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Microdisectomy - neurosurgeons or orthopedic surgeons?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:19 AM in Back Surgery and Neck Surgery
Hello! I am a newbie to these boards and would really appreciate any information/recommendations on the following: For those who have had microdisectomies, was it performed by an orthopedic surgeon or a neurosurgeon? Any recommendations on which to choose and why?

I am scheduled to have an L4-L5 discectomy on 7/28 by my orthopedic surgeon but I am having a consult with a neurosurgeon tomorrow for a second opinion. I'm 32 and have had 8 years of back pain on an off - herniated discs from L3 to S1 over the years. Up until now, I have done conservative treatments (injections, PT, pain meds) and usually bounce back from a flare-up within a few months. This is the first time I have been recommended for surgery (because this is the only time I've had leg pain) and I'm pretty nervous about whether to do it. However, I have been out of work since 5/12 (the longest time i have ever been out with a back episode) so I feel I need to do something. But reading so many bad stories on here about post-surgery has me super nervous! I am afraid if I take the step to have surgery, I am starting a road of surgery for the rest of my life. Anyway, thanks in advance for any information on picking a NS vs. OS and I hope to get to know you all on here in the future :)



  • Hi Wyndmil

    I had my microD done at L4L5 in January by a neurosurgeon. I was referred initially to an orthopeadic guy but spinal surgery was outside his area of expertise so he passed me on to the neuro.

    I am really pleased with the result of my op to date, so there are good news stories too. I have no idea if I will need any further surgery along the road, but I was out of options when I decided to go for the MicroD as my pain was just awful and I was really stuggling to manage my baby and toddler.

    Keep us up dated on what you decide,

  • Thanks so much Cheeka for sharing your success story! It is comforting to know that it did alleviate your pain, especially since you have little ones to contend with. I feel like I am out of options too but keep doubting my decision to get the surgery - I guess it's just jitters talking.
  • I had both my surgeries done by an ortho. He is a spine specialist....It is all he does, and he is highly recomended by the hospital nurses and others who have gone to him. I think he is a great doctor, and he always answers questions completely.
  • Mine was done by a spine specialist Orthopedic doctor as well. I think you can find both Orthos and NS who are skilled in this area. Good luck!
  • I have had several of my doctors tell me that when it comes to surgery of the spine, they would always opt for a neuro. An ortho is a bone doc and is used to being a little rough with bones where a neuro is used to working with fragile nerves and is more gentle during the surgery therefore the recovery would be much easier. Makes sense to me. I had a micro in Dec 07 and it looks like I will need a fusion one day and I will go to a neuro. I always ask my docs what type they would use if it were them and all of them have given me the same answer so far. Good luck and keep us posted.
  • i would go with a nuro surgen that is what i did but when you go for the surgry make sure your comfrutiable with the guy and to the person in the last post you have to make sure you would trust the doc cause the one i had for both surgrys was consided the 2 surgry i had i have not seen hims since pre ope and it has been 2 weeks
  • I went with an ortho spine specialist who was a part of a larger practice that I had experience with (ACL replacement). As for the surgery....the recovery is long, but worth it.

    I am 11 weeks out today. I still have some left foot numbness and left leg pain occassionally....but it is very tolerable. I am getting back into the activities I was able to do before my surgery...though maybe a little slower than I was before.

    My doc has told me that I need to keep my weight down and stay fit. He said those two factors (which I control) will greatly decrease the chances that I will ever need another surgery. He said he can't guarantee that I won't need another surgery..but if I put on lots of weight and don't stay in shape....he can almost guarantee I will.

    Good luck, get well...and take it slow.
  • Thank you all for your feedback - I wish I'd discovered these boards sooner! What a wealth of knowledge and caring. I went to the neurosurgeon today and he confirmed my orthopedic's recommendation for the discectomy. It is a comfort to have the 2nd opinon and now I just need to decide whether to stick with my orthopedic surgeon or have this neurosurgeon do it. Sounds like people have had good experiences with both so it's not such an anxious decision to make anymore.
  • We are frequently asked on this message board “Which surgeon is better? An Orthopaedic Surgeon or Neurosurgeon? The truth is, depending upon your specific condition, probably either in many situations.

