgeons also tend to do certain types of complex surgery around the spinal cord, such as cervical corpectomy for cervical stenosis with myelopathy.
Both types of spine surgeons typically have advanced spine surgery training by completing a spine fellowship program.
These spine fellowships provide advanced, 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.
This was not always the case. Before spine surgery was a recognized subspecialty starting in the 1990’s, spine fellowships were not commonly available. For surgeons who have been in practice for over 20 - 30 years, 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.
The number one reason back surgery fails is because of an incorrect diagnosis. Finding an experienced, skilled spine surgeon will help increase the odds of getting a correct diagnosis and effective surgery.
How to Select Your Spine Surgeon
For most types of spine surgery, the real question to ask is not whether to select an orthopedic surgeon or neurosurgeon, but rather, "What specific surgeries does this surgeon specialize in?"
A back surgeon with good results and appropriate qualifications will not be threatened by your questions and will respect your attention to these matters.
For example:
- Some surgeons have a deep expertise in certain kinds of cervical spine surgeries
- Spine surgeons will have deep expertise in lumbar spine surgery
- Some types of surgery require advanced training and experience, such as cervical artificial disc replacement, endoscopic discectomy, multilevel fusion surgery, cervical corpectomy, and more.
Some more telling questions to ask your surgeon are questions such as:
- How many of these specific surgeries do you do each year? (All types of spine surgery have a steep learning curve, and as a general rule, surgeons with more experience in the specific surgery will have better results.)
- What types of complications and risks are experienced with this type of surgery?
- What are your outcomes for the specific type of surgery being considered?
- What is the natural course of my back problem if I don’t have the surgery?
For most types of spine surgery, careful selection of the individual surgeon is far more important than whether the surgeon is a neurosurgeon or orthopedic surgeon.
Selecting an appropriately experienced and skilled surgeon gives you an improved chance of having the right type of surgery and a favorable outcome. Reading articles such as this to get educated on the subject is an excellent first step in deciding on your spine surgery.
