Specialty care physicians
Spine Surgeons—Orthopedists and Neurosurgeons
Physiatrist (M.D. or D.O)
Anesthesiologist (M.D. or D.O.)
Neurologist (M.D. or D.O)
Rheumatologist (M.D. or D.O)
- Spine Surgeons—Orthopedists
and Neurosurgeons perform the overwhelming majority
of spine surgery and frequently extend their general
Orthopedic or Neurosurgical training by participating
in a spine fellowship. These spine fellowships
accept a select group of physicians who have completed
four to seven years of a surgical residency and are
either board certified or board eligible in their
respective specialties and provide additional training
in performing spine surgery.
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Orthopedic Surgeon (M.D. or D.O.)—Orthopedic
surgeons are either Medical Doctors or Doctors
of Osteopathy who have completed a five-year
residency focused on the surgical treatment of
musculoskeletal conditions. Orthopedic surgeons
are trained in the diagnosis and treatment of
spinal disorders, arthritis, sports injuries,
trauma, and fractures.
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Neurosurgeon (M.D. or D.O.)—Neurosurgeons
are Medical Doctors or Doctors of Osteopathy
who complete a five or six-year residency that
focuses on the surgical treatment of patients
with neurological conditions. Neurosurgeons are
trained in the diagnosis and treatment of disorders
of the brain, spine, spinal cord, nerves, intracranial
and intraspinal vasculature. |
Both orthopedic surgeons and neurosurgeons
complete training to do most types
of spine surgery. There are only
a few instances in which one specialty
tends to be better trained for specific
conditions: e.g. orthopedic surgeons
do spine deformity surgery (e.g.
scoliosis) and neurosurgeons do surgery
for intradural (inside the thecal
sac) tumors.
In recent years, spine surgery has become
increasingly specialized within the orthopedic and
neurosurgical professions, and often a surgeon will
focus a majority of his or her practice on spinal
surgery. It is thought that the increasing level
of specialization and focus on the spine has contributed
to enhancements in surgical technique, which in turn
has led to overall improved success rates and reduced
morbidity (e.g. reduced post-operative discomfort,
faster healing time).
- Physiatrist
(M.D. or D.O)—A
physiatrist is a Medical Doctor or Doctor of
Osteopathy who specializes in Physical Medicine
and Rehabilitation (also
called PM&R physicians). Essentially, physiatrists
specialize in a wide variety of conservative
treatments for the musculoskeletal system and
do not perform surgery.
Physiatrists complete four years of graduate
medical education and four additional years of
residency training. Residency training includes
one year spent developing fundamental clinical
skills and three additional years of training
in the full scope of the specialty. Many physiatrists
choose to pursue additional advanced degrees
(M.S., Ph.D.) or complete fellowship training
in a specific area of the specialty, such as
spine medicine/musculoskeletal rehabilitation.
To become board-certified in physical medicine
and rehabilitation, physiatrists are required
to pass
both a written and oral examination administered
by the American Board of Physical Medicine and
Rehabilitation
(ABPM&R). The ABPM&R also has agreements
with each of the boards of pediatrics, internal
medicine,
and neurology to allow special training programs
leading to certification in both specialties.
Physiatrists diagnose and treat both acute pain
and chronic pain and musculoskeletal disorders.
They can order and interpret all types of spine
imaging (x-ray, CT myelogram, MRI, bone scan)
and perform specialized nerve tests (EMG, NEV,
SSEP) to help assess the location and severity
of nerve damage. They commonly treat patients
with any kind of back pain or neck pain, work
or sports-related injuries, fibromyalgia, myofascial
pain, arthritis, tendonitis, spinal cord injuries.
Typical treatments may include:
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Active physical therapy (e.g.
exercise, stretching) |
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Passive physical therapy (e.g. heat/ice,
TENS units) |
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Prescription medications |
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Massage therapy |
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Some perform interventional
medicine (e.g. epidural steroid injections,
selective nerve root blocks, IDET |
Physiatrists have varying
degrees of specialization and may practice in rehabilitation
centers, hospitals, or private practice, and often
practice as part of an integrated spine treatment
center. They focus on keeping individuals as functional
as possible and work to coordinate the patient’s
care.
