October 2019 Edition. Volume XIX

In the early days of neurosurgery it was common knowledge that if one was admitted to a hospital for a neurosurgical procedure they probably wouldn’t be coming back home. As neurosurgery advanced and became more effective this observation became the exception rather than the rule.

It also wasn’t that long ago when patients undergoing spine surgery also “never seemed to get better.”  It became, in fact, the dictum passed on to newly trained orthopedic and neurosurgeons was to avoid getting involved in back surgery because of this.  Well, spine surgery has also advanced quite a bit since then but finding a good spine surgeon remains a daunting task.

Because of the poor results occurring with spine surgery it used to be considered the “dog” of the surgical specialties.  Remarkably, this worm has turned and spine surgery has now emerged as the “darling.”  This is clearly documented by the fact the greatest number of fellowship training programs in orthopedics and in neurosurgery are now spine fellowships. Yet, with the entry of minions of newly trained spine surgeons into this specialty the quality of surgical results is far from having achieved a “golden age.”  The number of “failed back surgery” patients continues to be inordinately high.

What is the reason for this?  Many of the answers explaining this phenomenon turn out to be quite interesting:


Most of the orthopedic spine specialists began their careers treating trauma, scoliosis and deformity.  While the incidence of trauma has remained high the increasingly effective management of scoliosis and deformity have caused these surgeons to cast their eyes toward the management of genomic and degenerative disorders.  Something they were never trained to do.


Most neurosurgeons, over the years, have derived a large part of their income from performing relatively straight-forward spine procedures such as discectomy.  As minimally invasive radiology has replaced neurosurgery for the treatment of arterio-venous malformations and aneurysms, and as radiation therapy has replaced a great deal of tumor surgery neurosurgeons have begun to cast their eyes on performing more complicated spinal procedures, such as fusions, for which they also never received basic training.  Despite this many have migrated into the specialty of spine surgery lacking basic understanding or receiving adequate instruction in this now advanced discipline.

The observations made above are not intended to imply that any orthopedic or neurosurgeon can not obtain the necessary education, training and experience to perform any form of spine therapy or spine surgery.  The Burton Experience indicates that few, already in practice, have been willing to do this.  The “migration” of these otherwise qualified surgeons into endeavors in which they have not added expertise has resulted in a unnecessarily high incidence of excessive and ill-advised surgical procedures.  This sad situation has unfortunately led to the creation of cadres of “failed back surgery” patients.

How To Find A Good Spine Surgeon

(it really isn’t difficult)

This then is the health care consumers dilemma.  How does one find a good spine surgeon?

To begin with find out if the surgeon is active in orthopedic or neurosurgical spine-related organizations or if they are members of the North American Spine Society or diplomates of the American Board of Spine Surgery.  This information is important but it is not as important as asking:

  • An Anesthesiologist
  • A Nurse Anesthetist
  • An Operating Room Supervisor
  • An Operating Room Nurse
  • A Operating Room Scrub Technician

who works at the hospital the surgeon practices at whether or not they would have that surgeon operate on them, or a member of their family.

Unless the circumstance is emergent, surgery should be an option only when appropriate conservative care has failed. Be particularly wary of surgeons who:

  • Only see “surgical patients”; they usually don’t know much about non-surgical care.
  • Demean other physicians and their opinions (disagreeing with them is, however,  just fine).
  • Don’t take you to task for being a cigarette smoker.
  • Are not willing to review your x-rays with you.
  • Recommend repeat spine surgery without your obtaining a second opinion by a spine specialist.
  • Do not recommend post-surgical therapy or long-term patient rehabilitation programs.
  • Do not know the difference between segmental dysfunction and segmental instability.
  • Do not know the difference between rigid spine fusion and flexible stabilization.
  • Are not capable of dealing with post-surgical problems.
  • Are rude and disrespectful.

Special Note:

If you are in a managed care program and are referred to their “specialist” check them out very carefully as they are often the only ones who will work for an organization whose primary concern is not the patient’s welfare.

Remember, if you think you are a hammer all the rest of the world looks like a nail.

Burton Report is an independent and non-commercial internet journal which was first published on January 1, 2000 and is dedicated to the principle that health care and the health care process MUST reflect truth and integrity as well as the best interests of the patient.

The information presented in Burton Report is intended for dissemination without alteration.

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