Neurosurgeon vs. Orthopedic Surgeon for Spine Surgery [2020 Update]

When it comes spinal surgery, there’s a lot of confusion in the healthcare industry surrounding the difference between a neurosurgeon and an orthopedic surgeon.

That confusion is well-warranted and runs so deep that even referring physicians don’t fully understand the difference between the two professions. 

Both perform spine surgeries, both claim to provide cutting-edge, minimally invasive procedures and both can specialize in the spine. The truth, however, is that the two fields are very different and can provide patients with very different surgical outcomes.

In this article, we’ll explore the similarities and, more importantly, the differences between orthopedic surgeons and neurosurgeons and will help shed some clarity on the unique characteristics of each of these distinct medical professions.

Here is the answer in a nutshell: 

What is the difference between a neurosurgeon and an orthopedic surgeon?

The biggest and most fundamental difference between the two physicians is also the most obvious: orthopedic surgeons and neurosurgeons receive different training in different medical fields.

Indeed, even where these fields happen to overlap, as in the case of orthopedic surgeons and neurosurgeons who both treat the spine, the primary difference between orthopedic surgeons and neurosurgeons will always come down to a difference in training and specialized competence.

How have these two distinct worlds become so intertwined?

In order to answer that, we need to first look at the state of back pain in the U.S.

Back Pain in the United States

Neck and back pain are among the most common medical issues facing Americans today. Roughly 65 million Americans report recent back pain, while nearly 16 million report suffering from chronic back pain.

This pain can often and easily interfere with daily life and activities. Approximately 60-70% of adults will experience back pain during their daily activities, while 20-70% will experience neck pain that interferes with their daily life.

Even though most of the people who suffer from neck and back pain do not need to seek consultation with a surgeon, some most certainly suffer from conditions for which surgical treatment is necessary. These are mostly patients whose neck and back pain is recurrent, persistent, resistant to non-surgical treatment, and seriously debilitating.

The Confusion

For these patients, spinal surgery is a viable treatment option and this is often where the confusion begins.

But when considering spine surgery, many patients don’t even know that neurosurgery and orthopedic surgery are two different fields. They simply look for a “spine surgeon” online and lack the information they need to know which specialist is the best choice for them and their treatment needs. Even many referring physicians don’t understand the difference between these two kinds of medical professionals.

Much of the confusion results from widespread use of the term “spine surgeon” to refer to anyone who is qualified to perform surgical procedures that affect the spine.

In recent years, “spine surgery” has come to be viewed by many as a kind of emerging medical subspecialty open to both orthopedic surgeons and neurosurgeons.

In common parlance, the term “spine surgeon” is often used by referring physicians to designate an orthopedic surgeon with some advanced training in spine surgery. This terminological coinage, however, serves to obscure the important differences in training, skill, and competence that separate orthopedic surgeons from neurosurgeons.

In addition, the Internet has only caused a further blurring of the lines between the two specialties. Vague marketing language, fake reviews, ads, flashy names for surgical procedures, paid “top-doctor” awards and more can lead uninformed patients to feel that anyone who calls themselves a “spine surgeon” does the exact same things as all the other spine surgeons online.

This simply isn’t the case and this confusion is dangerous.

The neck and back together constitute a complex musculoskeletal system supported by the spine, which itself is a crucial and delicate component of the central nervous system. In seeking surgical treatment for such a complex and fragile part of the body, it is imperative that patients know the precise qualifications and competence of their surgeon. Otherwise, informed consent and patient-doctor trust is not possible.

So what are those qualifications? And how can patients spot the difference between and orthopedic and a neurosurgeon?

We’ll start by defining the two medical fields of orthopedic surgery and neurosurgery before exploring the more specific differences between orthopedic surgeons and neurosurgeons in terms of training, competence, and specialization.

