Who performs surgery for a herniated intervertebral disc, orthopedic surgeons or neurosurgeons (neurosurgical specialists)?

From the Guidelines

Both orthopedic surgeons and neurosurgeons are qualified to operate on herniated discs, and the choice between them should be based on the individual case details, physician availability, and regional practice patterns. When it comes to surgical intervention for a herniated disc, the primary goal is to relieve pressure on the affected nerve root, and both orthopedic spine surgeons and neurosurgeons have the necessary training and expertise to perform procedures such as discectomy, microdiscectomy, or laminectomy 1.

Key Considerations

• The surgical approach is generally the same regardless of which specialist performs it, with both focusing on relieving pressure on the affected nerve root.
• Some medical centers have both specialists collaborating on complex cases, highlighting the importance of interdisciplinary cooperation in spine surgery.
• Patients should consider the surgeon's experience with spine surgery specifically rather than focusing exclusively on their specialty designation.
• Surgery is typically considered only after conservative treatments like physical therapy, medication, and injections have failed to provide adequate relief, as recommended by guidelines for the treatment of low back pain 1.

Specialist Expertise

• Orthopedic spine surgeons specialize in the musculoskeletal aspects of spine surgery, bringing a deep understanding of the spinal anatomy and its relationship to the surrounding muscles and bones.
• Neurosurgeons focus on the neurological components, offering expertise in the management of nerve root compression and other neurological complications associated with herniated discs.

Decision Making

• The decision on which specialist to consult should be based on the individual patient's needs and the specific characteristics of their condition.
• Patients should discuss their options with their primary care physician or a specialist to determine the best course of action for their particular case.

From the Research

Surgical Treatment for Herniated Discs

• Both orthopedic surgeons and neurosurgeons operate on herniated discs, depending on the location and severity of the condition 2, 3, 4, 5.
• The decision to perform surgery is typically made after conservative treatment options have been exhausted, and the patient's symptoms persist or worsen 5, 6.

Specific Conditions and Surgical Approaches

• For thoracic disc herniation, a transthoracic approach is recommended for central calcified herniated discs, while a posterolateral approach is often suitable for non-calcified lateralized TDH 2.
• For lumbar disc herniation, transforaminal lumbar interbody fusion (TLIF) surgery may be performed to manage large lumbar disc herniations with severe pain and radicular symptoms 4.
• The choice of surgical approach and technique depends on various factors, including the location and size of the herniated disc, the presence of calcifications or intradural extension, and the patient's overall health and medical history 2, 3, 4.

Indications for Surgery

• Absolute surgical indications for herniated discs include deteriorating neurological deficits with myelopathy or cauda equina syndrome 5.
• Relative indications for surgery vary depending on the level of disc herniation, but may include failure of conservative measures, worsening neurological symptoms, and giant calcified disc herniations 5.
• Surgery may also be considered for patients with persistent symptoms despite conservative treatment, or for those with imaging confirmation of disc herniation consistent with clinical findings 5, 6.