Do You Need a Neurosurgeon for Your Neck or Back?

A neurosurgeon is a board certified MD who specializes in preventing, diagnosing and treating problems related to the nervous system. This includes the brain, spinal cord, spinal column and also the peripheral nervous system. Of these, the spinal column and spinal cord are of the most concern to people with neck or back pain.

As the title suggests, going to see a neurosurgeon usually means surgery as a treatment is on the table. Some of the spine conditions that neurosurgeons treat include (but are not limited to) disc replacement, cauda equina syndrome, scoliosis, spinal bifida, spinal cord injury, spinal infections, cysts, tumors and more. That said, orthopedic surgeons can operate on some of the same conditions as neurosurgeons. A good example of this is spinal fusion for degenerative disc disease or scoliosis.

Tools of the neurosurgeon include bone grafts and spinal instrumentation, for example, plates, screws, rods, and cages.

Getting Started With a Neurosurgeon—Are You In the Right Place?

Generally speaking, one doesn’t start out going to a neurosurgeon for spine pain (or for other reasons.) Instead, you would first go to your primary care doctor, and if, after examining you, taking a medical history and possibly ordering and reviewing diagnostic tests, she deems a visit to a specialist is in order, she’ll write you a referral.

The problem is, not all primary care doctors are acutely aware of the criteria for a successful referral.

Deis and Findaly in their study, "Appropriateness of lumbar spine referrals to a neurosurgical service," which was published in the November 2010 issue of the Canadian Journal of Neurological Science reviewed referrals to 10 neurosurgeons at the University of Alberta every two months for six months. The goal of the reviews was to determine how effective the referrals were. In this study, referrals were categorized into one of three groups: Appropriate, uncertain and inappropriate.

Appropriateness was defined either when leg pain was the chief complaint, a physical exam provided evidence of neurological deficit, or diagnostic tests (CT scan and/or MRI) came back positive for nerve root compression.

The researchers found that of the 303 records they reviewed, only 26% (i.e., 80 patients) had been referred to the neurosurgeon appropriately. The authors conclude that primary care doctors and other first-line practitioners who see patients with neck or back pain should really be better informed about what makes for an appropriate referral.

What does this mean to you? That perhaps if your doctor does not seem to know what to do after you’ve been through the first round of appointments (or that if, given your symptoms and pain levels, you simply want to be extra sure she is routing you to the right place) you might consider mentioning the above referenced study, and the three criteria to her.

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Article Sources
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  1. American Board of Medical Specialties. ABMS guide to medical specialties. 2019.

  2. Hyun SJ, Jung JM. Spinal deformity surgery : it becomes an essential part of neurosurgery. J Korean Neurosurg Soc. 2018;61(6):661-668. doi:10.3340/jkns.2018.0150

  3. Deis N, Findlay JM. Appropriateness of lumbar spine referrals to a neurosurgical service. Can J Neurol Sci. 2010;37(6):843-848.

Additional Reading
  • Conditions and Treatments. AANS website, Patient Information Page.

  • Willems, P. Decision Making in Surgical Treatment of Chronic Low Back Pain: The Performance of Prognostic Tests to Select Patients for Lumbar Spinal Fusion. Acta Orthop Suppl. Feb 2013.