It is important for patients to realize that both neurosurgeons and orthopaedic surgeons perform spine surgery. Currently, neurosurgeons and orthopaedic surgeons seek different certifications from the Belgian health ministry. It is very important that patients make sure that their doctor is certified in either neurosurgery or orthopaedic surgery. All neurosurgeons and orthopaedic surgeons trained in the European Union gain experience in the diagnosis and non-surgical and surgical treatment of spinal disorders during a six or seven year residency training program, after medical school. When physicians graduate from an accredited neurosurgery training program, they usually have assisted in many hundreds of spinal procedures.
Though most patients think of neurosurgeons as “brain surgeons”, it is interesting to know that the majority of operations performed by neurosurgeons across the country are spine surgeries. In large group practices and certainly in university neurosurgical departments, some neurosurgeons specialize in brain surgery and do very little spine surgery. In these settings, they will have a colleague who specializes in spine surgery.
All orthopaedic surgeons are also exposed to spine surgery during their training program. Some orthopaedic residencies are at institutions where there are one or more orthopaedic surgeons who specialize in spine surgery. At these institutions, orthopaedic residents in-training may be exposed to a volume of spine surgeries comparable to neurosurgery programs. In some orthopaedics training programs, the emphasis is on trauma or joint surgery or on sports medicine.
Today there is a large number of both orthopaedic surgeons and neurosurgeons who specialize in spine surgery. More and more, we are referring to each other as “spine surgeons” as the distinction between us is becoming nonexistent. Both neurosurgeons and orthopaedic surgeons specializing in spine surgery are skilled in taking care of disc herniation, disc degenerations, spinal stenosis, fractures of the spine, spondylolisthésis, bone tumours of the spine, etc.
There are a few areas where there still is a difference. Only neurosurgeons are trained to perform procedures inside the dura such as spinal cord tumours, arachnoid cysts, syringomyelia, Chiari malformation, spinal cord arterio-venous malformation, diastematomyelia, tethered spinal cord, spina bifida or myelomeningocele, tumors at the junction of the base of the skull and upper cervical spine, nerve root tumours, and a few other diagnoses still fall under the domain of the neurosurgeon. Similarly, both paediatric and adult scoliosis are still primarily treated surgically by orthopaedic spine specialists.
Anyway, orthopedic surgeons and neurosurgeons do not look at each other as competitors; rather, we look at each other as colleague with the same interests. Currently, a patient does not have to settle on a neurosurgeon who does “mostly brain surgery and a little bit of spine surgery” or an orthopaedic surgeon who does mostly “joint surgery and a little bit of spine surgery.” A patient today can seek consultation with either a neurosurgeon or an orthopaedic surgeon appropriately trained in spine surgery who has devoted his or her practice to spinal disorders.
Don’t be afraid to ask your surgeon about his training, practice focus, experience with whatever operation has been recommended, and whether you the patient have been presented all of the options that exist (regardless of whether your surgeon performs all of them or not). Don’t be afraid to speak up. It’s your body, your spine. Physicians place great value on educating patients to the best of their ability so that satisfactory decisions can be made and acceptable treatment initiated.