I am an orthopedic spine surgeon. Quite often my patients ask what the difference is between my specialty and neurosurgery. Some people assume that all spine surgeons are neurosurgeons. So, is there a difference and if so, what is it?
These days spine surgery is performed by two separate specialties, orthopedic surgery and neurological surgery (neurosurgery). There is a trend for them to merge into one specialty called “spine surgery,” but it has not happened yet. Because of the two separate training tracks, there are still some differences. I was fortunate to have training from both specialties during my fellowship.
There is no separate residency in spine surgery. One needs to go either through an orthopedic or neurosurgical residency to specialize in the spine.
I finished five years of an orthopedic surgery residency and then one year of a spine surgery fellowship that combined both orthopedic and neurosurgical training. Neurosurgeons have six or seven years of residency.
Up to this point, orthopedic and neurosurgical training curriculums differ to a significant degree, so each specialty has developed its own diagnostic styles and treatment techniques. As you will see below, these differences are gradually disappearing.
Differences in diagnostic approaches
While orthopedists learn in-depth musculoskeletal examination, neurosurgeons are keen on neurological exam.
Training in the musculoskeletal system helps orthopedists differentiate symptoms related to spine from pain caused by other bones and joints. As an example, the shoulder pain may come from either a pinched nerve in the neck or from a problem in the shoulder joint itself.
When it comes to imaging studies, neurosurgeons rely heavily on MRI that shows nerves primarily. Along with MRI, orthopedists will always request an X-ray and at times a CT-scan to evaluate bone structure and spine alignment.
Surgical techniques and clinical approaches
In the not-so-distant past, spine surgery required the presence of both an orthopedic surgeon and a neurosurgeon during the operation. The neurosurgeon would remove pressure from the nerves, and the orthopedist would correct the deformity and stabilize the spine with screws and rods.
These days, one doctor, the spine surgeon, regardless of the specialty, performs both parts. We use the same procedures, and the types of surgeries depend more on the individual doctor and not on his or her specialty.
At the same time, there are some differences in the type of diseases addressed by each field. Abnormalities of the spinal cord would be managed by the neurosurgeons, while scoliosis in children and adolescents more commonly would be treated by a pediatric orthopedist.
Crosstalk and gradual merge between the two specialties
As the field of spine surgery is developing, there is more interaction between both specialties. There are several societies and conferences, where we meet and share ideas. We use the same diagnostic and surgical techniques.
At Grace Clinic we developed a close collaboration between both specialties: together with my partner neurosurgeon Dr. Richard George we meet twice a week to discuss recent scientific literature and review challenging cases.
How do you decide which specialist to see?
In general, you can see either an orthopedic or a neurological spine surgeon for most of your neck- or back-related problems.
If there is a problem that requires a different specialist, you will be referred to them. This happens rarely and may include pathologies like spine tumors or complex spine deformity.
The main question is whether you are comfortable with the physician. One of the best ways to find the right doctor is to ask your primary care provider or talk to this doctor’s previous patients.
You are welcome to send us any questions through this website.