Neurosurgeon or Orthopedic Surgeon — Which Should You See?

If you have an injury or condition that requires spinal surgery, you may be overwhelmed with your treatment options. A good place to start is to decide what kind of physician is best for you.

Neurosurgeons have traditionally been the providers of choice when spine surgery is needed. However, as the field of medicine has advanced, orthopedic surgeons have become qualified to operate on the spine, as well. While orthopedic surgeons work with the musculoskeletal system and have training in spine surgery, neurosurgeons specifically treat the spinal cord, brain and nerves.

Understand more about the differences and similarities between neurosurgeons and orthopedic surgeons to decide which to see for your back concerns.

What Are Neurosurgeons and What Do They Do?

Neurosurgeons are medical doctors who identify and treat problems that involve the nervous system, which comprises the nerves, spinal cord and brain.

Neurologists will refer a patient to a neurosurgeon if they believe the patient’s condition can benefit from a procedure or surgery. Neurosurgeons then typically meet with patients in a clinic and perform surgery at a hospital or surgery center.

In addition to performing complex brain and spine surgery, neurosurgeons perform other, less invasive procedures to treat a condition. Neurosurgeons will usually try nonoperative measures like medications, injections and physical therapy before suggesting surgery.

Neurosurgical Techniques

Following are some of the surgical and procedural techniques that neurosurgeons can perform:

Noninvasive surgery
Microsurgery
Endoscopic surgery, which uses a small camera to see in the body and operate on organs
Endovascular surgery, which can remove blood clots
Traditional open surgery
Chronic pain interventions

Diagnostic Tests

Neurosurgeons are also trained to administer and analyze tests used to detect neurological conditions, such as:

CT scan
MRI scan
Electroencephalography (EEG), which records brain activity
Positron emission tomography (PET) scan, which looks at organs’ biochemical functions
Magnetoencephalography (MEG), which looks at magnetic fields related to brain activity

Conditions

Neurosurgeons can treat the following conditions:

Carpal tunnel syndrome
Tumors of the brain
Cerebrospinal fluid (CSF) leak
Chronic neck or back pain
Congenital brain and spinal defects
Herniated disks
Hydrocephalus, which is a fluid buildup within the brain
Essential tremors
Brain aneurysms
Parkinson’s disease
Multiple sclerosis (MS)
Sciatica
Pinched nerves
Seizure disorders such as epilepsy
Spinal bone spurs, fractures and tumors
Spinal deformities such as scoliosis
Traumatic head, brain, neck or spinal injuries

Surgeries That Neurosurgeons Perform

Neurosurgeons perform various surgeries depending on which part of the nervous system is affected.

Brain surgeries may include:

Tumor removal
Blood clot removal
Aneurysm repair
Shunt insertion, which relieves pressure on the brain
Trauma repair
Brain bleed stoppage

Peripheral nerve surgeries may include:

Spinal surgeries include:

Discectomy
Spinal fusion
Stereotactic spine radiosurgery
Spinal stabilization and reconstruction

What Are Orthopedic Surgeons and What Do They Do?

Orthopedic surgeons are medical doctors who specialize in the prevention, diagnosis and treatment of conditions affecting the musculoskeletal system, which comprises the bones, muscles, joints, ligaments and tendons.

Because the field of orthopedics is so broad, many orthopedic surgeons choose to specialize in a specific area of the body. Common specialties include hand and wrist, foot and ankle, knees and the spine.

In addition to prescribing treatment and performing procedures, orthopedic surgeons can assist with rehabilitation after surgery and help patients adopt long-term measures to treat musculoskeletal issues.

If you’re referred to an orthopedic surgeon, you can typically expect to remain in their care beyond treatment. They will follow you through physical therapy until you are completely rehabilitated.

Orthopedic surgeons work in practices and hospitals. Often, the surgeon will consult with patients at a practice and perform surgery at a hospital or an outpatient surgery center.

