Answering Your Questions About Spine Specialists

A spine specialist is a doctor who focuses on treating spinal conditions. There are many types of spine specialists, including surgical and non-surgical specialists. The kind of specialist you see will depend on the condition you have and what your treatment goals are.

Let’s take a look at some of the different categories of spine specialists.    

Orthopedist

Orthopedics (sometimes spelled orthopaedics) is a medical specialty devoted to the diagnosis and treatment of disorders of the musculoskeletal system. Some orthopedists are generalists, while others specialize in specific areas of the body, such as the spine.

Orthopedists frequently treat pain or injuries caused by physical activities, but their expertise extends far beyond sports medicine. An orthopedic doctor can provide advanced treatment for conditions like back pain, arthritis, bone tumors, and osteoporosis (4).  

Orthopedic Surgeon

Most people associate orthopedic doctors with surgery. While it’s true that all orthopedic surgeons are orthopedists, not all orthopedists are surgeons. Orthopedic surgeons typically start by exploring non-surgical treatment options – such as medication, physical therapy, and lifestyle changes – and only use surgery when more conservative treatment options fail (5).

Still, some situations will require surgery. Orthopedic surgeons perform procedures for spondylolisthesis, spinal deformity, and disc replacement, among other conditions.

Physiatrist

Also known as Physical Medicine & Rehabilitation (PM&R) physicians, physiatrists are doctors who specialize in non-surgical care for musculoskeletal disorders. Physiatrists focus on restoring function, reducing pain, and improving quality of life through minimally invasive treatments (6). 

Osteopath

According to the American Osteopathic Association, “Doctors of osteopathic medicine (DOs) are licensed physicians who practice in all areas of medicine” (7). Osteopaths receive particularly intensive training in musculoskeletal care over the course of their medical education. Many practice Osteopathic Manipulative Treatment (OMT), a hands-on method of diagnosis and treatment.

While some consider osteopathy a branch of alternative medicine, DOs receive much of the same training as MDs (sometimes called allopathic physicians), with the primary difference being their philosophy of patient care.

Osteopathy is growing in popularity in the United States. The American Osteopathic Association estimates that by 2030, more than 20% of all practicing physicians will be DOs (8).

Neurosurgeon

Neurosurgeons are doctors who are trained in the diagnosis and treatment (both operative and non-operative) of the brain, spine, and nervous system (9). They differ from osteopathic surgeons in that they have special training which allows them to perform procedures inside the lining of the spinal canal. This means that in addition to treating conditions like spinal stenosis and degenerative disc disease, they also perform surgery on patients with tethered spinal cords, spinal tumors, and syringomyelia (10).   

What About Neurologists?

A neurologist is a physician who diagnoses, treats, and manages disorders of the brain and nervous system, such as epilepsy or Parkinson’s disease (11). While the role they play in the medical field is important, they’re not back pain specialists and their input doesn’t ordinarily impact diagnosis or treatment of back pain disorders (12).

At this point, you’re probably wondering what makes spine specialists so special. One thing that sets them apart from other doctors is the amount of training they receive, which can take up to 17 years to complete (13)! In this section, we’ll look at the educational requirements for orthopedists, neurosurgeons, and other spine specialists.

College and Medical School

All licensed physicians – whether they’re MDs or DOs – have both bachelor’s degrees and advanced degrees from medical school.

After four years of undergraduate studies, aspiring doctors must pass the Medical College Admission Test (MCAT). It’s a rigorous exam – only about 50% of test-takers pass on the first try (14).

Once they’ve passed the MCAT, future doctors go through another four years of schooling. The first two years of medical school are primarily classroom and laboratory work; the second two years mostly consist of hands-on work under the supervision of experienced doctors.

Licensing Exam

In the United States, all physicians have to pass a licensure examination before they can practice medicine. Physicians with an MD degree must pass the United States Medical Licensing Examination (USMLE); those with a DO degree can choose to take either the USMLE or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX).

Both exams are divided into three parts. Students complete part one after their second year of medical school, part two during their fourth year of medical school, and part three after the first year of their residency.

Residency

After finishing medical school, new graduates must complete a residency program. Residency is supervised, hands-on training that gives future doctors the chance to work alongside other healthcare providers as a part of a patient care team and hone their skills in their chosen specialty.

Residencies typically last three to seven years and are usually carried out in hospital settings.

Fellowship

While completing a fellowship isn’t a requirement of practicing medicine, some doctors choose to complete one in order to receive more in-depth training in their chosen subspeciality. Fellowships last between one and two years (15).

Board Certification

Board certification isn’t mandatory. It’s an extra step doctors can choose to take to demonstrate that they are at the top of their profession. Board certification requires extensive specialty-specific training and satisfactory completion of a board exam.

