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Which type of Surgeon? Orthopedic Surgeon or Neurosurgeon?

BruceBBruce Posts: 516
edited 12/21/2015 - 6:24 AM in Back Surgery and Neck Surgery
Which type of Surgeon? Orthopedic Surgeon or Neurosurgeon?

We are frequently asked on this message board “Which surgeon is better? An Orthopedic Surgeon or Neurosurgeon? The truth is, depending upon your specific condition, probably either in many situations.

As you can read here, both can perform 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 orthopedic 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 focus on diagnosis and treatment of the brain and nervous system, such as the brain, spine and spinal cord, nerves, and blood vessels within the skull. Neurosurgeons must complete a five to six year training program in a neurological surgery residency program.”

Orthopedic Surgeons
“Orthopedic surgeons diagnose and treat bone and joint disorders such as spinal disorders, arthritis, sports injuries, bone tumors, skeletal deformities, and joint replacements.Orthopedic surgeons complete a five to six year training program in an orthopedic surgery residency.”

Source: Spine-Health Surgeon vs Neurosurgeon Info
The following perhaps gives an even clearer definition and comparison:
Both Can Specialize in Spine Surgery
Unlike in the past, both types of surgeons - neurosurgeons and orthopedic surgeons - are considered "spine surgeons". Since the spine is a central point of both the skeletal structure and the nervous system, it is an important area for both types of surgeons. Many surgeons of both types sub-specialize to treat exclusively or primarily a single type of condition, such as herniated discs or spinal fractures, or they may specialize in juvenile patients.
Orthopedic surgeons are generally more qualified at treating spinal deformities while neurosurgeons are generally more qualified to treat problems within the dura of the spinal cord.
The most important difference between any surgeons will be their level of experience with the specific procedure you are having done.
Of course expertise, training, experience and track record should be the top priority when determining which surgeon is best, but there are other ‘non technical’ or at least ‘more human’ factors that you also should consider, such as:
- How well does your surgeon communicate with you?
- Will he/she spend the time to answer your questions?
- Does he/she come across as empathizing with you?

Or more simply, how comfortable do you feel with your surgeon?

Spine-health.com also has lots of good information regarding selecting the right surgeon:


Keep positive!


...an old timer here and ex-moderator



  • thanks Bruce that is alot of useful info.
  • I say Neurosurgeon! My dad used an Orthapedica and it did not go well, where I had a Neurosurgeon and had a totally different recovery!

  • I have to agree with Bruce,

    It depends entirely on the surgeon, on his training and skills. Prior to my three-level fusion in May, I consulted both ortho-and neurosurgeons. I really liked the ortho plus my PCP told me that she would definitely select that particular ortho as he is outstanding. I am really happy I went with him, I had an absolutely pain-free surgery (from the moment I woke up I felt no pain whatsoever) and a very easy recovery. All my symptoms are gone, so needless to say that I am very satisfied.

    So I say, scrutinize the surgeon very very carefully, look at his qualifications, ask other doctors, nurses, and learn all you can about him. Also, prepare yourself for the surgery as well as you can, eat right, try to be in good physical shape, and have a positive attitude.

  • First you need to do your own research on the potential surgeons. Years ago neurosurgeons were the only ones to work on the cervical portion of the spine but now-a-days ortho surgeons do the disc surgeries too. Either surgeon will be fine as long as you do your research on them and you feel comfortable with him/her. For any reason you fell iffy or you get a gut feeling about the doctor, keep looking. My first surgeon was a neuro but the one doing my future surgery is an ortho. Good Luck.
  • HI,

    Mines an Ortho has a good repuation but is a man of few words which is really annoying. He often skims over my questionsand when I left relaise he hasn't answered them!

    The nurses say that he works by, if you don't ask you don't want to know but sometimes the lack of straight talking is quite frustrating. And yes, I told him this too.

    So, I know what a mushroom feels like, In the dark!
  • I have a spinal sergeon that is both He is the head of a great hospital here in Colorado. So If anyone is looking for a great Dr. or even a 2nd opinion I think my Dr. is one of the best. I have had the great joy of being rejected by Dr.s cause how complex my case is. And had a few that just didn't know how to treat what was going on. I have fusions in neck and back

  • Hi Itsalongwalk,

    Even though my own OS is very approachable, I could relate to your description of feeling like a mushroom, as I had a boss once who was like that. As bad as that was, perhaps it is preferable to have a surgeon who keeps you in the dark. My doc is good at paying attention to me, but for my own piece of mind, I still write them up on a small index cards, let him know that I need to ask him some questions, and then go through item=by-item. Maybe your surgeon is just not a believer in idle chat, but when you present pre-formulated and and very specific questions, he will respond better. Does not hurt trying it.

