Orthopedic surgery is a medical specialty focused on the diagnosis, treatment, and prevention of disorders affecting the musculoskeletal system, including bones, joints, ligaments, tendons, and muscles. Orthopedic surgeons do perform back surgery, but only those who have pursued advanced training in the spine. Spine care is a highly specialized field within orthopedics, requiring dedicated training to address the intricate nature of the spinal column and perform complex back and neck operations.
The Orthopedic Spine Specialist
The journey to becoming an orthopedic spine specialist extends beyond the standard orthopedic residency. After medical school, a physician completes a five-year surgical residency program in orthopedic surgery. This foundational training provides broad exposure to the musculoskeletal system, covering trauma, joint replacement, sports medicine, and general spine pathology.
Following residency, specialization requires a post-residency Spine Fellowship, which typically lasts one additional year. This fellowship is a structured training period devoted exclusively to the diagnosis and management of spinal disorders. During this intensive year, the surgeon gains concentrated experience in both non-operative and operative techniques for treating the spine.
This additional training distinguishes a general orthopedic surgeon from an orthopedic spine surgeon capable of managing complex spinal conditions. The fellowship ensures the surgeon develops a deep understanding of spinal biomechanics, instrumentation, and surgical approaches to the cervical, thoracic, and lumbar regions. This focused year of study is the standard for specializing in spinal operations.
Conditions and Procedures Handled by Orthopedic Spine Surgeons
Orthopedic spine surgeons treat a wide spectrum of disorders, focusing on restoring stability, correcting alignment, and alleviating pressure on neural structures. Their practice often begins with comprehensive non-operative care, such as physical therapy, injections, or medication, before considering surgical intervention. When surgery is required, they utilize a range of procedures tailored to the specific problem.
A significant portion of their work involves treating degenerative conditions, which occur as spinal structures wear down over time. For patients with a herniated disc, a common procedure is a microdiscectomy, where the surgeon removes the portion of the disc compressing a nerve root. Spinal stenosis, or the narrowing of the spinal canal, is often addressed with a decompression surgery like a laminectomy, removing bone and ligament to create more space for the nerves.
Spinal instability, frequently caused by degenerative disc disease or a condition like spondylolisthesis, may necessitate a spinal fusion. This procedure involves joining two or more vertebrae using bone graft material and metallic hardware, such as rods and screws, to eliminate motion and stabilize the segment. They also manage significant spinal deformities, including adult and pediatric scoliosis and kyphosis, which require specialized surgical correction and instrumentation to realign the spine.
Orthopedic spine specialists are also trained to manage acute spinal trauma, such as fractures and dislocations resulting from accidents or falls. The goal in these cases is to stabilize the damaged vertebral column and protect the spinal cord and nerve roots from further injury. They are skilled in performing minimally invasive spine surgery techniques, which use smaller incisions and cause less disruption to surrounding muscle tissue, potentially leading to faster recovery times.
Orthopedic Surgeons Versus Neurosurgeons in Spine Care
The difference between an orthopedic spine surgeon and a neurosurgeon is a common point of confusion for patients seeking back surgery. Historically, orthopedic surgeons focused on bony structures and alignment, while neurosurgeons focused on the nervous system. This distinction has largely faded due to specialized post-residency training.
Today, both specialties perform a substantial amount of the same spine surgery procedures, such as discectomies, laminectomies, and spinal fusions. The majority of spinal operations involve both bony work and nerve decompression, making the skills of both surgeons equally applicable. The most important factor for a patient is whether the surgeon has completed a dedicated spine fellowship, not the initial residency.
While the overlap is extensive, subtle differences in focus may remain. Orthopedic spine surgeons may emphasize complex spinal deformity correction, like severe scoliosis, and the biomechanics of spinal instrumentation. Conversely, neurosurgeons retain the specialized expertise required for rare conditions involving the tissue directly surrounding the spinal cord, such as intradural tumors.
In many modern medical centers, orthopedic and neurosurgical spine specialists often work together in integrated spine centers. This collaborative approach allows patients to benefit from a combined expertise, ensuring the surgeon’s specific training aligns optimally with the patient’s particular spinal condition. A fellowship-trained, board-certified spine surgeon from either background is typically qualified to perform the most common back surgeries.