Neurosurgeon or Orthopedic Surgeon: What’s the Difference?

by lyndal, February 12, 2013

surgeon operating 300x225 Neurosurgeon or Orthopedic Surgeon: What’s the Difference? The spine is a complex anatomical structure. It is actually made up of bones, joints, muscles, ligaments, tendons, nerves, and the spinal cord itself.

Some doctors train to treat diseases of the bones, and these are called orthopedic doctors. Those who decide to perform surgery on the bones are called orthopedic surgeons, and some specially trained orthopedic surgeons can perform surgical procedures to treat back pain.

Doctors who specialize in the study of the nerves, spinal cord, and brain are called neurologists. Doctors who perform surgery on any of these organs are called neurosurgeons and have deeper training for all spine injuries.

The question then arises: which doctor is best suited to the back problem that I have? The answer is not a straight forward one, and the lines between these two types of surgeons are blurring. It is important to understand what each surgeon does and how that will impact your back condition and recovery time.

What is an Orthopedic Surgeon?

Orthopedic surgeons generally treat any gross deformation of the skeleton. If you have a fracture of a long bone, need a joint replaced, or experience trauma that impacts a bone, you will most likely need an orthopedic surgeon. Like their neurosurgeon counterparts, they undergo a rigorous four to five year residency in orthopedic medicine. In large facilities, they may actually experience as many spinal surgeries as the neurosurgeon, but in smaller cities, they may see a wide range of orthopedic bone injuries.

Like the neurosurgeon, they also have particular conditions that they specialize in. Most scoliosis cases – either adolescent onset or adult complications arising from scoliosis – are still treated by orthopedic surgeons.

However, they can also treat herniated discs with spinal fusion, perform minimally invasive surgery to relieve impinged nerves, and treat other spinal conditions in the absence of a more experienced neurosurgeon.

What is a Neurosurgeon?

Neurosurgeons are typically thought of as brain surgeons, but in fact, most of the surgeries they perform are on the spine. They will have a training program in neurosurgery, called a residency, which typically lasts five to six years. After this, they can choose to specialize in spinal surgery by taking a further training program known as a fellowship.

In larger medical facilities, there may be doctors who focus only on surgery of the brain or surgery of the spine. In smaller cities and hospitals, these surgeons will often handle both conditions.

Some procedures on the spine can only be performed by neurosurgeons, and these would include any procedure inside the dura mater, or the protective lining around the spinal cord. Examples of conditions only a neurosurgeon can treat include spinal cord tumors, Chiari malformation, spinal cord arteriovenous malformation, tethered spinal cord, spina bifida, nerve root tumors, and other less well known conditions.

If you have one of these particular problems, then you will be referred to a neurosurgeon.

Making the Best Choice

The availability of so many spine professionals is a boon to the patient, although it can be confusing at first. Making a choice may depend on the professionals available in your area. If you have less complex surgery required, an orthopedic surgeon will be qualified to perform the procedure. If the orthopedics department seems to mainly treat fractures and knee replacements, a neurosurgeon is a better specialist to help you with your back and spine problems.

One group of doctors is not necessarily better than the other. You must individually examine each doctor to find out their philosophy and specialty. You should not hesitate to ask a doctor for his or her credentials, where they have trained, and what procedures they have performed. If you need to find a doctor that is more in tune with you condition, it may be worth it for you to travel to the nearest large city and have your procedure performed by a specialist there.

Provided that you do not have any of the specific conditions treated by neurosurgeons, either doctor type should be able to help you. It rests on the abilities of the individual doctor, and you must ferret out whether he or she can help you most effectively.

The doctors at BASIC Spine who perform spinal surgery are neurosurgeons who have deep specialization in spinal procedures. This means that if you have any of the neurosurgeon-specific spinal abnormalities, we can help you with your treatment. In addition, all of our doctors have experience in spinal procedures, from simple spinal fusion to more invasive hardware insertion.

If you need help with your back, contact us for the opportunity to interview one of our neurosurgeons for more information.


    • Chris
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    • September 26, 2013

    My father is a board certified Gastroenterologist and a fellow of the American College of Gastroenterology. Over his career, he has become good friends with multiple Orthopedic Spinal Surgeons and Neurosurgeons. My dad's best friend growing up died from leukemia during his neurosurgical fellowship. He would always tell my father the same thing; that a Neurosurgeon will always do a much more softer, more aligned, more flawless job of performing surgery on a spine than an Orthopedic Spinal Surgeon. A large factor that contributes to a Neurosurgeon's capabilities over an Orthopedic Spinal Surgeon is their training. Neurosurgeons deal with extremely critical, precise, and careful surgical techniques. Think of it this way. What do you think with happen if an Orthopedic Surgeon accidentally sliced through a bone during surgery; he would reattach the bone, right? What do you think would happen if a Neurosurgeon accidentally sliced through a major nerve during surgery; the patient would become paralyzed, right? This is why Neurosurgeons are trained to perform much more critical, more precise, more careful surgical techniques than Orthopedic Spinal Surgeons, and that is why Neurosurgeons are the best possible choice for a spinal operation.

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      • September 26, 2013

      Chris, this is a really great response and your insight and experience living with this background in your family and sharing your view is what helps everyone better understand. Thank you and please feel free to share your views on our write ups. We thank you for your time! Best, BASIC Staff

    • Dr Arun L Naik
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    • July 20, 2014

    A commonly asked question in various forums on line. Spine surgery as a specialty is highly diversified. All neurosurgeons are trained spine surgeons. Some of the Orthopedists may have exposure in spine surgery during their training. But that is not true at least in my country. In most places Orthopedic trainees have patchy exposure. That is some thing to worry about. They should not think that spine is 'just another bone'. That's is when the trouble starts. Decision making is the most important thing in the success or failure of spine surgery. You operate on wrong patient, and you will repent for it. I have seen surgeons operating based on MRI scan findings. Many surgeons do not even know how to read images. All these factors have led to conclude that 'spine surgery is a dangerous procedure.' How true! Matter of the fact is do a smart research on the 'credentials' of the surgeon. Make sure that he has a good experience in operating on the most important 'bone' in your body. And finally take first hand opinions about that surgeons old patients. They will surely be your best source of information. While writing this comment, I am not judgmental, just that I have seen so many instances of improper unnecessary surgery on in the last 14 years of my practice as advanced spine surgeon in India. Dr Arun L Naik MD www-dot-neurospinesurgeonindia-dot-com

    • david moran
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    • September 9, 2014

    >> a Neurosurgeon will always do a much more softer, more aligned, more flawless job of performing surgery on a spine than an Orthopedic Spinal Surgeon. A large factor that contributes to a Neurosurgeon’s capabilities over an Orthopedic Spinal Surgeon is their training. Neurosurgeons deal with extremely critical, precise, and careful surgical techniques. Wow, what a bald assertion. It is sometimes true, maybe often true, that a neuro may propose a more conservative and less aggressive approach than an ortho (not always, though) --- a microdiscectomy instead of DLIF, say, for nerve decompression, because one sees no instability and the other is concerned about possible future instability. Sometimes it is the other way round, though. I think this sort of generalization should be taken with salt, and am kinda shocked at the response of the Basic staff. Certainly the ortho spine staff at say MGH or Baptist in Boston would find this anecdote dubious as generalization. I have no dog in this hunt, am not a doc nor related to one, but do have serious OA back problems and have seen many of these guys of both types. I say reasonably shop around as your insurance permits. But this definitive assertion is bunk.

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