Conditions Orthopedic Surgeons Treat

Orthopedic surgeons work on more than just broken bones and arthritic joints. They also treat:

Sports injuries
Back pain
Bone tumors
Hip dysplasia
Limb lengthening
Osteoporosis

Noninvasive Treatments

Orthopedic surgeons usually try noninvasive treatment methods before suggesting surgery. Some of these procedures include:

Fluid drainage
Steroid injections
Bracing, booting and casting
Joint manipulation
Physical therapy

Common Orthopedic Surgeries

Orthopedic surgeons can perform a wide range of surgeries, like:

Fusion: Also known as arthrodesis, this surgery immobilizes a joint by fusing the adjacent bones.
Internal fixation: This procedure reconnects broken bones with hardware like screws, rods and plates.
Arthroscopy: This minimally invasive procedure allows the surgeon to see inside a joint and diagnose any problems.
Osteotomy: In this procedure, surgeons cut bones to realign or reshape them.
Soft tissue repair: This surgery repairs the muscles, tendons and ligaments surrounding a joint to enhance joint stability.

Difference Between Neurosurgeons and Orthopedic Surgeons

While the roles of neurosurgeons and orthopedic surgeons can overlap, the main difference is in their training and specializations.

Training

Neurosurgeons and orthopedic surgeons undergo significantly different training during their medical residencies. A residency is the period of training doctors receive after graduating from medical school.

Neurosurgeons spend around seven years in residency. During this time, they train in both brain and spine surgeries. They may complete an additional fellowship to train in more advanced, complex surgeries.

Orthopedic surgeons have a shorter residency of around five years. Because they train in all types of bone surgeries, their experience with spine surgery is more occasional and limited than that of neurosurgeons. Orthopedic surgeons may choose to complete a fellowship to build on their surgical experience.

Specializations

Neurosurgeons and orthopedic surgeons are each armed with specific competencies.

Neurosurgeons specialize in minimally invasive surgeries for conditions that affect the brain, spinal cord and nerves. Only neurosurgeons are qualified to operate inside the spinal canal on what is known as the dura mater. This skill allows them to treat spinal stenosis, fractures, tumors and other similar problems.

Orthopedic surgeons’ competencies lie in addressing the health of the entire musculoskeletal system. Their scope is much broader than that of neurosurgeons. They can, however, choose to specialize in spine surgery. Orthopedic spine surgeons are best suited to perform surgery on spinal musculoskeletal deformities such as kyphosis and scoliosis.

Advances in medical technology have given rise to a degree of cross-specialization between the two fields. Orthopedic surgeons have gained competence in nerve-related treatments, and neurosurgeons have become knowledgeable in orthopedic surgeries like bone fusion and bone reconstruction.

Similarities Between Neurosurgeons and Orthopedic Surgeons

There is a degree of overlap between the training and work of neurosurgeons and orthopedic surgeons.

Work

Each of these surgeons works with the nervous system, and for neurosurgeons, it’s their primary focus. An orthopedic surgeon will consider the nerves in relation to the rest of the musculoskeletal system.

Crossover happens in the operating room. Neurosurgeons may conduct procedures that include bone grafts, like spinal fusions, and orthopedic surgeons may perform nerve-related surgeries, such as nerve repair in the arm or leg.

Neurosurgeons and orthopedic surgeons are skilled in nonsurgical treatment methods, as well. The goal is often to treat patients as minimally invasive as possible. Doctors may work through nonsurgical procedures with a patient first. If they don’t provide relief, doctors may perform surgery as a last resort.

Education and Training

All doctors undergo intense training for around 12 years. They attend college for four years, then medical school for another four years. Following is a residency of varying duration.

Neurosurgeons will fulfill a year of training in general surgery, then advance to the neurosurgery part of the residency. Orthopedic surgeons can train in all subspecialties of orthopedic surgery.

Most neurosurgeons and orthopedic surgeons then become certified by their respective organizations.

When to See a Neurosurgeon

Neurosurgeons can treat many conditions, diseases and disorders of the nervous system. While they can perform various surgical procedures to treat these issues, their offerings extend to nonsurgical interventions, also known as conservative care.

Your primary doctor may refer you to a neurosurgeon if you’re experiencing severe illness or discomfort related to:

Persistent numbness or pain in the neck, back, arms or legs, which may be a sign of nerve damage
Frequent dizziness or trouble balancing
Abrupt loss of vision
Seizures
Weakness
Long-lasting headaches or migraines, which may be caused by overstimulated nerves

Doctors may refer patients to a neurosurgeon when a particular diagnosis has been reached or when their condition cannot be alleviated with nonoperative measures like pain medication or physical therapy.

