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Who’s a Spine Specialist?

Updated: Nov 25, 2020

There are many types of health practitioners that care for patients with spinal conditions, and each has a slightly different role. Selection of the most appropriate type of health professional - or team of health professionals - largely depends on the patient's symptoms and the length of time the symptoms have been present.

The different types of health professionals who treat back pain tend to have varied training and interests. While it is common to start off with a primary care provider (a medical doctor), if the patient's back pain is resistant to initial treatment then the services of a spine specialist may be necessary.

There are three broad groups of health providers who treat back pain:

  1. Primary care providers are often the first port of call for patients when back pain strikes, and generally include:

  • Primary care physicians (Family practice doctors, Internists, Obstetricians, Gynecologists, Pediatricians)

2. Spine specialists have a more specific area of expertise in certain diagnoses and/or treatments for back pain and spinal conditions, and generally include:

  • Neuro-Surgeons

  • Ortho-Spine Surgeons

3. Therapists have expertise in either physical or occupational rehabilitation for back pain or psychological help for chronic pain, and generally include:

  • Physical therapists

  • Occupational therapists

  • Clinical psychologists

A medical doctor, is a practitioner who examines patients, analyzes the results of laboratory tests, diagnoses and treats the patient's medical condition, and advises the patient about methods of preventive health care.

Primary care physicians (MBBS/ MD)

types of primary care physicians typically include family practice doctors, internists, obstetricians, gynecologists, and pediatricians As back pain is extremely common, these doctors often have some experience in treating acute lower back pain and muscle strains.

Primary care physicians often utilize prescription medications to help reduce pain and inflammation, as well as the services of physical therapists to assist in maintaining range of motion and muscle tone. Often, they may order a variety of spinal diagnostic procedures to more fully investigate the potential causes of persistent back pain and neck pain and refer patients to a Spine-Specialist for further diagnosis and treatment.

Spine Specialists (MBBS, MS, MCh)

Neurosurgeons and Orthopedists perform the overwhelming majority of spine care and frequently extend their general Neurosurgical or Orthopedic training by participating in a spine fellowship. These spine fellowships accept a select group of physicians who have completed four to seven years of a surgical residency and are either board certified or board eligible in their respective specialties and provide additional training in performing spine care.

  • Neurosurgeon (MBBS, MS, MCh) - Neuro-Surgeons are medical graduates who, after completing their medical school go and complete a 6-7 years residency in Neurosurgery which includes formal training in every aspect of Brain and Spine treatment. Other associated medical health workers (such as Physiotherapists, chiropractors, and physiatrists) frequently refer their patients to a Neuro-Surgeon for Spine care. Neuro-Surgeons often consult and practice with a variety of other professionals, and some are part of an integrated spine practice. Neurosurgeons are specifically trained in the diagnosis and treatment of disorders of the spine, spinal cord, nerves, brain, intracranial and intraspinal vasculature.

  • Orthopedic Surgeon (MBBS, MS) - Ortho-spine surgeons after completing their medical school, go on to do a residency for 3 years after which they become Orthopedic Surgeons and then if they wish to become an Ortho-Spine Surgeon they complete a 1-3 years Fellowship in Spine. An Ortho-Spine surgeon is typically involved in Spine deformities correction like Scoliosis.

In recent years, spine surgery has become increasingly specialized within the neurosurgical and orthopedic professions, and often a surgeon will focus a majority of his or her practice on spinal surgery. It is thought that the increasing level of specialization and focus on the spine has contributed to enhancements in surgical technique, which in turn has led to overall improved success rates and reduced morbidity (e.g. reduced post-operative discomfort, faster healing time).

Physiotherapist (BPT)

A physiatrist is a person who specializes in Physical Medicine and Rehabilitation (also called PM&R physicians). They are not medical Doctors, they receive ‘Bachelor of Physical Therapy’ (BPT) degree instead of MBBS/ MD.

Essentially, physiatrists specialize in a wide variety of exercises and physiotherapy for the musculoskeletal system. Typical treatments may include:

  • Active physical therapy (e.g. exercise, stretching)

  • Passive physical therapy (e.g. heat/ice, TENS units)

  • Massage therapy

Physiatrists have varying degrees of specialization and may practice in rehabilitation centers, hospitals, or private practice, and often practice under a Spine Specialist (medical Doctor) in integrated spine centers. They focus on keeping individuals as functional as possible and work to coordinate the patient's care.

Anesthesiologist (MBBS, MD)

Anesthesiology is the practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during and after surgery.

After completing medical school, they enter a three-year anesthesiology residency training program. While anesthesiologists have been known primarily as physicians who administer anesthesia during surgery, they also provide medical care and consultations in other situations in addition to the operating room.

Anesthesiologists as part of the spine team frequently diagnose and treat patients suffering from acute and chronic pain syndromes. Some anesthesiologists complete Pain Fellowships and concentrate their practice on doing injections (such as epidural steroid injections). They may practice in a variety of settings, such as a Pain management clinic or an integrated spine care center where they work along with Spine Specialists (Neurosurgeon or Ortho-Spine Surgeon)

Neurologist (MBBS, MD, DM)

A neurologist (Neuro-Physician) specializes in diagnosing and treating disorders of the nervous system, including diseases of the brain, spinal cord, nerves, and muscles (such as strokes, epilepsy, headaches, Alzheimer's, multiple sclerosis, Parkinson's, and various forms of pain).

Usually a Neurologist (Neuro-Physician) do not treat patients with Spine problems as they are mainly concerned with nerves of other parts of the body and for Spine patients they rely more on their Spine colleagues like Neurosurgeons or Ortho-Spine Surgeons.

Neurologists rely on the clinical examination along with certain other commonly used tests (such as CAT Scans and MRI/MRA scans). These tests can provide detailed anatomic pictures of the brain, spinal structures and the blood vessels.

Rheumatologist (MBBS, MD)

A Rheumatologist specializes in the diagnosis and treatment of arthritis and other musculoskeletal diseases (involving joints, muscles and bones).

Rheumatologists diagnose and treat a wide variety of chronic musculoskeletal diseases, including osteoarthritis, rheumatoid arthritis, musculoskeletal pain disorders, fibromyalgia, certain autoimmune diseases, osteoporosis, and tendonitis. Many types of rheumatic diseases are difficult to identify, and rheumatologists are trained to accurately diagnose musculoskeletal disorders so that appropriate treatment can begin early.

Rheumatologist sometimes act as a consultant to advise another physician about a specific diagnosis and treatment plan, and sometimes leads the patient's treatment and may include a team approach to treatment involving as physical therapists, psychologists, or other specialists.

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