A study published Sept. 24 in the Journal of the American Academy of Orthopaedic Surgeons found “little differences” in surgical outcomes between orthopedic spine surgeons and spinal neurosurgeons.
The study evaluated 80 studies before May 2022 that compared neurosurgeons and orthopedic spine surgeons. The majority of articles found no differences in postoperative outcomes. There weren’t any notable differences in outcomes when analyzed according to author type.
David Skaggs, MD, and Alexander Tuchman, MD, both co-directors of Cedars-Sinai Spine in Los Angeles, shared their perspective on what the outcomes mean for the specialties.
Note: This response was lightly edited.
Question: What do the findings of this study mean for the future of spine and neurosurgery?
Dr. David Skaggs and Dr. Alexander Tuchman: When we set out to conduct a systematic review of every study comparing orthopaedic and neurosurgical spine surgeons, we honestly didn’t know what to expect. One concern was that the literature might reveal subtle — or not-so-subtle — bias, with authors favoring their own specialty or minimizing the contributions of the other.
We were relieved, and encouraged, to discover this was not the case.
In our new JAAOS article, we analyzed 80 studies. The results were clear: there are minimal differences in outcomes between orthopaedic and neurosurgical spine surgeons. Just as importantly, there was no measurable evidence of bias, regardless of author specialty, journal, or database.
This finding mirrors our experience at Cedars-Sinai, where the Spine Center is evenly composed of orthopaedic and neurosurgical faculty. Every day we hold joint conferences to review the latest literature, and we routinely discuss cases before and after surgery. Our patients undergoing surgery with faculty surgeons benefit from multiple expert perspectives, typically from both orthopaedic and neurosurgical surgeons.
Of course, differences between individual surgeons remain. Access to quality perioperative infrastructure and staff, depth of experience, and familiarity with differing techniques all contribute to outcomes. But our review suggests that the specialty background itself is not a primary driver. We believe the cross-pollination of ideas between disciplines strengthens the field and improves patient care.
Looking ahead, the focus in spine surgery should not be on whether orthopaedic or neurosurgical training provides the “best” foundation for a general spine practice. Instead, it should be on subspecialization within spine surgery and on building collaborative partnerships across backgrounds.
The future of spine care is not rivalry — it is partnership. Note, Cedars-Sinai Spine is jointly led by spine surgeons coming from an orthopaedic and neurosurgical background.
