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. This article profiles the similarities and differences between the two specialties, and provides additional advice on how to select a spine surgeon.
Both Can Specialize in Spine Surgery
Many years ago, neurosurgeons were primarily responsible for spine surgery, but in the past 20-25 years or so 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 specialties, the surgeons may subspecialize, such as in the case of surgeons who specialize in pediatrics, cervical spine, lumbar spine, hand surgery, plastic surgery, foot and ankle surgery or in other areas or procedures.
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:
- Spine and spinal cord
- 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 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.
- Spinal disorders
- Sports injuries
- Bone Tumors
- Hand injuries and deformities
- Foot and Ankle problems
- 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:
- Orthopedic surgeons tend to be better qualified to do spinal deformity surgery, e.g. scoliosis, other types of spinal deformity.
- Neurosurgeons tend to be more qualified to perform intradural surgery (surgery inside of the dura in the spinal cord), e.g. thecal sac tumors.
Both orthopedic surgeons and neurosurgeons may extend their training after residency by participating in 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. The 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 - 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 with this type of tenure, if they have specialized their practice in spine surgery, then they have likely earned their additional training in their practice.
Insights on Choosing a 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?” For example, some surgeons have a deep expertise in certain kinds of cervical spine surgeries. Others will devote a third of more of their practice to operative intervention for lumbar disorders. So more telling questions to ask your surgeon are: how many of these specific surgeries do you do each year? How much of your practice is focused on this specific type of surgery? All types of spine surgery have a steep learning curve, and as a general rule, surgeons with more experience in the surgery will have better results. You should also enquire as to what complications they have had.
Other questions, such as the surgeon’s outcomes for the specific surgery in question, are also important. For more information on selecting a spine surgeon, see:
Careful selection of the surgeon gives patients an improved chance of having an appropriate surgery and a favorable outcome. Reading articles such as this to get educated on the subject is a good first step in the process.