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Anesthesiologist (M.D. or D.O.)—Anesthesiology
is the practice of medicine dedicated
to the relief of pain and total
care of the surgical patient before, during
and after surgery.
After completing four years of
medical school, they enter a four-year
anesthesiology residency training
program. Fellowships in an anesthesia
subspecialty and in education or
research may also be taken for
an additional year. While anesthesiologists
have been known primarily as physicians
who administer anesthesia during surgery,
they also provide medical care and
consultations in other situations in
addition to the operating room.
The anesthesiologist’s role may be a perioperative ("peri-" meaning "all-around")
who provides medical care to each patient throughout
his or her surgical experience. This may include
medical
evaluation before surgery, consulting with
the surgical team, providing pain control and support
of life functions
during surgery, and supervising care after
surgery and medically discharging the patient from
the recovery
unit.
Anesthesiologists as part of the spine team
frequently diagnose and treat patients suffering
from acute and chronic pain syndromes. Some
anesthesiologists complete Pain Fellowships and
concentrate their practice on doing injections
(such as epidural steroid injections). They
may practice in a variety of settings, such
as a Pain management clinic or an integrated
spine care center. Typically, other medical
practitioners (primary care or specialists)
refer patients to them.
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Neurologist (M.D. or D.O)—A
neurologist specializes in diagnosing and
treating disorders of the nervous system, including
diseases of the brain, spinal cord, nerves,
and muscles (such as strokes, epilepsy, headaches,
Alzheimer's, multiple sclerosis, Parkinson's,
and various forms of pain). Neurologists may
serve as a consultant to other physicians as
well as providing long-term care to patients
with chronic neurological disorders.
Neurologists are trained to perform a detailed
examination of all the important neurological
structures in the body. This includes the
nerves of the head and neck, the muscular
strength and movement, sensation, balance
testing, ambulation and reflex testing.
Importantly, an examination by a neurologist
can be helpful in distinguishing a primary
neurological problem (e.g. multiple sclerosis)
from a musculoskeletal disorder.
Neurologists rely on the clinical examination
along with certain other commonly used tests
(such as CAT Scans and MRI/MRA scans). These
tests can provide detailed anatomic pictures
of the brain, spinal structures and the blood
vessels. A neurologist can also perform a lumbar
puncture (spinal tap) to obtain the cerebrospinal
fluid for analysis. Some neurologists interpret
EEG (electroencephalography) used in the evaluation
of seizure disorders, or perform EMG/NCV (electromyography/nerve
conduction velocity testing) which is used
to diagnose nerve and muscle problems.
Neurologists use many forms of medication to
treat problems involving the nervous system.
They may send patients to other specialists
for some forms of treatment. A neurologist
may refer a patient to a surgeon for a surgical
evaluation, but does not perform surgery.
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Rheumatologist (M.D. or D.O)—A
Rheumatologist specializes in the diagnosis
and treatment of arthritis and other musculoskeletal
diseases (involving joints, muscles and bones).
After four years of medical school and
three years of training in either internal
medicine or pediatrics, rheumatologists
complete two to three years in specialized
rheumatology training. Most rheumatologists
who treat patients become board certified
by the American Board of Internal Medicine.
Rheumatologists diagnose and treat a wide variety
of chronic musculoskeletal diseases, including
osteoarthritis, rheumatoid arthritis, musculoskeletal
pain disorders, fibromyalgia, certain autoimmune
diseases, osteoporosis, and tendonitis. Many
types of rheumatic diseases are difficult to
identify, and rheumatologists are trained to
accurately diagnose musculoskeletal disorders
so that appropriate treatment can begin early.
Rheumatologist sometimes act as a consultant
to advise another physician about a specific
diagnosis and treatment
plan, and sometimes leads the patient’s
treatment and may include a team approach
to treatment involving as physical therapists,
psychologists, or other specialists.
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