Surgical procedures

How to Choose Your Back Surgeon – Neurosurgery vs. Orthopaedics.

It may seem obvious that back surgery would be performed by an orthopaedic surgeon who knows about bones but what if your spine condition has neurological complications? Who is accredited to do what when it comes to spinal surgery? Can orthopaedic surgeons work with delicate nerve structures, do neurosurgeons know when to remove bone, ligaments, and discs? If you’re contemplating back surgery then read on to find out how to choose your spine surgeon.

Spinal Surgery Training

Neurosurgeons and orthopaedic surgeons are currently certified by separate medical boards but in many cases the knowledge acquired during training is very similar. Neurosurgeons are trained to operate on the central nervous system and peripheral nervous system and they are called on to perform procedures involving the brain, spinal cord, and various nerves outside the spinal canal.

Human spinal cord

Neurosurgical Expertise for Back Surgery

The education of neurosurgeons is the longest of any medical speciality so you can rest assured that your surgeon has substantial knowledge of spine conditions both in diagnosing and treating. Their experience is not just limited to surgery either, with neurosurgeons also taught about non-surgical interventions for conditions. During training as a neurosurgeon the resident will undertake numerous spinal surgeries and many continue to do so after choosing to specialize in neurosurgery where brain surgery also becomes part of their expertise. Neurosurgeons often perform more spinal surgery than brain surgery as many more people suffer from pinched nerves or spinal cord compression due to spine degeneration than suffer from problems in the brain treatable with surgery.

sciatic nerve

Neurosurgeons vs. Orthopaedics

The expertise of neurosurgeons and orthopaedic surgeons overlaps significantly, and although ‘spinal surgery’ is not a recognized field of its own in terms of having a regulatory body it is emerging as a viable career option for those interested. Whilst some neurosurgeons perform only brain surgery and call on other specialists when the spine is involved, there are also orthopaedic surgeons who concentrate on parts of the body outside of the spine. Joint surgery, sports injuries, and prostheses may be the particular specialties of some orthopaedic surgeons meaning that a neurosurgeon may be the better option, given the choice for back surgery.

Orthopaedic Surgeons for Back Surgery

Orthopaedic surgeons are knowledgeable about musculoskeletal conditions resulting in muscle tumors, fractures, ligament damage and degeneration, and other chronic and acute conditions affecting the bones and connective tissues.

Which Surgeon Performs Which Surgery?

Whilst your chosen surgeon may, therefore, have accreditation based on their neurosurgery training or training in orthopedics they may simply refer to themselves as a spinal surgeon. Both types of surgeon can generally perform discectomy, laminectomy, and other types of back surgery for spinal stenosisscoliosis, bone tumors in the spine, and vertebral compression fractures. Back surgery for tumors of the spinal cord, or to correct spina bifida, syringomyelia, nerve root tumors, or arachnoid cysts have to be performed by a qualified neurosurgeon, however, as with any surgery inside the spinal cord’s lining known as the dura.


Neurosurgeons and orthopaedic surgeons work together to improve current surgical treatments for spine conditions and develop new methods of restoring and maintaining spinal health. There are specific societies, such as the Scoliosis Research Society and the Cervical Spine Research Society, dedicated to the advancement of spine care who call upon both types of specialist to further their aims.

Questions to Ask Your Surgeon

When choosing a surgeon for back surgery it helps to pay more attention to the particular surgeon’s experience and focus than to the certifying body (although they should, of course, be board certified). Ask about surgical outcomes, the types of procedure that are routinely performed, and whether another specialist may need to be involved to ensure safety and efficacy of treatment. Many orthopaedic surgeons have a working relationship with a specific neurosurgeon or pool of neurosurgeons to call upon in complex cases, and neurosurgeons may have a similar set-up with experienced orthopaedic surgeons where rare bone deformities or abnormalities are complicating otherwise routine surgery.

doctor showing x-ray of spine to senior man at hospital

Choose a surgeon that takes times to explain the options, the procedure, and to answer any concerns and queries about pre-operative and post-operative care as well as the back surgery itself. Whether a neurosurgeon or an orthopaedic surgeon performs back surgery it is the expertise and focus on a successful outcome that matter most.

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