For Spine surgery: Neurosurgery or Orthopaedics?

  • Neurosurgery

    Votes: 35 76.1%
  • Orthopaedics

    Votes: 11 23.9%

  • Total voters
    46

Good Mountain

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Three questions:

If you need a spine surgery, would you choose a nuerosurgeon or a orthopaedic?

If you want to enter into the spine surgery field, would you enter through neurosurgery or through orthopaedics?

what are the pros and cons of each?
 

DrRobert

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I would go to a neurosurgeon.

There have been debates about this on here in the past - you might want to do a search. One thread in particular had well-supported arguments from an orthopod and a neurosurgeon.

The crux of the neurosurgeon's argument revolved around the fact that they do much, much more spine surgery during their residency and thus a fellowship would be useless. In addition, the amount of experience that an orthopod may gain during fellowship still does not compare to the experience that a neurosurgeon gains during his/her training.

disclaimer: I am personally neither an orthopod nor a neurosurgeon. Also, just like in any other job, skill varies from person to person. There are some orthos that are better than some neurosurgeons at spine cases, and vice versa.
 

OB/GYN Sim

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Orthopaedic because I find working with bones to be more interesting than surgery on the brain. Also the patients are often better in ortho.
 

LuckyMD2b

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I'm applying in ortho and think spine's pretty cool.

I think I'd choose my surgeon based on the surgeon and not his/her specialty. If you had spinal stenosis, you probably won't go wrong with an ortho spine guy who's done laminectomies and discectomies all day every day for his whole career.

I think if I knew I wanted to do spine and that's it; I'd probably go with Neurosx. If you think of the entire breadth of spine pathology Ortho spine is limited. That said Ortho spine guys have more than enough work to do.

4 me personally i think i'll like an ortho residency a lot more than neurosx residency, cuz there's other stuff in ortho that I prefer over neurosx e.g.:
(ortho trauma >> neuro trauma) (sports med >> anything in neurosx)

So that clinches it.
 

Dimoak

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Yeah, I believe there has also been a pretty indepth discussion regarding this either in this, or another forum. I don't remember much of it, but I believe that it was mentioned that the majority of spine cases are often diverted to the Neurosurg service because the Orthos may not feel as comfortable working with all of the complex and sensitive nerve systems in and around the spinal cord. I'm no expert, but I believe most spinal cases are often managed by a team that includes both a Neurosurg and an Orthopod, due to the necessity of precision both in the nervous system as well as the bone structure of the spine itself.
 

dawg44

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Neurosurgeons are probably better at the exposure.
Orthopods are better at dealing with bone obviously, so they probably have an edge in achieving stability and fusions with instrumentation.
Which is what I have seen at some hospitals the neurosurgeon does the exposure and the orthopod comes in and does the instrumentation.
 

Bombrainiac

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Neurosurgeons are probably better at the exposure.
Orthopods are better at dealing with bone obviously, so they probably have an edge in achieving stability and fusions with instrumentation.
Which is what I have seen at some hospitals the neurosurgeon does the exposure and the orthopod comes in and does the instrumentation.
This is NOT the norm for sure. The surgical approach to the spine is easy for the vast majority of spine cases, so there's not need to have an "approach surgeon" unless you're doing an anterolateral or anterior approach where a vascular or general surgeon would be helpful (although there are neurosurgeons and orthopedic spine surgeons who sometimes do those approaches by themselves -- not something I would recommend, though).

The debate here is simple and someone else on the thread already mentioned it. Choose your surgeon, not their specialty. Orthopedic spine surgeons cannot go intradural, whereas neurosurgeons can go anywhere in the spine. Orthopedic spine surgeons also don't general deal with the craniovertebral junction, but, on the other hand, they are may be more comfortable dealing with low sacral/pelvic pathology. More orthopedic spine surgeons seem to get into scoliosis surgery/major deformity work, whereas most neurosurgeons do not (mainly because it requires a humongous referral base and it's painful surgery, and neurosurgeons are busy with the rest of their neurosurgery practice).

The other factor I would consider, and I hope I'm not offending any orthopedic surgeons out there, is that orthopedic surgeons have a reputation of being good technicians, but terrible doctors…meaning, they don't know how to truly take care of a sick patient. Neurosurgeons, on the other hand, are intensivists by training and the specialty board exam they pass qualifies them to be intensivists. A lot of their training involves sick patients, and they are generally very skilled at taking care of sick patients.

And FINALLY, I would say that orthopedic surgeons and neurosurgeons often work together and consult each other, so the spine world is truly a mixed bag with much more collegiality and crossover of training methods and skills than ever before. For example, neurosurgeons are training orthopedic spine surgeons and orthopedic spine surgeons are training neurosurgeons in fellowships and residency programs across the country.
 

doc05

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Neurosurgeons are probably better at the exposure.
Orthopods are better at dealing with bone obviously, so they probably have an edge in achieving stability and fusions with instrumentation.
that's a ridiculous assertion. why would you say that??


Which is what I have seen at some hospitals the neurosurgeon does the exposure and the orthopod comes in and does the instrumentation.
nonsense - when this is done, it's usually to share/maximize the billing, nothing more.
 

KinasePro

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Excellent surgeons from either training path will give equivalent care. Really doesn't matter.

But for your garden variety spine surgeon in Anytown USA, based on my experience I'd vote ortho. Ortho spine (as a stereotype) is more adept at placing hardware... they obsess over fixation, always get orthogonal views, and are more familiar with the wide variety of bone quality out there in the population. Also no offense to the neuro guys, but ortho tends to have narrower (i.e. better) indications for surgery and broader differentials, therefore operating less (I've seen a lot of people with hip arthritis/carpal tunnel/ biceps tendonitis get spine surgery by nsurg...) Sure neurosurgery gets more spine in residency... but that spine training is with other neurosurgeons, so these particular shortcomings are propagated. Ortho spine also dominates deformity, and most neurosurgeons need to train with orthopaedists to acquire that skill set. As they say, "if you can do spinal deformity, you can do any spine surgery." Many of the pioneers of modern spine surgery are orthopaedists (Lenke, Bohlman, Garfin...).

Pediatric deformity is ubiquitous, and adult deformity is more common than you may realize. With all the adjacent segment disease brewing in the community, the need for deformity correction is only going to grow.

Ortho has no restrictions or specializations on level of the spine as mentioned previously... any decent fellowship-trained ortho spine surgeon will place C1 lateral mass screws, fuse occiput to T1, etc...

That said, anything intra-dural is neurosurgery's jam. But the only thing interesting inside the dura is a lawsuit (jk), and those cases are less common compared to the usual adult degenerative conditions. I'll reiterate, a good spine surgeon is a good spine surgeon regardless of training path. There are plenty of neurosurgery giants in the field, and they will always be an important part of spine care and research advancing the field.
 
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