Whom should you trust with your back surgery, a neurosurgeon
or an orthopedic surgeon?
When you require something as complicated as spinal surgery,
it is important to choose the right doctor and the right program. Neurosurgeons
and orthopedic surgeons have historically competed, with each specialty claiming
superior training for the complexity of spinal surgery.
Well, I completed both a neurosurgery residency and a combined
orthopedic surgery/neurosurgery spine fellowship, and I can tell you without hesitation
that the specialty to trust to operate on your back is … either one.
Rather than just ask what your doctor’s background is, also
ask how many minimally invasive procedures he or she has done. Find out from
nurses and other doctors about your surgeon’s reputation as a clinician. The
words on a person’s diploma are not nearly as important as experience and skill
when choosing the right spinal surgeon.
More and more, both sides are starting to agree: A skilled
surgeon can do it all, regardless of the specialty. So go with the person who
has the most experience and best outcomes.
This means finding a program that emphasizes conservative
treatment and minimally invasive surgeries. About 90% of back surgeries can be
done minimally invasively, which cuts down the length of hospital stay, the
recovery time, pain, and cost. These days, a good surgeon will work to make
sure your back surgery is performed with as much precision as possible.
Both specialties arrive at that ability differently. In
general, an orthopedic surgeon is better trained to understand the mechanics of
the body. The spine has a lot of complexity and joints to it, and orthopedic
surgeons are skilled at handling scoliosis and curves and hardware
implementation. Neurosurgeons, meanwhile, are typically better equipped to deal
with delicate elements like the brain, spinal cord and nerves. They tend to be
gentler, and better at decompression and freeing nerves from compression and herniated
Because of this, at the end of residency training, the
orthopedic surgeons and neurosurgeons emerge with quite different skill sets.
That is why I chose to do an extra fellowship and split my training between the
two specialties when I was a resident at the University of California, San
Diego Medical Center. I wanted to learn the tricks of the trade from both
At the time, my mentors thought I was crazy, but they let me
do it and I ended up publishing a textbook about minimally invasive surgery
with contributions from both sides.
Now, this type of dual training is catching on, with
surgeons willing to concede that it makes sense to learn from each other. That
collaboration is spilling over to hospitals. My partner at Hoag, for instance,
is an orthopedic surgeon, and on particularly complicated cases, we will often
So who really is the best surgeon? Specialists from both
sides will tell you it’s the clinician who is conservative and has expertise in
the spectrum of spine surgery including minimally invasive surgical techniques.
Your spine is way too important, and surgery puts you at
risk of complications – scar tissue, nerve injuries, and spinal fluid leakage,
to name a few. A conservative surgeon will exhaust all the other options, such
as physical therapy and medication before jumping into the OR.
Once you have tried the other options, and if it is clear that
surgery is your best or only option, talk to family friends, neighbors and find
out who, by word of mouth, is the best, most talented and conservative surgeon.
He or she could be a neurosurgeon or an orthopedic surgeon.
As long as he or she is a reputable and experienced minimally invasive surgeon,
you’re in good hands.
Dr. Burak Ozgur is
Chief of Service of the Hoag Neurosurgery Spine Program and is board-certified
by both the American Board of Neurological Surgery and the American Board of