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Who has your back when it comes to back surgery?

By Dr. Burak Ozgur

Categories: Neurosciences

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 disc.

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 sides.

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 work together.

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 Spine Surgery.