Summary:

The term “spine surgeon” is often used to describe a surgeon with some advanced training in spine surgery. This term, however, is vague and serves to obscure the important differences in training, skill, and competence that separate orthopedic surgeons from neurosurgeons.

WHAT IS ORTHOPEDIC SURGERY?

Orthopedics is the medical specialty that deals with issues related to the musculoskeletal system. This system comprises the body’s many bones, ligaments, tendons, joints, and muscles.

An orthopedic surgeon is trained to treat a wide variety of musculoskeletal disorders with an equally wide variety of surgical procedures. Some of the most common orthopedic procedures include knee arthroscopy and meniscectomy, hip replacement, and carpal tunnel release.

Orthopedic surgeons may receive training and education in a subspecialty. Some such subspecialties pertain to specific parts of the body, like the elbow or knee, while others pertain to types of surgery, such as adult joint reconstruction or pediatric surgery. Many orthopedic surgeons work with athletes in the field of sports medicine, treating for those conditions of the musculoskeletal system that only emerge with the stress, strain, and injury of athletic wear and tear on the body. And, yes, a few orthopedic surgeons do receive some additional special training in treating conditions that afflict the spine.

In fact, one spinal condition that is primarily treated by orthopedic surgeons is scoliosis.

Summary:

Orthopedic surgeons specialize in the musculoskeletal system, meaning that their focus typically falls on bones, ligaments, joints and muscles. They are typically the surgeons responsible for knee surgeries, hip replacements and athletic injuries.

WHAT IS NEUROSURGERY?

Neurosurgery is a medical specialty that deals with medical issues related specifically to the nervous system. Neurosurgery treats conditions affecting both the central nervous system, composed of the brain, spinal cord, and spinal column, and the peripheral nervous system, which is distributed throughout the body.

Neurosurgical care extends to both pediatric and adult patients. Some distinctive and important neurosurgical procedures include minimally invasive spine surgery, cervical spine surgery, brain tumor excision, and a host of advanced microsurgical repairs to the nervous system and to the cerebrovascular system.

Certain neurosurgeons may pursue additional specialization in a subfield within their specialty in order to better perform a specific type of brain or spine surgery.

That said, it is important to note that, as a medical field, neurosurgery is already extremely focused and specialized. Unlike orthopedics, which treats a wide array of conditions of which only a few concern the spine, neurosurgery specifically and exclusively treats conditions that afflict the spine and the broader nervous system of which it is a part.

Summary:

Neurosurgeons are specifically trained to treat issues dealing with the nervous system. This includes the spine, spinal cord and the brain.

Important Differences Between Neurosurgeons and Orthopedic Surgeons

So, having defined orthopedics and neurosurgery, what are the precise differences between the orthopedic surgeon and the neurosurgeon? The biggest and most fundamental difference is also the most obvious: orthopedic surgeons and neurosurgeons receive different training in different medical fields!

Indeed, even where these fields happen to overlap, as in the case of orthopedic surgeons and neurosurgeons who both treat the spine, the primary difference between orthopedic surgeons and neurosurgeons will always come down to a difference in training and specialized competence.

Training

Neurosurgeons and orthopedic surgeons receive remarkably different training during their respective medical residencies.

Neurosurgery residency typically lasts between 7-8 years. Neurosurgeons in residency receive daily training in both brain and spine surgeries, with about 60-70% of their time devoted to spine surgeries in particular. Some neurosurgeons may pursue an additional fellowship year in order to practice more with advanced or especially complex spine surgeries.

Orthopedic residency, by contrast, typically lasts only 5 years and most often involves only limited or occasional experience with spine surgery.

To make up for this limited exposure to spine surgeries during their residency, many orthopedic surgeons will pursue an additional year of fellowship training to learn how to perform surgeries on the spine. Some orthopedic surgeons will receive dual fellowship training, something that typically just means that the orthopedic surgeon in question worked alongside neurosurgeons early in his or her training.