    Good luck,

  • Hi,
    I am new to the site.I had spinal fusion from T9 to L1 with rods,cage,etc.I had an anterior and posterior approach.I think I am doing well,but would like to hear from others.It's hard to know if you are on track when you don't have a first post op visit with doc until 9 weeks after surgery.Any feedback will be appreciated.
    Thanks Kay
  • I wasn't sure if I needed an Orthopedic Surgeon or Neurosurgeon for my C7 fracture. After talking to both, the neurosurgeon convinced me. My C7 was loose and was affecting my spinal cord. So since the surgery would involve the surgeon working so close to my spinal cord, it was easy to decide on the Neurosurgeon.
  • ToYoung, I was really excited to see someone in Colorado in a post talking about surgeons. I've put a link below to the doc that I'm consulting with about surgery on Monday - he was referred to me by a friend's co-worker who said he's fantastic. Who did you use?

  • Three years ago I was in bad shape because, I had two ruptrued disc plus three bulging. Also My sciactic nerve was pinched down my left leg with a dropped foot. The neurosurgeon i was refered to said he could fix my but, did not know how much nerve damage was done. So he offered two options L4S/L5S1 microdiscectomy or an fusion we went with the microdiscectomy. The unexpected hapened during surgery the discs that ruptured calicfied around my nerve and, he scraped all of around the nerve.

    Right after sugery I did not have a dropped foot and, everyone was amazed how well things worked out for me. The only never damage have is a little numbess in my big toe so, I'm very happy how I turned out. For the neurosurgons get my vote. Still for my situation I have to stay active tru to walk 1-2 miles per plus daily stretching. If I ever need anything spine related I'm back to my neurosugeon because, he made me a believer. On a light note I'm a avid bowler and, I was able to get back to bowling and did not miss a beat. I'm sure there plenty ortho surgeons that could have this same surgery with no problem. It is amazing what surgeons can these days. Best of luck to everyone
  • and I feel I coudn't have made a better choice. Now I also has developed a severe scoliosis from the disc being lost on one side for several levels so an N/S was out of the question.
    The O/s both fused my lumbar and corrected the scoliosis and I have to say he is wonderful. He patiently answers all my questions and even draws diagrams where necessary (I am a visual person) and I have never been out of his office in under 30 mins.
    He is polite and diplomatic and I feel I really picked a winner on all counts.

    I do know a lot of both O/S and N/S who wouldn't give you the time of day if you begged for it so I do think it is up to the individual Dr and the condition you are having treated.

    Blessings Sara O:)
  • Personal experience, and research.... Neuro's wait until your fusing before throwing you into PT (makes sense), Orthopedics throw you right into PT, some people ending up needing to get surgery over again. ewwwwww......
  • lynnsy said:
    Personal experience, and research.... Neuro's wait until your fusing before throwing you into PT (makes sense), Orthopedics throw you right into PT, some people ending up needing to get surgery over again. ewwwwww......
    I have not heard before that neurosurgeons wait before introducing patients to PT while orthopedic surgeons start patients straight away on PT. My orthopedic surgeon had me wait 4 months before commencing a PT program.
    Keep positive!


    ...an old timer here and ex-moderator

  • Do you have any sites for Canadian trials? Thanks Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Afraid none that I know of.
    Keep positive!


    ...an old timer here and ex-moderator

  • I went to an orthopedic surgeon 2 days ago in Conroe Tx. He wants to do a lumbar fusion on me. He said I would be in intense PT 2 weeks after the surgery. That really concerns me. I had a laminectomy/discectomy in 2005 and they started PT soon after that. I really beleive that is a big reason why I still have so much trouble with my back. I am really trying to decide what to do.

  • When I had my back fused 2 years ago, I first went to a OS,a NS assisted him, which I was told they always do with any back surgery. Had I known better, I would have gone to the NS first, his care and knowledge helped more than the OS. I am dealing with scar tissue as a result of the surgery and the NS has been more helpful. Hope this helps.
  • my ortho does not even send u to pt unless you cannot move right after 8 weeks, they give u exercises to do at home and then they take it from there. i went to a ns 18 months ago and his reply was "I wouldn't touch that, just keep going to traditional therapy your not in any danger and it really doesn't look like a surgery is necessary" this after 10 years of pain, and getting worse. this year went to a very good os and he said this should of been done a long time ago!! so i guess they are all different. I'm sure a ns would of thrown me in some hard collar and i would of hated that and not been able to wear it anyway. most younger docs are getting away from that, and I am more comfortable with that!! i been in pt all my life. I hope i don't need it ever again. never really helped, and most those exercises you can do at home!!
  • I went with the neurosurgeon as I had the fear of
    a surgeon damaging my nerves and arachnoid spaces.

    I was assigned a post operative physical therapy program and went to a week in a step down rehab unit after a week in the hospital for three level fusion with cages and instrumentation.

    I am now going to have a revision surgery because an auto accident caused a disc fragment and non union which we have
    following for three years.

    I did so great after my spinal fusion and three months had
    an auto wreck that damaged my SI joint and back again.

    I am so scared, although the radiologist said it won't be as bad as the first surgery as this is a type of touch up.

    I will get second and third opionions again. Anyone have to have a revision of their fusion for non union? How did you do ?

    BJ :''(
  • I am sorry about all your troubles and that you need a revision. Several people posted on this site who needed or had revision surgeries. Hopefully some people will respond who would be able to share a similar experiences with you.

