What is the difference between ortho spine and neuro spine ?

[piu]

hi just curious about the differences between these two programs and the routes to getting there. thanks =)

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[Vukken99]

Spine surgery was traditionally Neurosurgical field.
But ortho made it as their subspecialty...

I know that Neurosurgery can operate well on spinal cord aspect.
And, I think Ortho spine surgeons have some uncomfortable feelings about handling spinal cord. But ortho guys are just as good in the bony structure aspects of it

 

[Vukken99]

If you read Spine journal..

There was an issue in which the president of Spine surgery for neurosurgeons expressed how neurosurgeons allowed the field to be invaded by ortho guys.

But, they were optimistic that Neurosurgeons would regain greater control of this field.

But, I think if you envision being a spine surgeon then
it is much better to do a neurosurgical track then after completion
do a ortho spine surgery fellowship with combined faculty.

Somehow ortho spine surgery are less afraid to work on the bony structures.

 

[rotty1021]

Are ortho spine fellows trained in the treatment of spinal cord pathology, or just problems of the bony vertebrae?

 

[ecpiii]

I am sure I will catch some hell for this comment, but it is from the mouths of babes (AKA anesthesiologists, who track blood loss during a case) about the subject:

Neurosurgeons usually cause (at our institiution at least) about 1/3 of the blood loss during a typical fusion, from a liter (ortho) to a third of a liter (neurosurg) on average, usually worse when an ortho attending is doing the procedure. Other than that, most reputable studies on outcomes from spine journals cannot find much of a difference in outcomes.

By the way, Vukken99, I know of no neurosurgeon scared of bone. What do you think the grey matter is encased in??? Conversely, I don't believe any ortho guy who goes into spine has a stiffling fear of screwing up the nervous system. I bet they've seen those long, stretchy things before, perhaps somewhere around the joints. Bottom line is, I foresee learning from each other, hopefully limiting the number of people walking around with hardware overall. Cheers...

 

[Vukken99]

Once my senior neurosurgery attending told me
the different is that ortho guys are less concerned if i may say about the delicate nature of spinal cord...Sort of strange since consequences can be devastating.

But, Neuro guys are much more careful not afraid of working on bone....
It is different philosophy and approach...

I would prefer a Neurosurgeon with spine training to work on spine.
Not really a bias on ortho guys...

 

[Tenesma]

there is no real difference between ortho spine and neuro spine as far as outcomes.... however, in the event of dural tears - it always ends up w/ a neurosurgeon fixing it.... oh and the neurospine guys take longer because they have to do their ritual 3 hour prep w/ 8 million different drapes 😀 ... just kidding (but you guys know there is some truth to this)

 

[ecpiii]

If you think about what tenesma said, that is an argument for having neuro do it...What kind of technical mastery can you claim over a procedure if you aren't equipped to deal with a relatively common complication???

Oh, by the way, don't those ortho guys chew up time getting into their space suits? 😀 ... just kidding (but you guys know there is some truth to this)

 

[bluegill]

I spent one month in the OR on spine cases, 90% of which were Neuro and 10% Ortho. I found the neurosurgeons to be much more careful in their approach and instrumentation. They were also very meticulous about the precise location of the "hardware" that they left in place, which was not the case on the ortho $ide. They checked location with fluoro about 10 times, while ortho palpated and said, "okay, let's clo$e and get the next patient on call..."

And in terms of pre-op and post-op evaluation, there is no doubt that a neurosurgeon is better at evaluating neurologic disease/outcome. I noticed that the ortho $urgeons took people to the OR that the neurosurgeons would have turned away because they could admit that an operation would not decrease pain/symptoms. The ortho resident$ at my hospital $carcely know how to perform a decent neuro exam - they often consult neurology or neurosurgery for this task that all doctors should be able to do.

And no, I'm not going into neurosurgery. Just some objective observations from a good ol' general surgeon in training.