    As you can read here, both can perfom a wide range of spine surgery so, much more of an issue for most of us should be, not which type of surgeon, but the specific area of expertise, qualifications, practical experience and success rate in your type of surgery, of the surgeon that you choose. Also very important is choosing a surgeon who you feel you can communicate easily with.

    So, anyway, still what is the difference?

    Simplistically, neurosurgeons work on the nervous system, while orthopaedic surgeons work on “bones”. But this is too simplistic, as many of our spinal problems involve both the nerves (spinal cord) and bones (e.g. vertebrae). The following is a better “Surgeon 101” definition:

    “Neurosurgeons diagnose, evaluate and treat disorders of the brain and nervous system, such as aneurysms, head and spinal cord trauma, and brain and spinal cord cancers. To become a neurosurgeon, medical school graduates must complete one year of training in a general surgery residency program and five years of training in a neurological surgery residency program.”

    Orthopedic Surgeons
    “Orthopedic surgeons diagnose and treat disorders that impair movement, such as arthritis, fractures, lower back pain, joint degeneration, and shoulder, hip and knee injuries. To become an orthopedic surgeon, medical school graduates must complete one year of training in a general medical specialty residency, such as general surgery, internal medicine or pediatrics, followed by four years of training in an orthopedic surgery residency.”

    Source: http://www.sjo.org/FindaPhysician/specialties.htm

    The following perhaps gives an even clearer definition and comparison:
    Both Can Specialize in Spine Surgery
    Though things were different many years ago, today there are a large number of both orthopedic surgeons and neurosurgeons who specialize in spine surgery. More and more, we are referring to each other as "spine surgeons" as the distinction between us is becoming nonexistent. Both neurosurgeons and orthopedic surgeons specializing in spine surgery are skilled in taking care of disc herniations, disc degenerations, spinal stenosis, fractures of the spine, slippage of the spine (spondylolisthesis), scoliosis, bone tumors of the spine, etc. For younger patients, there is a subset of spine specialists that is devoted to the pediatric patient (usually defined by patients below age 15 or so).
    There are a few areas where there still is a difference. Only neurosurgeons are trained during their six or seven year residency to perform procedures inside the lining of the spinal canal called the dura. Thus, spinal cord tumors, arachnoid cysts, syringomyelia, Chiari malformation, spinal cord arteriovenous malformation, diplomyelia or diastematomyelia, tethered spinal cord, spina bifida or myelomeningocele, lipomyelomeningocele, tumors at the junction of the base of the skull and upper cervical spine, nerve root tumors, and a few other diagnoses still fall under the domain of the neurosurgeon. Similarly, both pediatric and adult scoliosis and other spinal deformities are still primarily treated surgically by orthopedic spine specialists.
    Source: http://www.spineuniverse.com/displayarticle.php/article2471.html


    Finally, of course spine-health.com also has lots of good information regarding selecting the right surgeon:


    Keep positive!


    ...an old timer here and ex-moderator

  • I just had a microdiscectomy/laminotomy at L5-S1 due to extreme foot drop 11 days ago. I had opinions from a neurologist, an orthopedic surgeon and 2 neurosurgeons. My husband and I researched all the differences between neuros and orthos. We even asked the doctors themselves. Basically, they all responded that disc surgery is relatively simple and both specialties are qualified to do it.

    In the end I went with the ortho because he was recommending the least invasive option and had the most experience with this type of surgery. One neurosurgeon recommended I have 3 levels fused and the other thought that was not necessary, but described a more invasive discectomy which likely would have increased the risk of destabilizing the spine. My husband and I agreed that the neuros we met would be great if we needed brain surgery, but were not ideal for what I needed.

    I did have a neuro for my neck fusion (C5-6) as it was a fusion and the surgery was performed from the front.

    So anyway I would recommend going with the person with the most experience and highest success rate. And I would go for the least invasive option offered...

    Thus far, my recovery has been great. The first week was tough. But I am feeling better everyday.

    Good luck!

  • hi Lesley,

    It is also possible to have both present.
    This is what I had.
    On the sunny and mild Central Coast of California

    L4-L5 endoscopic transforaminal microdiscectomy June, 2007
    L5-S1 endoscopic transforaminal microdiscectomy May, 2008
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