When most people think about what a neurosurgeon does, they think of surgery on the nervous system. When people think about what an orthopedic surgeon does, they think of surgery on the bones and joints. It’s easy to know you should see a neurosurgery for a brain problem and an orthopedic surgeon for a knee problem. But who should you see when you have a problem with your spine, which involves both your nervous system and bones?
Both neurosurgeons and orthopedic surgeons are trained in spine surgery. In most instances, either specialty can treat most conditions. However, there are both good and bad neurosurgeons and orthopedic surgeons. Therefore, you should always research who is treating you to make sure they have good outcomes, use the most up-to-date and advanced techniques and that you are comfortable with the surgeon. However, there are a few differences worth noting.
Training
Neurosurgery residency is usually 7-8 years. During that period, a neurosurgeon will spend every day of that training performing both brain and spine surgeries. In fact, about 60-70% of that time is spent performing spine procedures alone. As the neurosurgeon at Rocky Mountain Brain & Spine Institute, I can say that during my residency training, I did over 1,000 spine procedures. For this reason, many neurosurgeons do not pursue fellowship training in spine following residency, as they are already highly trained in the spine. Orthopedic residency training is usually five years. During that period, an orthopedic surgeon will be trained to perform all types of joint surgeries on the shoulder, elbow, wrist, hand, hip, knee, foot and spine. The exposure specifically to spine surgery during orthopedic residency may be limited, so most orthopedic surgeons spend an additional year in fellowship training to learn spine. Overall, most neurosurgery residents probably see more spine procedures in their residency than do orthopedic residents/ fellows combined, depending on the program.
The hands-on experience also varies among neurosurgical and orthopedic training programs. There are usually only two residents per year in a neurosurgery training program. There are usually about 8-12 residents per year in an orthopedic training program. The number of surgeries available for each resident to be trained should not vary. This means that the average individual resident often gets more surgical experience during neurosurgical residency than orthopedic residency.
Lastly, since neurosurgeons are specifically trained to preserve and work carefully around the nervous system, some argue that treating conditions compressing the nerves such as disc herniations, spondylolisthesis or tumors are better treated by a neurosurgeon. This of course is a subjective opinion. Scoliosis, on the other hand, which involves primarily correcting the bone alignment may be better treated by orthopedic spine surgeons. Again, this is subjective as neurosurgeons also treat scoliosis.
Outcomes
A surgeon’s outcomes will always vary and be independent of specialty. No matter which specialty spine surgeon you see, verify their outcomes. This is best achieved by knowing someone else who had surgery with this provider. Internet rating sites can be highly manipulated and misleading. However, multiple recent studies have researched general cost and complication rates between neurosurgery and orthopedic specialists.
In a recent study comparing the cost of fusion, the differences in cost did not appear to vary between specialty but more so between individual surgeons. Therefore, it’s important to inquire about a surgeon’s costs before undergoing surgery. Some surgeons operate at surgery centers where they are a partial owner. Some surgeons have contracts with instrumentation companies and only implant expensive instrumentation which makes them more money. It’s important you know if your surgeon has special financial relationships that may raise the cost of your surgery. The financial relationships may also affect the outcome of surgery as the surgeon may be using faulty instrumentation from a small irreputable company because they are paid to do so.
A large study recently compared complications between neurosurgeons and orthopedic surgeons performing lumbar spine procedures from a database of 50,000 patients. Patients who underwent orthopedic surgery were twice as likely to have a prolonged hospital stay (more than four days) and more likely to need a blood transfusion, suffer major complications, need to return to surgery within 30 days and to require continued care after hospital discharge.
Minimally Invasive Spine
Both neurosurgeons and orthopedic surgeons can perform minimally invasive spine procedures. Be careful of surgeons that say they are “minimally invasive” because many surgeons just use this as a marketing ploy. Traditional back surgeries require an incision about 6 inches long. Some surgeons claim to perform ‘minimally invasive” procedures just because their incision is only 4 inches long or place instrumentation using a robot or navigation. You want to choose a neurosurgeon or orthopedic surgeon that can perform true minimally invasive spine surgery using tubular retractors and muscle sparing techniques. These incisions tend to be much smaller around 1 inch or less. However the real benefit is preserving the muscles and avoiding disruption of adjacent levels.
At Rocky Mountain Brain & Spine Institute we provide truly minimally invasive spinal procedures. Contact us today with any question you might have or to schedule your consultation.
