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Is it true that neurosurgeons are more conservative than orthopedic surgeons?

LovinggardenerLLovinggardener Posts: 494
edited 06/11/2012 - 8:30 AM in Back Surgery and Neck Surgery
I've consulted with two neurosurgeons and one orthopedic surgeon in the past year and half. I've been told that neurosurgeons are more conservative than orthopedic surgeons.

What is opinion on this?


  • never saw an ortho so Im not sure - I have seen two neurosurgeons though...I'll be interested in the responses...
  • My experience was exactly the opposite. I had a total of 8 consultations. Six told me that due to my spondylolisthesis, I had no choice but to have fusion...ONE level. I went to two neurosurgeons, one who was head of the spinal fellowship training program at a major university. I saw this doctor fairly late in the process. He told me he would perform fusion. I just assumed he was talking about the same one level that I'd heard about from the other surgeons....but, almost as I was walking out the door, I asked. I was shocked when he said a minimum of 3 levels and maybe 5 -- he wouldn't know till he got in there.

    The second neurosurgeon I saw said the same thing. I also think that in general, neurosurgeons are more difficult to communicate with and less likely to want to discuss the possibilities with the patient. Of course this is just my opinion, based on my experiences and from what I've heard others say.

    How are you feeling by today? Are you planning ahead to a fusion?
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  • in my life i have seen and been operated on by both neuro and Orthosurgeons .the ortho then to be more about preserving the structure of your spine where as the nuro tend to concentrate on the functions of the nerves coming out of the various bits of your spine .a good surgeon will perform diagnostic tests such as MRI /cat scan / etc before deciding what if any and by whom the surgery should be done by.neurosurgeons tend to be seen as higher up the food chain but having seen the work of an orthosurgeon .i would say that there skills are equally matched.just make sure you find the right one for your problem!
  • dilaurodilauro ConnecticutPosts: 13,525
    towards Neurosurgeons in the more aggressive mode than Orthopedic doctors. But to me, what I find much more
    important is basically what Straker said.
    I would go to an Orthosurgeon for bone related items and go to a Neurosurgeon for Spinal Disc and nerves.
    During my ACDFs' I had both, one for the disc/nerve piece and an Ortho for the bone graft
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
  • I am feeling well, but the two recent consultations confirmed my orthopedic surgeon's opinion. The neurosurgeon has three concerns: 1) loss of a lot of disc matter 2) he called it "mobic" I think I got this wrong, but something about change in the vertebra and 3) instability of the vertebrae

    Right now is just "wait and see". I just want to choose the right doctor when/if the fusion is needed. The two doctors had different strategies which is eye opening. Os wants to do an ALIF, and NS wants to MAST PLIF (minimally invasive fusion).
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  • When I first started to really explore what was causing my pain, I went to an ortho. During my first appointment, he mentioned surgery and it completely freaked me out! I talked with friends, and one friend begged me to visit a neuro. for a 2nd opinion. I was so glad I did. He also told me that surgery was probably my best bet, but I felt so much more at ease with him. As was mentioned earlier, the ortho. seemed to focus on the bone structure, and the neuro. focused more on how the nerves were being impacted. For me, the neuro was the answer.

    I think the most important consideration is finding a surgeon that you feel comfortable with and trust with your life (literally).

    Good luck to you with your decision!

  • My PM doc told me it was time to see a surgeon after many injections stopped working. I first went to an orthopedic doctor and he immediately said 1 level laminectomy/fusion. I then went to my current neurosurgeon and he said laminectomy only because my spondylolisthesis was a grade I and not bad enough to warrant a fusion. If the spondy gets worse then I may need a fusion someday. Time will tell and I did not want to have a fusion if it was not necessary. I am 60 years old.
  • Ok...I am done interviewing doctors. I've seen two OS and two NS. So far I give 1 point to OS and 2 points to NS.

    My current OS is very skilled but does't explain things in details and I just don't feel a connection. When he first saw me, he just looked at me and there was an awkward silence.

    The rest of the three doctors were completely different. Again, thank goodness that I have choices. The last three spent so much time with me; even though they might not operate on me was surprising.

    Today I met with a NS and he couldn't guarantee 100% that I wouldn't need a fusion but he is more optimistic than my OS.

    One of the doctors said that my OS shouldn't have given me the bad news in PostOp room while still getting orientated after anesthesia.

    The last NS spent the most time with me. Looked through the MRI films and explained things that I didn't even know about my disc. He did a thorough physical exam and talked to at length. I think he is the one.
  • I interviewed 2 orthos and 1 NS. I chose a NS and would do it again in a heartbeat, as I had nerve issues. I've worked with surgeons for many years and the best ones do not neccesarily have the best bedside manner. I look to them for SURGERY and hope there is a good support system in their practice (and around you) that will give you the rest of the things we need. The most important part is a good surgeon and this site gives you so much support, be thankful it is here! Yeah spine-health!

    Best of luck - keep us posted...


    12/18/08 - PLIF, decompression, sunovial cyst removed
    4 prior Epidurals- 3 disc, 1 facet joint; multitude of drugs, no releif, 2 MRI's w/ contrast.
  • All the fours doctors are well-known the community and they all have been featured in our city and state magazines. The last one has been voted many times as one of the best doctors in my city and he is the chief NS at his hospital.

    I think it is also important that the supporting staff is just as good as the surgeon because you do end up communicating with them a lot more than the surgeon after surgery.

    Thank you all for you input!
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