May 21, 2019

Referring Your Patients for Spine Surgery

By Jeffrey R. Carlson, MD


Simple back pain is the cause for 80% of annual physician visits, usually managed by Primary Care Physicians who are able to treat the condition effectively. When patients report with radicular pain, numbness and other symptoms indicative of a spine issue, they often are referred to a spine specialist – either an Orthopaedic Spine Specialist or a Neurosurgeon. In this article, I would like to compare and contrast these specialties for your consideration when referring your patients for a spine consult.

Both Orthopaedic Spine Specialists and Neurosurgeons are considered to be Spine Specialists. The major differences in the two can be found in the medical training each receives, how their patients are treated after diagnosis and how they are followed after surgery. 

Neurosurgeons are trained to diagnose and treat injury or pathology that affects the human nervous system. Their practice usually includes the brain, spinal cord, nerves and sensory ganglia, as well as the cerebro-vascular system. More and more Neurosurgeons are seeking fellowship training in spine surgery.

Neurosurgeons typically divide their practice and surgery time between pathology affecting the brain and conditions involving the spine. They may perform a cervical spine fusion one day, surgery to remove a brain tumor the next, and a procedure to treat a brain aneurism the next. The neurosurgeon may also choose an area of specialty – for example, pediatric brain surgery or a focus on diseases that affect motor control of the brain, such as Parkinson’s. 

Orthopaedic Spine Specialists are trained to treat musculoskeletal issues as well as spine pathology, which includes any spinal neurologic involvement. They complete a spine fellowship through an accredited spine program which may last a year after full orthopaedic training. The spine fellowship allows the specialist to focus solely on the cervical, thoracic and lumbar spine and to perform surgeries to repair structural problems caused by injury or disease, correct congenital deformities, scoliosis, pinched nerves and spinal cord compression, etc. Their concentration on the spine is key. They typically do not have training on diagnosis and treatment of the neurologic functions of the brain, but they diagnose and treat the neurologic component of any spine issue. Some Orthopaedic Spine Specialists may also complete combined fellowships in neurosurgery and orthopaedic spine to add to their surgical expertise, as I have. 

Orthopaedic Spine Surgeon training includes conservative, non-surgical methods which are typically the first line of treatment. The variety of non-surgical treatments range from stem cell therapy, muscular training and medical treatments to injections. When surgery is necessary, we closely follow our patients. Our basic training, and our continuous emphasis, is on the recovery of motion and function after bone and joint surgery. The theme of full functional recovery or returning to the athletic field is ingrained in orthopaedic surgery training.  

Orthopaedic spine surgeons put this into practice with their surgery patients as well.  We have discussions with our patients prior to spine surgery to reveal their expectations for their lives and favorite activities after surgery. We expect to have our patients return to physical functionality that is better than before their surgery. We oversee all aspects of post-surgical recovery and believe this emphasis on pre- AND post-surgical care gives our patients the best chance for an optimal outcome after spine surgery.

Jeffrey R. Carlson, MD is the President and Managing Partner of Orthopaedic & Spine Center in Newport News, VA. He holds a fellowship in Orthopaedic Trauma surgery and a combined Neurosurgery-Orthopaedic fellowship in complex spine surgery from Brigham and Women’s Hospital in Boston.