When to See an Orthopedic Surgeon

You may be referred to an orthopedic surgeon if you’re experiencing pain in a bone, joint or muscle or if movement is causing you discomfort. If you are stiff, swollen or have suffered an injury to a bone, joint, muscle or ligament, an orthopedic surgeon is who you should typically see.

Orthopedic surgeons also assist with recovery from serious injuries and the prevention of future injuries. Athletes commonly work with orthopedic surgeons because they treat injuries like ruptured ligaments, torn tendons and broken bones.

You do not need to have an injury to consult with an orthopedic surgeon. You may see them to relieve chronic aches, pains or loss of mobility.

You may also see an orthopedic surgeon to treat issues that result from long-term conditions like:

Arthritis
Bursitis
Noncancerous tumors
Cancerous tumors that originate in the bone
Cancerous tumors that invade the bone
Blood cancers that can erode the bone

How to Choose Which Surgeon Is Right for You

The musculoskeletal and nervous systems are complex parts of the human body. Because the nervous system operates within and close to the musculoskeletal system, surgeons who treat conditions that affect these systems have similar and sometimes overlapping skill sets.

If you are considering spine surgery, you may wonder whether to choose a neurosurgeon or an orthopedic surgeon. For most types of spine surgery, both of these surgeons are capable. Both neurosurgeons and orthopedic surgeons operate on the spine, and many choose to specialize in spine surgery.

However, certain conditions and procedures require the expertise of a neurosurgeon. Only neurosurgeons have the training to operate beyond the bone and inside the dura mater, a thick membrane that surrounds the brain and spinal cord.

If you have an intradural condition, a neurosurgeon is often your best choice. Your primary care doctor can help you identify your condition and choose the right surgeon for you.

Questions to Ask Your Surgeon Before Back Surgery

If you are preparing for spine surgery, it’s helpful to ask your surgeon questions beforehand so you know what to expect. Following are some questions to help familiarize yourself with your upcoming procedure.

Questions About Your Surgeon

You can ask these questions about who’s performing your surgery:

How many times have you performed this operation?
Are you board-certified?
What is the success rate for this type of surgery?
Can you refer me to another physician for a second opinion?

Questions About Your Surgery

Ask these questions about the procedure itself:

What kind of surgery are you suggesting for me and why?
Can you explain the surgery in detail?
How long will the surgery take?
What side effects, risks or complications might I experience?
Who else will be in the operating room?
Are there any nonsurgical options to treat my condition?

Questions About the Postoperative Period

Understand the post-op period better with these questions:

How much pain might I experience and for how long?
How long will I stay in the hospital?
What medications will I be sent home with?
Will I need to wear a back brace after my surgery?
Who should I call if I have questions once I get home?
What signs or symptoms warrant immediate medical care?
How long can I expect to be out of work or school?
How long before I can drive again?
What are your expectations for my recovery?

How to Prepare for Spine Surgery

In addition to asking your surgeon the questions above, there are many things you can do to prepare yourself for spine surgery. Following these recommendations helps prepare your body and home for surgery.

Quit Smoking

Surgery candidates who smoke or vape are at increased risk of complications following surgery. If you smoke or use smokeless tobacco, you should quit at least a few months before your operation.

Review Your Medications

Certain medications and dietary supplements can interfere with your surgery or recovery. Your surgeon will review a list of medications to stop taking or avoid leading up to your surgery.

Coordinate Assistance

You will likely need assistance with household chores and transportation while you recover. Talk to family members and friends to make arrangements for help during your recovery period.

Prepare Your Home

You can take measures to make your home comfortable upon your return from the hospital. For example, place frequently used items within reach. Stock your freezer and pantry with foods that are easy to prepare. Purchase slip-on shoes so you can avoid bending over.

Seek Pain Relief and Revive Your Life

At the Spine Institute of North America, our goal is to find the cause of your back pain and help eliminate it. We understand how limiting back pain can be, and we want you to return to the life you deserve. Our team of board-certified spine specialists will look for the least invasive procedures to provide you with long-lasting relief.

When you’re ready to treat your back pain with minimally invasive procedures, schedule a consultation with the Spine Institute of North America. Together, we will discuss your spinal concerns and how we can help.

Sources:

Neurosurgeon or Orthopedic Surgeon — Which Should You See?