Ask the Spine Surgeon
May, 2015 - Issue #127
Hi Dr. Moza. It seems like most people write you to ask whether or not you think they should consider surgery. Well, I already know I need surgery and I've even gotten it approved by my insurance carrier. The problem is, my insurance has approved my upcoming spine surgery under one condition: that it be performed by an orthopedic surgeon in my "network." I've done the research and I'm convinced that
I'll be best served by having my surgery performed by a neurosurgeon, not an orthopedic specialist. My wife thinks I'm just splitting hairs and that a "surgeon is a surgeon." I disagree. What's your take?

First, let me congratulate you for taking the initiative and researching your condition and treatment options. Informed patients are their own best advocates. Well done!

As a neurosurgeon, it would be easy to appear professionally biased towards my specialty. I wouldn't want you to take "my take" on the topic alone. Instead, I'd like to direct you to the recent research study published in Spine. The expansive study examined how a surgeon's specialty impacted elective spine surgery outcomes.

Researchers poured over data collected from the American College of Surgeons National Surgical Quality Improvement Project Database, analyzing the results of 50,361 patients. This incredibly-large pool of subjects allowed for the researchers to evaluate short-term and long-term affects of the patients' surgical procedures.
Of the over 50,000 surgeries performed that were included in the study, a full 66 percent of them were completed by neurosurgeons. The remaining percentage of patients was operated on by an orthopedic surgeon.

A significant amount of vital data can be drawn from this ground-breaking research piece, but there are several elements that are particularly important to note in reference to your question.

1. In the cases where orthopedic surgeons treated the patient, the incidence of prolonged hospital stays doubled when compared to the results of surgeries performed by neurosurgeons. Even when coordinating patients by their propensity scores, patients of orthopedic surgeons had higher odds of a longer hospital stay.

2. In the cases where patients were treated by orthopedic surgeons, there was a higher likelihood of complications, perioperative transfusions and discharges that required continued care. Even after matching patients, those treated by orthopedic surgeons had twice the chance of receiving perioperative transfusions.

While these matters are important to consider, I also think it's essential to note that the differences became more slight 30 days post op. Orthopedic surgeons are surgeons - and the vast majority are exceptional at what they do. These study results do not necessarily mean all neurosurgeons have better results than all orthopedic spine surgeons. Each practitioner should be evaluated individually. Where the study is helpful is this: It presents unbiased data for results and outcomes for both specialties.
I can, of course, only speak to my own experiences as a neurosurgeon who specializes in minimally-invasive procedures that, by nature of my methods, substantially reduce risk of complications; necessity for blood transfusions; hospital stays; and longer recovery times. I don't think that, as your wife opines, you are "splitting hairs." When you know you have to go under the knife, it's more than natural to want that experience to be as painless, convenient and risk-free as possible. I'm sure that if you share this article with your wife - and your insurance carrier - you'll be well on your way to having a neurosurgeon perform your spinal surgery. Good luck!

Kapil Moza MD, FACS
Diplomate, American Board of Neurological Surgery
Dr. Moza's Santa Clarita office is conveniently located in Valencia. 805-497-3622
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