If you are unlucky enough to suffer from chronic lower back pain you’ll know how this debilitating condition can make everyday life miserable and frustrating. An obvious question to ask when the pain becomes unbearable is “Where can I get the best treatment”? Unfortunately the answer is sometimes hard to find because nowadays both neurosurgeons and orthpaedic surgeons compete to treat and operate lower back disorders.

At this point many patients typically become confused. Surely neurosurgeons traditonally operate on the brain, spinal cord, nerve and cervical (upper) spine should be able to operate on the lower lumbar spine as well? I asked Khai Lam from the London Bridge Hospital to explain.

The fact is that over the last decade, and with the advent of stenting of cerebral aneurysyms, neurosurgeons lost a lot of this work because there is a much reduced need to operate them. They therefore started to venture south from their traditional area of expertise and began to operate on the lower lumbar spine. Until recently surgery to the bony aspects of the spine, i.e. vertebral bodies, laid in the exclusive domain of Orthopaedic Spinal surgeons. This is because Orthopaedic Surgeons spend all their time mending broken bones and therefore are experts in the areas of bone fixation and healing, akin to lumbar spinal fusion.

Now it’s true that in today’s environment there is quite a lot of crossover, but, there is still a general perception that neurosurgeons lack an appreciation of spinal biomechanics and bone biology, e.g. spinal fusion. This is partly due to their somewhat lacking neurosurgical postgraduate training curriculum. Orthopaedic Surgeons however simply never stop thinking about bone stability and bone healing. In addition, most Orthopaedic Spinal Surgeons work a lot more closely with physiotherapists when treating lower back disorders.

So which type of surgeon should you seek out when you suffer from chronic lower back pain? The answer still isn’t obvious….

1. Neurosurgeons don’t really operate on lower back pain ALONE, but neither do many Orthopaedic Spinal Surgeons
2. Most surgeons (Neurosurgeons and Orthopaedic Spinal Surgeons) will operate on sciatica secondary to bony or disc compression (microdiscectomy or decompression)
3. Some neurosurgeons, whereas MOST Orthopaedic Spinal Surgeons, also do fusions when patients have a combination of sciatica WITH chronic lower back pain.
4. Neurosurgeons very rarely perform lumbar disc replacements (this surgery is to help treat chronic lower BACK PAIN and performed via a minimal access approach through the lower abdomen). Having said that, although most Orthopaedic Spinal Surgeons are trained with the lumbar anterior approach, few perform lumbar disc replacements because of their lack of familiarity, significant bleeding risks and their differing beliefs against this procedure.
5. Neurosurgeons are not trained and therefore DO NOT do deformity surgery (scoliosis and kyphosis), whereas trained Orthopaedic Spinal Surgeons regularly perform these operations.

The fact is that if you have debilitating chronic lower back pain, it is perfectly possible to seek treatment from either an Orthopaedic Spinal Surgeon or a Neurosurgeon. However, the key question to ask is whether your surgeon has a special interest in treating patients with lower back disorders, and the number of procedures that he has undertaken to indicate his level of competence. Only a genuine and well seasoned spinal specialist will be able to treat your chronic lower back pain condition effectively.

Hopefully that clears up the confusion!

Tags: disc replacement, lumbar spinal fusion, lumbar spine, orthopaedic surgeons, sciatica, spinal biomechanics, spinal cord