Most people think of orthopedic surgeons when they think of back surgery. But did you know that neurosurgeons also perform surgery on the spine, including the neck and back?
“Neurosurgeons offer precise microsurgical techniques different than the methods orthopedic surgeons use,” Dr. Foroohar explains. “So when neurosurgeons do back surgery, we treat the spine like the brain. There's a difference. Also, we spend more time freeing the nerve and making sure the nerve is fully visualized.
“And only neurosurgeons are trained to perform surgery inside the lining of the spinal canal on the spinal cord and spinal nerves,” she adds.
“Everybody thinks that when you have a back problem, you go to an orthopedic surgeon,” says Dr. Foroohar. “The reality is that all neurosurgeons treat back problems—but only orthopedic surgeons with fellowship training in spinal surgery treat the spine. That's a big difference that most people don't realize.”
“Yes. Most patients I see for back problems do not require surgery. I work closely with other specialists such as pain management and physical medicine and rehabilitation, or physiatry, to create the best treatment plan for each patient with back pain.
I also recommend a physical therapy regimen for most of my patients in conjunction with their treatment plan.
In some ways, a neurosurgeon's pre-operative approach to back surgery is like that of an orthopedic surgeon. We both often use imaging tests such as MRIs, CT scans, and x-rays to help determine whether a patient needs surgery.
The element that distinguishes a neurosurgeon's approach is the added focus on nerve involvement. In addition to imaging studies, I will order pre-operative neurophysiological testing such as an EMG to understand the condition of the nerve and determine whether a nerve is being pinched by a herniated disc or spinal stenosis.
Together, these tests help me determine whether to do surgery, and if so, which type of procedure to perform.
Orthopedic surgeons are focused primarily on biomechanics and hardware; my goal as a neurosurgeon is also to free the nerve. If the patient has a herniated disc and during surgery we find a compression from bony narrowing, I will address that to keep the spinal structures from pinching the nerve.
That depends on whether I'm operating on the neck and upper back or on the lower back. In surgery involving cervical discs, I can put the hardware, such as plate and screws, in place as well as decompress the spinal cord and nerves that are being pinched.