Spine Surgery: Orthopedic Surgeon or Neurosurgeon?
Among the more common questions I get from patients and referring physicians alike is “Who should I see — an Orthopedic Spine Surgeon or a Neurosurgeon?”
Spine surgery is an area of medicine where two different specialties — Orthopedic Surgery and Neurosurgery — overlap in the care of a group of conditions.
To answer this question, let’s go back in time. The first documented Spine surgery, a laminectomy, was reported around 650 AD. This must have not gone well because several hundred years passed before written accounts describe surgery on the spine. In fact, it was much later that the first laminectomy in the U.S. was performed in 1829 by Dr. Alban Smith, a general surgeon and resident of Kentucky (my home state). Nearly a century later in 1911, another Kentuckian (and coincidently an alumnus of Vanderbilt and the University of Louisville School of Medicine, just like me), Dr. Russell Hibbs, performed the first spinal fusion surgery. Dr. Hibbs was an Orthopedic surgeon and treated several patients with scoliosis and spinal deformities.
Both Orthopedic surgeons and Neurosurgeons contributed to advancements in Spine surgery during the mid-1900’s, leading to new techniques for the treatment of both neck and lower back conditions. By the 1990’s, Neurosurgeons were performing much of the neck/cervical spine surgery while Orthopedic surgeons were developing fixation techniques still used today for thoracic and lumbar surgery. In some hospitals and regions, it became common for Orthopedic surgeons and Neurosurgeons to work together in the operating room. Over time, this led to changes in medical training and overlap in surgery expertise between the two groups of specialists. This remains true today and in modern training of Spine surgeons, there is no difference in technique or approach to care between Orthopedic Spine surgeons and Neurosurgeons.
While it is commonly questioned by patients that Neurosurgeons may have more experience in “nerve surgery”, the reality is that the techniques used in Spine surgery are exactly the same regardless of the training background. Nearly all Orthopedic Spine surgeons complete a residency training program (which covers a wide breadth of Orthopedic surgery) and then go on to complete additional Fellowship training in Spine surgery. Roughly half of Neurosurgeons complete additional Fellowship training in Spine surgery, mostly due to the fact that Spine surgery makes up a larger percentage of their residency training. Recently published studies have demonstrated equivalent training between the two specialties. In the future, Spine surgery may eventually have it’s own dedicated residency program rather than splitting the training between Orthopedics and Neurosurgery.
So what’s the answer? Both Orthopedic Spine surgeons and Neurosurgeons can help you achieve a successful outcome. But you may want to consider the following factors when choosing a surgeon right for you:
Make sure your surgeon is board certified, Fellowship trained in Spine surgery, and focuses only on Spine surgery.
Your surgeon should ideally perform greater than 200-300 spine surgeries per year. This demonstrates a focus on Spine surgery.
You should feel comfortable with your surgeon. Your surgeon should discuss alternatives to surgery and listen to your goals and not just treat your MRI. The relationship between you and your surgeon is important, especially given the long term care needed for many spine-related conditions.