What type of surgeon operates on cervical and lumbar radiculopathy?

Surgical Specialists for Cervical and Lumbar Radiculopathy

Both neurosurgeons and orthopedic spine surgeons perform surgical procedures for cervical and lumbar radiculopathy, with the choice depending primarily on local availability and surgeon expertise rather than specialty designation.

Surgical Specialists

Neurosurgeons

• Neurosurgeons perform both anterior and posterior approaches for cervical radiculopathy, including anterior cervical discectomy and fusion, and posterior laminoforaminotomy 1
• These specialists routinely manage lumbar radiculopathy requiring surgical decompression through procedures such as hemilaminectomy and medial facetectomy 2, 3
• The evidence base for cervical radiculopathy surgery is predominantly published in neurosurgical literature, with extensive case series demonstrating 92-97% good to excellent outcomes 1

Orthopedic Spine Surgeons

• Orthopedic surgeons with spine fellowship training perform identical procedures for both cervical and lumbar radiculopathy 1
• These specialists utilize the same surgical techniques including anterior cervical decompression and fusion, cervical disk arthroplasty, and posterior foraminotomy 4, 5
• Both specialties contributed to the development of surgical guidelines published by the American Association of Neurological Surgeons and Congress of Neurological Surgeons 1

Surgical Approaches by Anatomic Location

Cervical Radiculopathy

• Anterior approach: Anterior cervical discectomy and fusion or anterior corpectomy for disc herniations and spondylosis 1
• Posterior approach: Laminoforaminotomy for lateral disc displacement or foraminal stenosis, with 93% good/excellent outcomes in appropriately selected patients 1
• The first documented cervical disc surgery was performed via posterior laminoforaminotomy by Spurling and Scoville, predating anterior approaches by 10 years 1

Lumbar Radiculopathy

• Lumbar laminectomy with or without fusion is performed when patients have neural compression, moderate to severe stenosis on imaging, and failed 6 weeks of conservative therapy 2, 3
• Hemilaminectomy and medial facetectomy provide targeted decompression for single-level radiculopathy 2
• Surgical intervention between 4-8 weeks of symptom onset provides optimal outcomes based on natural history studies showing 70% improvement within 4 weeks 6

Critical Selection Criteria

Patient Selection Requirements

• Clinical symptoms must correlate with radiographic findings of nerve compression on MRI or CT myelography 1, 7
• Minimum 6 weeks of documented conservative management including physical therapy, anti-inflammatory medications, and activity modification 2, 3, 4
• Presence of significant motor deficits, debilitating pain resistant to conservative treatment, or progressive neurological deterioration 7, 8

Common Pitfalls to Avoid

• Do not proceed with surgery based solely on imaging findings without corresponding clinical symptoms, as degenerative changes are ubiquitous and often asymptomatic 4, 9
• Avoid premature surgical intervention before adequate conservative trial, as 75-90% of cervical and lumbar radiculopathy patients improve with nonoperative care 7, 4
• Do not attribute all symptoms to a single level without ruling out other sources of neurological deficit 3

Setting of Care

• Cervical and lumbar radiculopathy procedures should be performed in ambulatory/outpatient settings rather than requiring inpatient admission 3
• Outpatient laminoforaminotomy has demonstrated excellent outcomes with no immediate readmissions in prospective case series 1, 3
• Planned inpatient stays increase healthcare costs without clinical benefit for uncomplicated decompression procedures 3