This post will discuss the important topic of how to choose a doctor to operate on your back. Nothing is more important in your health care than making a wise choice of surgeon for spinal surgery. My practice is full of patients in the difficult position of having to have a bail-out or rescue operation because their first operation (or second...) was not properly performed or perhaps was not the right operation at all. They still have pain, are still suffering from the same old problem, or even worse, they have new problems now that weren't there before. Many of these problems can be avoided by choosing the right doctor from the start.
Now, I am not saying that every patient that fails to improve or who has a complication chose the wrong surgeon- EVERY surgeon has complications and treatment failures, including me. In fact, if you have a surgeon that says he/she never has complications or who 'guarantees' you a certain outcome, DO NOT let them operate on you! If a surgeon was perfect, all of us would send all the patients there and the rest of us would retire.
There are, however, some things that can be used to help you make a wise choice, and there ARE differences between surgeons. So how do we sort that out?
First of all, the obvious question is whether you should go to an orthopedic spine surgeon or a Neurosurgeon. What's the difference? In my (informed but obviously biased) opinion, the primary differences relate to training and philosophy.
In general, orthopedic surgeons spend a few months of their 5 year residency doing spine surgery, much of which is what we call "deformity" surgery- this is usually pediatric scoliosis work in many training programs. Then, if the surgeon is interested in having spine be all or a large part of their practice, he or she will do a one year (sometimes two year) fellowship training program that is dedicated to spinal surgery.
So, at the end of their training, the typical orthopedic spine surgeon has completed two years or less of concentrated training in spine. And then they go into practice.
More importantly, the philosophy of orthopedic surgery training revolves around bones. They are trained to align things, straighten things, connect things. They are master mechanics, and the are trained to hammer and nail broken bones back together. This is a good thing, and they are good at it. But what happens when you take a person trained to hammer big things together and ask them to delicately manipuate a bone that surrounds your spinal cord? In the course of orthopedic spine training, residents learn to approach the spine as if it were a frame upon which all your other bones are hung.
Neurosurgeons, on the other hand, train for 6 to 8 years. During that time, 60-70% of our training is in spine. By the time a Neurosurgeon finishes his or her residency, they typically have completed about 4 years of training in spine, usually operating over 1,500 cases in spine alone. Some Neurosurgeons also go on to focus on the spine in a fellowship program for one or two years.
During their other training, Neurosurgeons are doing brain surgery. They work under microscopes through tiny incisions and are trained to very delicately handle microscopic parts of your nervous system. So when a Neurosurgeon approaches the spine, he or she treats it like what God designed it for- the house for your spinal cord.
Both orthopedic surgeons and Neurosurgeons are trained to remove ruptured disks, handle fractures, repair mis-aligned vertebrae, and treat low back and neck pain. But Neurosurgeons are trained to go inside the spinal cord and remove tumors, reconnect injured nerves, and repair the neural elements inside the spinal canal. When an orthopedic spine surgeon accidentally cuts a nerve or discovers that the problem is actually inside the spinal cord- they call a Neurosurgeon to handle it.
That means for you, when you're choosing a surgeon, that you have questions to ask:
1. How many of this type of operation have you done?
2. How many per year?
3. What is your complication rate?
4. What type of training did you complete to learn this type of surgery?
5. What percentage of your patients have a good outcome? And define "good."
When you are thinking of having surgery, you should always pray about it, study everything you can about it, and ask a lot of questions. You should strongly consider a second opinion. I encourage people to seek an opinion from both Neurosurgeons and orthopedic spine surgeons. I tell them that orthopedists who have not done a fellowship program in spine should not be their first choice, and that Neurosurgeons who do not perform a lot of spine surgery shouldn't be, either.
There are many orthopedists who are excellent spine surgeons, and many Neurosurgeons are as well. Ask your primary care doctor what other patients have reported to them. Ask around your community about the surgeon in question. Ask questions!
In the next article, we'll talk about another difference that is very important to understand in today's medical climate- "Minimally Invasive Surgery." There are some MAJOR differences between different surgeons in this area of spine surgery, and I will arm you with the information you need to make a wise choice.
Please consider carefully who you allow to operate on your spine. It's not brain surgery, but it is a huge decision that can have a lot of impact on the quality of the rest of your life.
Have a great day, and I'll write more soon.
God Bless,
TheBrainSurgeon