    Best wishes,

  • Has anybody had nucleoplasty done? If so, did it work or help? Also, if you have any knowledge about nucleoplasty's success that would help. I have an L5-S1 contained herniation that causes mild sciata down my right leg. I have done some research and talked to an ortho about it. He seems to say its kind of new and they dont know how well it works quite yet, but he didnt seeme opposed to me finding a dr in town who does this procedure. The ortho said that it wouldnt inhibit his ability to do a microdiscectomy if i so chose to go that route eventually. Any input would be greatly appreciated.
  • I have worked with both Ortho and Neuro guys in my career. I am a highly trained health professional who decided to go into research & development instead of medicinal practice.
    Furthermore I have been in hundreds of spine surgeries with both Ortho and Nuero surgeons.

    I ll make this short and sweet...
    Nuero docs are more maticulous and skilled generally when dealing with spinal procedures. And when your in situ(in the wound) and working around the dura with instrumentation...thats a good thing.
    Whereas Orthopedic guys (or ladies) tend to run into in situ itrogenic (surgeon caused) complications that require longer procedure time and potentially less efficacious post surgical results.

    Go Nuero - going ortho is like taking a import car to a garage that specializes in domestic... even though they know what they re doing, take it to the import guy, its they re specialty
  • I actually know the exact product you re refering to. And yes, its relatively new.

    All I can tell you is what I know I really don t have an answer because of its novelty. It will take some years before ID studies can be completed...

    This procedure & product is based on the philosophy of minimal invasive-anatomic preservation. Which it does promote. However, degenerative disc disease will likely continue its course, and potentially require another adjacent level surgery later...

    I can tell this, an ideal candidate for this procedure is someone who is younger rather than older, someone with only one level of unhealthy disc & preferably 5-1...like you.
    Also, someone who is going to diligently follow up with they re post surgical care. Which is essential!

    Good luck!

    p.s. im going to tell you a little secret.... newer procedures like these or annular repair and dynamic stabilization... are approved by the FDA but take years to get coded. So your surgeon & hospital will have issues getting reimbursed for it... between that and the lack of data, most surgeons will not be willing to do a procedure.

    which by no means either validates or opposes the theory of this particular surgical medicine...just mentioning
  • To put an international perspective on this, as we have many international members, what you say may be more applicable to the US scene (I am assuming that you are in the US). Whereas in many other countries where our members come from (e.g. Australia, New Zealand, UK, Singapore (me)) a far greater proportion of spinal surgeries, especially lower spine surgeries, are carried out by orthopaedic surgeons. It may not hold true in these countries that orthopaedic surgeons are potentially any less competent than neuro surgeons when it comes to spine surgery.

    Keep positive!


    ...an old timer here and ex-moderator

  • Well, I am in the US, in California to be precise, and I believe that when it comes to the lumbar area below the point where the spinal cord ends, a skilled OS can be every bit as good as some NS, of course, he or she has to have special training in spinal surgery. My OS had his spinal fellowship at Harvard, and has a very good reputation (in addition to being just a real nice guy). I had a textbook perfect three-level spinal fusion and both at the hospital and at the rehab the OT and nurses kept telling me that they can spot his patients because they are doing so much better than others, with significantly less complication. I know that not all OSs are created equal, as neither are all the NSs, but before somebody makes this judgment just based on the speciality, this person should do extensive research about the surgeon in question, in order not to dismiss perhaps the best choice.

  • I have decided to have a neurosurgeon perform my L4-L5 level PLIF next month. I had seen a couple of orthos last year...all saying that a fusion would be my only choice. Then, I started having nerve problems in my right leg, so I went to see a couple of neurosurgeons. Both of them said that a fusion was the only alternative. So, since I am currently having nerve problems along with disk issues, I chose to go with a neurosurgeon for my operation. I'll let you know if I should have chosen otherwise after the fact (like it'll make a difference then).
  • Well I am feeling pretty lucky, I get to have both, my surgery was originally scheduled for Dec. 10th but was canceled due to a big misunderstanding, I just had it rescheduled and my ortho surgeon got a better look at the area he would enter in and he noticed I have a short neck with a high collar bone which is going to be difficult with a C5 to 7 fusion, so he is calling on a neuro to assist in the surgery and I am glad now it was cancelled, cause having two surgeons on the job makes me feel a little safer.
  • Great information everyone. Thanks
  • I have had both lumbar and cervical fusions. I had the same surgeon do both, an Orthopedic Spine Surgeon. I actually did not find a neuro I felt I could trust my spine to. When I had L3-S1 fused 360, my surgeon had a Vascular surgeon open anteriorly for him. Good thing he did, I had a softball-sized lipoma lying on my anterior spinal column, wrapped around some arteries... :O
    Fused L2-3 to S1 and at C5-6. I have a central herniation @ T11-12 and multiple bulging discs in my thoracic. I also have fibromyalgia and suspected arachnoiditis, awaiting my results of a recent MRI.
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