Importantly, dual fellowship training does not make up for the difference in the type of surgical experience and exposure that obtains between neurosurgeons and orthopedic surgeons in residency.

Another important difference in training pertains quite simply to the amount of surgical experience available to neurosurgery and orthopedics residents.

In the United States, there are roughly 10x the number of orthopedic surgeons than there are neurosurgeons.[10] This is because only a small number of neurosurgeons are trained in the United States per year by design.

Since neurosurgeons are required to obtain the specialized microsurgical skill needed to operate on the brain as well as the spine, only a small number can be accepted for training. In practice, this higher selectivity translates directly into more first-hand surgical experience for neurosurgery residents as compared to orthopedics residents. The average individual neurosurgery resident simply gets much more surgical experience than the average individual orthopedics resident.

Specialized Competence

In addition to the differences in training and residency requirements, neurosurgeons and orthopedic surgeons are each equipped with unique and distinctive specialized competencies.

Neurosurgeons typically specialize in procedures such as minimally invasive spine surgery and other complex microsurgical procedures for conditions that affect the nerves within the spine.

Furthermore, only board-certified neurosurgeons are properly qualified to perform any operations inside the dura mater of the spinal cord (i.e., the interior of the spinal canal). This means that neurosurgeons alone possess the specialized competence to treat spinal tumors, symptomatic degenerative disc disease, spinal stenosis, spinal fractures, and other similar conditions.

Meanwhile, orthopedic surgeons who have specialized in spine surgery are generally better-suited to treat musculoskeletal deformities like scoliosis, kyphosis, and certain other spinal procedures that work with the pelvic area. The orthopedic surgeon receives specialized competence mostly in addressing the health of the bones and vertebrae in the spine.

Within the last 20 years, advances in technology have allowed for a certain degree of cross-specialization among neurosurgeons and orthopedic surgeons. Orthopedic surgeons have begun to acquire competence in nerve-related treatments, and neurosurgeons have become well-versed in traditional orthopedic procedures pertaining to bone growth, bone fusions, and orthopedic reconstruction.

As mentioned above, this cross-specialization has fueled use of the term “spine surgeon” to lump together neurosurgeons and orthopedic surgeons, even though no such specific medical profession as “spine surgery” in fact exists. But again, it’s important not to let a certain degree of overlap between neurosurgery and orthopedic surgery obscure the important differences highlighted above.

All this means that, while there are some areas of overlap between the orthopedic surgeon and the neurosurgeon, their specialized competencies diverge as much if not more than they converge.

Even though, with modern day advances in technology and education, both neurosurgeons and orthopedic surgeons are qualified to perform certain more or less routine operations on the spine, neurosurgeons most of all possess the degree of specialized competence appropriate to treat a wide array of important and difficult spinal conditions. This is especially true when it comes to any conditions that threaten the nervous or cerebrovascular systems directly.

Bottom Line

Agreeing to spine surgery of any kind is a significant decision that should not be made lightly. As always when pursuing serious surgical treatment, the best practice is to seek a consultation with several different surgeons before agreeing to be treated by any single one of them. Without a strong relationship of trust and confidence between you and your physician, you can’t be sure you’ve made the right decision when entrusting your neck, back, or spine into another person’s care.

When deciding who is best qualified to be your spine surgeon, there are many factors to consider. There simply is no single, universal answer that fits with every unique situation. Neither can anyone claim that either neurosurgeons or orthopedic surgeons are always the better choice. The only good choice is the choice that’s best for you.

The bottom line is that there are many capable neurosurgeons and orthopedic surgeons in the United States. The most important factor in choosing a surgeon is the rapport and trust that you feel after a consultation.

Spine surgery of any kind is significant and having a strong relationship of trust and honesty with your physician is incredibly important. Patients simply must feel confident asking their doctor specific questions about their education, their experience with spinal surgery, their results and practice focus.

In all of this, it’s important to keep in mind that neurosurgeons and orthopedic surgeons are not interchangeable professionals. They bring unique medical competencies and training backgrounds to the operating table.

