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Neurosurgeon vs orthopedic spine surgeon

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:28 AM in Neck Pain: Cervical
Hello everyone, I have been dealing with a C5-6,6-7 left sided herniation with nerve impingement and DDD C4-C7 since last April all stemming from a bad car accident I had at age 16. I had conservative treatments including PT with traction and ESI's which held me over for a short period of time. Late December early January the pain is back with a vegence. I just had another ESI that only lasted 4 days,and then had excruciating pain. The pain currently is radiating down my arm with tingling in my fingers, I am now back in the philadelphia collar intermittenly.

Last year I saw a NS who said I was not a surgical candidate, which was hard for me to take considering how bad the nerve impingement is on two levels. I have just started looking into finding an orthopedic spine surgeon in hopes that this type of spine doctor will be more likely to suggest surgery as I strongly believe that is what I need.

My question is, has anyone had better options for surgery using an orthopedic spine surgeon vs a NS ? I have read alot of posts here and my problems seem to paralell lots of other people who have been candidates for surgery.


  • Andrea,
    I had both surgeons work on me. My OS did my ACDF's and my NS did my 3 level Laminectomy. The Hospital that I went to requires both surgeons to be working together when there is any spinal surgery done. The NS looks more at spinal cord and nerve issues, and my OS looked at the structure of my spinal colume and how stable it was or wasn't. Perhaps this link may help.

    It may help. Hope all goes well for you.

  • Hi Maroseone, thank you for your input. I am just realizing now that I probably should have seen an OS last year instead of the NS I saw. I should have known this considering I am an RN in the operating room no less. However I was sent in that direction from some of my co workers and to my dismay was told that I was not a surgical candidate. I realize now that unless I had central cord stenosis the NS was not the avenue I should have looked into. I now have an appt set up locally where I live to see a spinal OS.
    Another disappointing fact is when I call into the big Boston spinal group they will not see you until you fax them a copy of your MRI just to decide if you are a surgical candidate or not. I guess this is to wean out the non surgical cases. And another group at another big Boston hospital wants you to see thier physiatrist before seeing the OS to evaluate your circumstances. this is rather frustrating and time consuming. I really would prefer to have any spinal surgery done at the Boston Hosp, but the pain is so bad right now I am willing to go to whoever will see me, atleast for an opinion.
  • I was seen by both, the neurosurgeon and then a year later an ortho spine surgeon. The neru did not want to do anything but PT and a year later my spine became unstable. At that time my pcp sent me to an ortho spine surgeon. I had the surgery and was fused C4-C7 with a corpectomy. I do believe I waited too long because now I have nerve damage. I think neurosurgeons are more cautious and do not rush into surgery, which can be good but according to my MRI my cervical spine was in bad shape and PT would not have helped it.

  • Hi Shari51, Thanks for your input. I can completely understand that. It seems that if you do not have a central cord issue then the NS is not interested in your case. I am afraid that I already have waited too long and have been going in the wrong direction. I believe that if I had seen an OS last summer things would have gone differently. Now it's trying to chose the right OS and right hospital. I prefer to go to the bigger more reputable hospitals and OS but it is so difficult just getting an appt. I am seeing an OS locally next week, however I am nervous about the fact that he is not at the bigger hospitals. But I am looking forward to what he suggests.
  • My OS is with a large university/hospital with a great reputation. That was the only reason I let him operate on me. No matter how great the hospital or surgeon they can only do so much and in my case what he did was stabilize my spine.

  • dilaurodilauro ConnecticutPosts: 9,856
    Sometimes you may have both.
    My first Lumbar surgery was done in 1978 by an Orthopedic Surgeon. While successful, it did take almost 6 months to recover and I had about a 7 inch scar from L4/L5 non fusion
    For my ACDF surgeries, I had the Neurosurgeon doing the disc/cord work, while the Ortho did the harvesting of my bone scrap from my hip and using it as fusion material.

    Overall, my feeling (My feeling only)
    When I want someone to work on my Spinal Cord and its components, I only want it to be a Neurosurgeon
    When I need some bone work done, then I see an Orthopedic Surgeon

    Some of this is covered in our FAQ

    Definitions Chiropractor Orthopedic Neurosurgeon
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I had my decompression surgery done by an orthopedic surgeon who was very conservative, well known, and respected. It was over 6 months after the pain started, and I believe the nerve damage in my leg could have been reversed if I had arrived at his clinic sooner. My fusion was done by an excellent neurosurgeon and the surgery was technically successful but I still continue to have pain to this day. I really can't say that one is better than the other but I really believe they did their best.
    Moral of the story- if you have a pinched nerve, don't wait too long if they tell you surgery is needed, esp if you are experiencing neurological deficits. Always go for the least invasive surgical option. I believe spinal fusions are a last resort measure. Keep in mind this opinion is solely from my personal experience.
  • I have used an Orthopedic Surgeon for all three of my surgeries however, he ALWAYS has a Neurosurgeon present during all of his surgeries. My first Neurologist I ever went to for my neck pain looked at my MRI and told me that there was absolutely nothing wrong with my neck.


  • Andrea, I had a OS for my spinal fusion with excellent results. My 1st neck surgery was done by a NS for a large herniated disc. One year later when I had cervical issues again, I saw a OS and a NS. BOth had great reputation from a leading teaching University Hospital and both said i needed surgery ASAP. I was not sure who to go with. The OS wanted to do a double fusion and flip me over and do a foraminotomy. The NS only wanted a single fusion done and felt thats all I needed. Since I had a spinal cord compression I picked the NS. I am still on the fence if I picked the right one. My arms still hurt and they are weak 3 months post op.It's a tough decision to make. Good luck. Bethy
  • MetalneckMetalneck Island of Misfit toysPosts: 1,364
    We have boney defects effecting our nerves .... Not neural defects effecting our bones ... I have had both work on me .... the NS botched the job .... the os fixed the mess left by the NS .... Simple answer - ORTHOPEDIC is the way to go!! Fix the structure and function of the bones, and the nerves remain patent and free.

    Spine-health Moderator
    Welcome to Spine-Health  Please read the linked guidelines!!

  • My experience started out with my Primary Care Doctor referring me to an orthopedic spine doctor. My Orthopedic Spine Doctor in turn sent me to a Neurosurgeon.

    I also have nerve impingement between C-5 and C-6 as well as other levels.

  • Thank you all for your input. It really helps. I do believe that if the structure is fixed the nerves then become patent and free, well stated by metalneck.

    This injury is something that happened many years ago and has worsened over time. I was in a bad car accident at age 16, went through the windshield twice,as we hit a car and then a tree. Over the years I had always had neck issues and 5 years ago had my first herniation of C3-4 at age 38 and then C4-5 a couple years later Usually it resolved with PT, traction and NSAIDS. It wasn't until last April when I herniated 2 levels at once did things start to get ugly. After 2 courses of oral steroids, 6 weeks of traction nearly everyday and then 2 ESI's with minimal relief, I realized this was much worse than anytime in the past. It wasn't even until last year when the pain doc asked if I had ever been in a car accident, that I put it all together. Now at age 43 I am understanding what has happened to me.

    Ironically I am an RN in the operating room and have actually done alot of the surgeries that people have encountered on this forum. Maybe that was to prepare me for what I have ahead of me. Thanks everyone.
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