Now more than before, spinal pain sufferers have many choices for treatment. Along with these choices comes more patient responsibility to understand all the options. We think that help can begin even before you walk in the door by giving you the right questions to ask before choosing your spine surgeon.
When considering surgery, every patient should keep in mind that spine surgery is almost always an elective procedure, and there are very few times that spine surgery is absolutely essential. You are the only one who knows how bad your pain is, and the decision to proceed with surgery is absolutely your decision.
What is the surgeon’s role?
The surgeon’s role is to educate you and assist with the decision-making process – providing you with information about your full range of options, and describing what is technically possible, the difficulty and risk of the procedure and potential benefits. Therefore, it’s important that you select a surgeon who is helpful in providing you the information you need to decide whether or not to proceed with surgery
Which Surgeon? Orthopedic Surgeon vs. Neurosurgeon for Spine Surgery
When patients are considering having spine surgery, one of the most common questions they have is “which is better, a neurosurgeon or an orthopedic spine surgeon?” The quick answer is that for most types of spine surgery, both specially trained orthopedic surgeons and neurosurgeons may be considered.
Neurosurgeons are Medical Doctors, and have completed a 4 year specialist programme focused on the surgical treatment of neurological conditions. Neurosurgeons are trained in the diagnosis and treatment of disorders involving:
Some neurosurgeons specialize exclusively on brain surgery, some on spine surgery, and some split their practice between the two.
Orthopedic surgeons are Medical Doctors who have completed a 4 year specialist programme focused on the treatment of musculoskeletal conditions. Orthopedists specialize in the diagnosis and treatment of almost all bone and joint disorders.
Some orthopedic surgeons focus their practice exclusively on spine surgery, some on other types of joints (e.g. hips, knees, shoulders), and some split their practice among two or more areas.
Is the spine surgeon fellowship trained?
Both neurosurgeons and orthopedic surgeons may complete fellowship training to do most types of spine surgery, but there are a few types of spine surgery in which one specialty tends to be more qualified than the other, such as:
Orthopedic surgeons tend to be better qualified to do spinal deformity surgery, e.g. scoliosis, other types of spinal deformity.Neurosurgeons tend to be more qualified to perform intradural surgery (surgery inside of the dura in the spinal cord), e.g. thecal sac tumors.
Both orthopedic surgeons and neurosurgeons may extend their training after residency by participating in a spine fellowship program. These fellowships provide additional, specialized training for orthopedic surgeons and neurosurgeons that have successfully completed their residency training and earned their board certification or eligibility in their specialty. The fellowship is a marker of a surgeon who has chosen to specialize in spine surgery and is willing to make the extra investment in training to become more skilled.
How much of the spine surgeon's practice is specifically spine procedures?
When a doctor has a spine problem, you can bet they choose a surgeon that spends most, if not all, their time treating related spine conditions. Get the numbers - how many of your specific procedure have they done? Another very important factor is the amount of the surgeon’s practice devoted to spine surgery. A physician who focuses on spinal surgery is going to be far more adept and current in newer surgical techniques then one who performs spine surgery only occasionally. For example, the North American Spine Society requires that at least 50% of a physician’s practice be devoted to spine treatment as inclusion criteria for the society, which is probably a pretty good benchmark.
How do they educate you on your diagnosis and treatment?
When a surgeon and his or her staff takes the time to educate you on more than just the basics, you should get a pretty good sense of how up to date they are with the latest technology and research. After spending some time talking to the doctor and support staff, ask yourself, has their process made you feel confident you are working with the best treatment provider possible? If they make you feel like asking a question is uneccessary or an inconvenience, that's should be a big red flag.
What do other doctors you trust recommend, and why?
Ask your doctor who they would recommend and why. Listen closely to the answer, and ASK questions. Has he or she referred other patients? How many? For what? How long ago? How did it go?
Ask other patients.
Typically, a busy surgeon with a track record for successful outcomes leaves a trail of patients. Many you may already know. If not, unfortunately, privacy laws create a situation where physicians are restricted from sharing this information without permission. But your spine surgeon should understand the anxiety and importance of the decision, and do whatever they can to put you in touch with people who have received similar procedures.
Insights on Choosing a Spine Surgeon
For most types of spine surgery, the real question to ask is not whether to select an orthopedic surgeon or neurosurgeon, but rather “what specific surgeries does this surgeon specialize in?” For example, some surgeons have a deep expertise in certain kinds of cervical spine surgeries. Others will devote a third of more of their practice to operative intervention for lumbar disorders. So more telling questions to ask your surgeon are: how many of these specific surgeries do you do each year? How much of your practice is focused on this specific type of surgery? All types of spine surgery have a steep learning curve, and as a general rule, surgeons with more experience in the surgery will have better results. You should also enquire as to what complications they have had.Other questions, such as the surgeon’s outcomes for the specific surgery in question, are also important.