Who Is Best Positioned to Do Your Spine Surgery? - Spinal DISC Center | Kris Radcliff, MD | New Jersey

wp-singular,page-template-default,page,page-id-17231,wp-theme-bridge,bridge-core-3.3.5,wp-schema-pro-2.12.4,qode-optimizer-1.2.3,qode-page-transition-enabled,ajax_fade,page_not_loaded,,qode-theme-ver-30.9.1,qode-theme-bridge,disabled_footer_bottom,qode_advanced_footer_responsive_1000,wpb-js-composer js-comp-ver-9.0.1,vc_responsive,elementor-default,elementor-kit-16783

Who Is Best Positioned to Do Your Spine Surgery?

More and more types of doctors now offer spine operations. Here is a simple way to think about it, and the questions to ask before you say yes.

Procedure or surgery? Here is the difference that matters

Doctors use the words “procedure” and “surgery” loosely. Here is the way I explain it to my patients.

A procedure treats pain without permanently changing how your spine is built. An injection, a nerve block, or a nerve ablation (burning a small pain nerve) are procedures. Your spine is the same afterward.

A surgery permanently changes the way your spine is built or how it moves. If an operation does any of these things, it is a surgery:

Opens up a space, by removing bone, disc or ligament to take pressure off a nerve.
Stops something from moving, by joining bones together or placing an implant between them.
Removes something you were born with, like part of a disc, a joint or a piece of bone.
Puts something permanent in your body, like a cage, a spacer, screws or an artificial disc.

It does not matter how small the cut is or what it is called. “Minimally invasive,” “outpatient,” “just a spacer” and “a quick implant” describe how it is done, not what is done. If it permanently changes your spine, it is surgery, and you are better off having it done by someone with a lot of training and experience in spine surgery.

Training is how surgeons learn

Surgery is learned on the job, under supervision, over years. That on-the-job training is called residency and fellowship.

Orthopaedic spine surgeon: medical school, then 5 years of orthopaedic surgery residency, then usually a 1-year spine surgery fellowship. That is 6 or more years of hands-on surgical training after medical school.
Neurosurgeon: medical school, then about 7 years of neurosurgery residency, which includes a lot of spine surgery. Many also do a spine fellowship.
Pain management doctor: medical school, then usually 4 years of residency in anesthesiology or physical medicine and rehabilitation, then a 1-year pain fellowship. This training is focused on injections, nerve treatments and medicines. It is very good training for those things. It is not years of training in spine surgery.

Some doctors learn to place spine implants, or to do a new operation, by taking a short course, sometimes over a weekend. That goes for any doctor, surgeons included. Why go to someone who learned an operation in a weekend when you can go to someone who spent more than half a decade learning to do it well?

Pain management doctors are important. They help many people avoid surgery, and I work with them every day. This is not about who is a good doctor. It is about matching the right training to the right job. Injections and nerve treatments are their specialty. Surgery is ours.

Pick a surgeon who can do all three kinds of spine surgery

Almost every spine surgery is one of three things: decompression (making room for a nerve), fusion (growing bones together) or disc replacement (putting in a moving part). Read more about the three kinds here.

If your doctor can only do one of these, that one operation may be what you are offered, even if another one would be better for you. A surgeon who does all three can recommend the one that fits your problem, not the one that fits their skills. If the only tool you have is a hammer, everything looks like a nail.

Can your doctor take it out?

Any implant can cause a problem. A spacer can sink, shift or break. Screws can loosen. Bone may not heal. When that happens, the implant may need to be removed or the surgery redone. That is called revision surgery, and it is usually harder than the first operation.

Before anyone puts an implant in your spine, ask: “If this causes a problem, can you take it out or fix it yourself?” I would be cautious about letting a doctor put an implant in my body that they cannot remove or revise if something goes wrong.

Orthopaedic surgeon or neurosurgeon?

Both can be excellent spine surgeons. They start in different residencies but end up doing the same spine operations. I am a Professor of both Orthopaedic Surgery and Neurological Surgery at Thomas Jefferson University, and I teach residents in both. The title on the door matters less than these three things:

Did they do a spine fellowship or spine-focused training?
Is their practice mostly or only spine?
Do they do your operation often, and can they do all three kinds?

Questions to ask any doctor who offers you an operation

Is this a procedure or a surgery? Will it permanently change my spine?
Which of the three is it: decompression, fusion or disc replacement?
Will anything be left in my body? What is it called?
Does bone need to grow for this to work? What happens if it does not?
What was your training? Did you do a residency and fellowship in spine surgery?
How often do you do this operation?
Can you do the other kinds of spine surgery too? Why is this one best for me?
If the implant causes a problem, can you take it out or redo the surgery yourself?
If this does not work, what is next, and who would do it?

A red flag: good doctors are happy to talk about their training. If you ask about a doctor’s training and background and they get defensive, that is a red flag. It is okay to walk out and get another opinion.

A second opinion is always okay

Getting a second opinion before any spine surgery is normal and smart. Seeing a spine surgeon does not mean you will need surgery. Many of the people I see never need an operation.

To schedule a visit or a second opinion, call 609-800-3472 or send us your MRI.

This page is general information, not medical advice. Talk with your own doctor about your situation.