Orthopaedists, Spine Surgeons, and Neurosurgeons
What should I know about spine surgeons?
Some surgeons may be a good choice as primary caregivers. Surgeons are thought of as performing only surgery, but that is generally not the case. There are some surgeons that only perform surgery and will only see a patient upon referral from a primary doctor. However, there are many great diagnostitions that have good conservative treatment guidelines. Only the rare surgeon has the surgical philosophy: "If all I have is a hammer, the whole world looks like a nail." Seek their counsel if you are only considering the surgical option. There are many ways to treat spinal disorders, and most of the time, surgery is only one of many options.
The orthopaedist is a surgeon and is formally trained for five years in a residency after four years in medical school. He or she is trained to treat all types of neurological and bony disorders, both surgically and nonsurgically. A good portion of this time is spent with spinal disorders. Most of these individuals have a very good understanding of the biomechanics and biomchemical nature of the spine and can design a good treatment program. Many, however, are becoming more specialized in specific treatment areas such as the knee or shoulder, and refraining from treating spinal disorders.
The spine surgeon is an orthopaedist who has taken an additional fellowship with a recognized program specifically to treat spinal disorders for an extra year after finishing the five-year orthopaedic residency. These individuals generally have an excellent understanding of the conservative and surgical treatment of the spine. Most only treat spinal disorders.
The neurosurgeon completes a surgical residency in neurosurgery that takes six years. They spend a good portion of their time with spinal disorders, and many are the equivalent of the spine surgeon in knowledge and understanding. Some neurosurgeons don't treat the spine, but perform brain surgery only. Some neurosurgeons take spine fellowships to increase their scope.
Should I Go to a Spine Surgeon or Neurosurgeon?
Today, there are very few differences between spine surgeons and neurosurgeons in regard to the spine and spine care. In the past, differences were more substantial. The orthopaedic spine surgeons come from a background of scoliosis and spine reconstruction, spinal fusion for instability. Neurosurgeons come from the tumor/decompression side.
Over the last ten years, the lines have been blurred, and in reality, there is minimal difference. Again, in my opinion, it is the surgeon himself or herself that makes the difference and not necessarily if he or she is a spine surgeon or neurosurgeon. About the only differences today are that most spine surgeons don't resect tumors in the spinal cord, and most neurosurgeons don't perform scoliosis surgery.
Donald S. Corenman, MD, DC is a practicing orthopaedic spine surgeon and chiropractor in Vail, CO and the author of Everything You Wanted to Know About The Back, a consumer's guide to the diagnosis and treatment of lower back pain. Click here for more information about the book.