Orthopaedic surgeons are experts in bony healing, bone physiology, and examination of the extremities and the musculoskeletal system. Their background enables them to evaluate all conditions related to the musculoskeletal system with high levels of accuracy. During their residency,orthopaedic surgeons learn about all sub-specialties in the field including: sports injuries, trauma to the musculoskeletal system including the spine, foot and ankle, joints of the extremities, pediatric orthopaedics, hand and upper extremity, spine, and tumors involving the bones and soft tissue of the spine and musculoskeletal system. They specialize in fixation of broken bones and reconstruction of muscle, tendon, and ligament injuries. This training provides them with knowledge of implantation of plates, screws, and rods to fix deformities and injuries to the bone. They are truly bone experts.
Neurosurgeons spend their residency learning about the specifics of cranial and brain pathology (tumors, trauma, and vascular abnormalities). They also learn about the peripheral nerves and the spine. Both surgeons are generalists in their fields unless they pursue additional fellowship training in a specific field. Some fellowships combine the best of both approaches with professors that are both Neurosurgeons and Orthopedic surgeons. These fellowships are not common and typically very difficult to be selected to. Only the top medical students are able to gain acceptance into orthopedic and neurosurgical residencies.
Competitive fellowships may be even more difficult to obtain due to the small number of fellowships available. When combining the background of an orthopedic surgeon whose expertise is in understanding bony healing and the mechanics of bony fixation with the specialized fellowship training in spine (particularly in a combined neuro/ortho fellowship), an orthopedic spine surgeon is uniquely qualified to handle from the simplest to the most difficult of spinal conditions. Most problems in the spine arise from the disc, bone, and joints of the spine. Therefore, when a problem exists with the nerves or spinal cord from external pressure, it usually results from a problem outside the nerve. This requires the expertise of a surgeon skilled in addressing the soft tissue and bony pathology causing pressure to be placed on the nerves. Many patients suffering from Migraine headaches in fact have cervical (neck portion of the spine) pathology causing neck and headache pain. These patients are mistakenly diagnosed with migraine headaches when the true diagnosis is cervical instability or degenerative disc disease causing malalignment or compression of the nerves and/or spinal cord resulting in referred pain to the neck, base of the skull, and headache pain. Particularly in the case of instability or scoliosis/deformity of the spine, the biomechanics of the spine have to be well understood by the surgeon in order to provide the most accurate diagnosis and treatment. Additionally, many times a pinched nerve results in radiation of pain to the shoulder, hip, and/or knee. A surgeon adept at differentiating the location of the pain because they have expertise in examining the extremities to know the difference between a spine problem or an extremity problem is best able to locate the source of the pathology.
Therefore, orthopaedic surgeons with spine training who understand extremity diagnoses along with spinal diagnoses can help to accurately diagnose the problem. If the wrong surgery is selected or the wrong type of spinal implants issued, a surgery is likely to fail. The subtleties of the spine are typically best understood by surgeons who have fellowship training, particularly those trained at the nation’s leading institutions. Both neurosurgeons and orthopedic spine specialists treat conditions such as:
Degenerative Disc Disease (arthritis of the spinal disc),
Spinal Stenosis (crowding of the nerves from arthritic changes),
Instability or slippage of the spine (spondylolisthesis),
Pediatric Spine (Less than 15yo)
As Neurosurgeons and orthopaedic surgeons break down the barriers that once divided them, more advances are being made in the field of spine surgery. The collegiality forming enables each to share the strengths provided by their unique training to enhance the approach to spinal pathology and the techniques to treat it. As with all professions, quality varies from person to person and training program to training program. Therefore, it is important to do your research. Important questions to ask as a patient are “Where did my surgeon train?”; “Is he/she fellowship trained?”; and probably the most important question is, “How are his/her patient outcomes?”. Doing research on the patient outcomes of a particular surgeon will give you the best idea of the type of outcome to expect. The only reliable way to grade a surgeon is by the success of their surgeries-not by the time they have been in practice or how fancy their office looks or the titles they have been given. Success can best be defined by how happy the surgeon’s patients are after treatment. Ask patients in the waiting room about your surgeon. See how their surgery turned out. That is where the truth lies.