The biggest patient misconceptions on spine surgeons


For many patients, there can be some mystery behind what their spine surgeons do when they are not in the operating room or seeing them in the clinic. This can lead to assumptions about the profession.

Five spine surgeons told Becker's the biggest misconceptions from patients about the job.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.

Next week's question: We are about halfway through 2023. What is one of your  accomplishments so far and a goal for the remainder of the year?

Please send responses to Carly Behm at by 5 p.m. CDT Wednesday, June 28.

Editor's note: Responses were lightly edited for clarity and length.

Question: What's the biggest misconception patients have about your job?

Chester Donnally, MD. Texas Spine Consultants (Dallas): From the total joint literature there have been several really interesting publications that ask patients "How much does your joint replacement surgeon make from this surgery?" and as you would guess, the patient way overestimates. This concept applies to spine surgery as well.

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): The biggest misconception patients have about spinal surgery is that there is one way to fix a problem. Often, there are many different surgical solutions to one given pathology. It is often a good indication of robust spine surgery training for a spine surgeon to conceptualize and contemplate several different approaches to the same surgery. Peer-reviewed medical literature and discussion forums at medical conferences are usually the places where spine surgeons are able to debate their surgical preferences for different types of cases. However, patients rarely ever witness the interaction of different surgeons expressing differences in opinions.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Most patients are extremely cognizant about the fact I have a personal life. They are apologetic if they call after hours or on the weekends. I actually encourage them to if they are having issues that can be handled before they become a real problem. They seem to think that my job is something that I was born into. Occasionally, they pause our interview and ask how long it took to become a neurosurgeon. When I tell them "16 years or so," most are incredulous. Patients seem to really appreciate the careful decisions and surgical techniques I discuss, realizing that it takes a lot of work and time to get to be able to do these things. They also realize that if I worked that hard to do what I do, that I do very much care how they do as my patient.

Richard Kube II, MD. Prairie Spine & Pain Institute (Peoria, Ill.): Two large misconceptions exist that are probably equal in amount. One is how physical spine surgery often can be. Many patients believe the procedures are very delicate. While work around the neural structures is delicate and precise, the bony work is quite physical. I also believe most patients would grossly underestimate the amount of administrative time spent throughout the week to be able to provide the medical services the patients need.

Alexander Vaccaro, MD, PhD. Rothman Orthopaedic Institute (Philadelphia): Being an academic spinal surgeon training residents and fellows is one of the most invigorating and rewarding surgical careers one can have. Most academic spine surgeons fulfill multiple roles and wear many hats which can be confusing to patients. One of the most important roles of an academic spine surgeon is training the next generation of spine surgeons. Patients often fear that because of this training environment, their surgeon isn’t the one actually performing the surgery. It’s important to clarify that this is simply not true and it is imperative that the lay public understand what it means when one receives care at a training institution. 

All surgeries, whether in academia, combined academia and private practice or private practice, require more than one operator. In private practice, that operator might be a surgical assistant, while in academia it is often a surgeon-in-training — i.e. a resident or fellow. One of the main advantages of being at an academic center is that the teaching environment and attending-trainee relationship necessarily fosters an environment of curiosity, questioning and learning, which in turn forces the teacher to continually strive to become more self-reflective, well-read and skilled so that we can continue to teach effectively at the cutting edge. 

Training the next generation of surgeons of course involves teaching them surgical skills, but they learn in an apprenticeship model observing an attending surgeon. The attending surgeon always performs the key elements of a procedure, or for the layman, the most crucial components of a case, and trainees are allowed to gradually increase their skills as they progress in a monitored fashion. However, training also entails so much more. Professors teach trainees the complete management of the patient from the preoperative evaluation to postoperative rehabilitation, management of complications, and gradual return to function. Patients benefit from this relationship as there are multiple skilled medical doctors involved and personally invested in their care, which often reduces the potential for adverse safety events. Indeed, it is important to remember that those being trained are MDs or DOs who have already completed four years of medical school and who have already completed several years of post-medical school graduate training. These are fully fledged doctors undergoing hyper-specialized training in the field of spine surgery. 

Finally, professors mentor trainees in developing their own career paths, in conducting research, and advancing the field of spine surgery for the benefit of patients today and tomorrow. This is vital if our profession is to survive and continue to improve. One of the biggest highlights of a teacher is being able to oversee and generate topical research and inspire young spine surgeons to do the same. This research would not have been possible without the work of surgeons-in-training who are highly curious and ambitious and are driven to pursue knowledge beneficial to patient care. In order to foster this, as a professor and academic, educators have an obligation to inspire a career built on the philosophy of lifelong learning. This starts fundamentally with our relationships and duty to our trainees. In the end, patients benefit greatly.

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