As always, it is imperative that you practice informed consent and select the medical professional who is uniquely right for your needs.

But given the complexity, difficulty, and seriousness of spinal surgery, making sure to seek consultation with a qualified neurosurgeon is very much a best practice throughout your time researching. As we’ve explored in this article, neurosurgeons characteristically receive the best training, most hands-on preparation, and most focused specialization for performing spinal surgeries. More often than not, a neurosurgeon will offer the advanced medical care you need for performing microscopic, top-of-the-line spine surgeries.

References

1. Health Policy Institute, Chronic Back Pain, accessed Jan. 22, 2020, https://hpi.georgetown.edu/backpain/

2. Patricia L. Sinnott, PT, PhD, MPH, Sharon K. Dally, MS, Jodie Trafton, PhD, Joseph L. Goulet, PhD, Todd H. Wagner, PhD, Trends in diagnosis of painful back and neck conditions, 2002-2011, Medicine (Baltimore), May 2017, 96(20), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440123/

3. Dr. Mark Mclaughlin, Electricians vs Carpenters, accessed Jan. 22, 2020, https://www.markmclaughlinmd.com/articles/electricians-vs-carpenters

4. Perimeter Orthopaedics, What is Orthopaedics, accessed Jan 22, 2020, https://www.perimeterortho.com/what-is-orthopaedics.html, accessed Jan 22

5. Cedars Sinai, What are the most common orthopedic surgeries, accessed Jan 22, 2020, https://www.marinahospital.com/faq/what-are-the-most-common-orthopedic-surgeries Jan 22

6. The Centers for Advanced Orthopedics, Sports Medicine, accessed Jan 22, 2020, http://www.dcorthodocs.com/services/sports-medicine

7. Oregon Health and Science University, What is Neurosurgery, accessed Jan 22, 2020, https://www.ohsu.edu/school-of-medicine/neurosurgery/what-neurosurgery

8. North Shore Private Hospital, Neurosurgical Procedures, accessed Jan 22, 2020, https://www.northshoreprivate.com.au/Our-Services/Neurosurgery/Neurosurgical-Procedures#cervical

9. Rocky Mountain Brain and Spine Institute, Why You Should Choose a Neurosurgeon Over an Orthopedic Surgeon, accessed Jan 22, 2020, https://rockymountainbrainandspineinstitute.com/choose-neurosurgeon-orthopedic-surgeon/

10. American Association of Medical Colleges, Active Physicians by Sex and Specialty, accessed Jan 22, 2020, https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-sex-and-specialty-2015

11. Martin H. Pham, MD, Andre M. Jakoi, Arvin Raj Wali, BA, Lawrence Lenke, MD, Trends in Spine Surgery Training During Neurological and Orthopedic Surgery Residency: A Ten-Year Analysis of ACGME Case Log Data, Neurosurgery, Volume 66, Issue Supplement 1, September 2019, https://academic.oup.com/neurosurgery/article-abstract/66/Supplement_1/nyz310_113/5551722

12. Front Range Spine and Neurosurgery, When to See Neurosurgeons vs. Orthopedic Surgeons, accessed Jan 23, 2020, https://www.frontrangeneurosurgery.com/when-to-see-a-neurosurgeons-vs-orthopedic-surgeons/

13. Dr. Mark Mclaughlin, Electricians vs. Carpenters, accessed Jan 22, 2020, https://www.markmclaughlinmd.com/articles/electricians-vs-carpenters

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Atlantic Brain and Spine A graduate of both Yale and Stanford, Dr. Jae Lim is a board-certified spine surgeon who specializes in minimally invasive spine surgery and robotic spine surgery, significantly reducing surgical impact and recovery times. (703) 876-4270
8501 Arlington Blvd. Suite 330
Fairfax
Virgina
22031
United States
Jae Y. Lim Ben L. Nguyen