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
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.