The American Board of Medical Specialties (ABMS) is made up of 24 member boards that offer Board Certification in 40 specialties and 85 subspecialties, including orthopedic surgery, neurosurgery, and physiatry (16).

Because of their specialized knowledge of the musculoskeletal system, spine specialists are well equipped to handle back pain and neck pain caused by a number of underlying conditions. In this section, we’ll take a look at a few types of cases commonly treated by these specialists. This is by no means an exhaustive list, but it should give you a good sense of what conditions would warrant a visit to a spine specialist.

General Back Pain and Neck Pain

A spine specialist will have a strong understanding of the way that the bones, muscles, tendons, and nerves of the neck and back work together. If you have back pain or neck pain that isn’t caused by an underlying condition or injury, then physiatrists, orthopedists, and osteopaths would be well-equipped to assess your case.

Spinal Stenosis

Spinal stenosis occurs when the spaces in your spinal canal narrow down excessively. This can place pressure on the nerves in your spine and on your spinal cord. Symptoms of spinal stenosis include numbness, tingling, or weakness in your hands, feet, arms, or legs, neck pain, back pain, and difficulty walking. Treatment options range from medication and physical therapy to spine surgery (17). 

Herniated Disc

There’s a small, pillow-like disc between each of the vertebra of your spinal column. Sometimes, either through injury or natural degeneration, the outer layer of the disc ruptures and some of the material inside the disc pushes out into the spinal canal, pressuring the spinal nerves. Symptoms of a herniated disc (sometimes called slipped disc) include sciatica (which can manifest as low back pain or radiating pain down one leg), pain in the neck or between the shoulder blades, and pain that radiates down the arm to the hands. Sometimes herniated discs can be resolved through conservative care, though other cases will require a surgery such as a disc replacement procedure (18). 

Back Injuries

Injuries to your back should be taken seriously, as they can have life-altering complications. Spinal cord injuries can arise from trauma – such as a sharp, sudden blow to your back – or from cancers or infections.

Doctors recommend anyone who has experienced trauma to their head or neck to be evaluated for a spinal injury as soon as possible. Serious spinal injuries may not be immediately apparent, and waiting to seek treatment can result in significant complications (19).

Sciatica

Symptoms of sciatica include lower back pain, numbness, tingling, burning, or weakness in one leg, and pain in the hips or buttocks that gets worse when sitting. Sciatica occurs when the sciatic nerve – the longest nerve in your body, running from your lower back down to your feet – becomes irritated or inflamed. Treatment for sciatica is usually conservative, involving NSAID medications, physical therapy, massages, and spinal injections (20).

Spinal Tumors

Spinal tumors are rare but serious. They can be benign (non-cancerous) or cancerous, and can form on your spinal cord or in your spinal column. The most common symptom of spinal tumors is back pain, especially in the middle (thoracic) and lower (lumbar) back (21).

Spine specialists employ a number of tools to diagnose the cause of your back pain. Let’s take a quick look at the most useful tools.

Physical Exam

Your physical exam will begin with your doctor going through your complete medical history. They’ll want to know about any previous medical conditions as well as your current symptoms.

Your doctor will then physically examine your body, paying special attention to the bones, joints, and muscles of your back. They may observe your posture, ask you to move in different ways to test your range of motion and see what kind of movements cause you pain, and palpate your spine as well as the muscles that support it.

Neurological Exam

A neurological exam can aid your doctor in pinpointing the cause of your back pain. You might be asked questions that specifically relate to neurological symptoms, such as if you’ve noticed weakness in your arms and legs. Your doctor may also ask you to walk around the room in different ways so they can examine your gait and balance, test your reflexes, and do a sensory exam using tools like alcohol swabs or tuning forks.

Imaging

Sometimes the best way to figure out what’s going on inside your body is to take a visual look. Your doctor may use any combination of X-rays, CT scans, or MRI imaging to aid in diagnosing the cause of your back pain (22).

Treatment recommendations from spine specialists will vary based on their practice philosophy, your condition, and your treatment goals. In this section, we’ll briefly explore some of those treatment options.

Physical Therapy

Physical therapy is often used as part of a conservative treatment plan. A favorite approach of physiatrists and orthopedists, it can be used to treat a wide array of conditions including scoliosis, sciatica, and kyphosis.

Prescription Medications 

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen or naproxen, COX-2 inhibitors, and muscle relaxants are all non-opioid medications a spine specialist might prescribe for pain management.

Injections

Corticosteroid medications, when injected into the epidural spaces in the spine, can provide significant medium-term pain relief for chronic pain caused by inflammation of the spinal nerves (23).

Surgery

Sometimes conservative methods of care aren’t enough to relieve chronic back pain. In these cases, surgery may be the best option to improve your quality of life. Some procedures performed by spine surgeons are (24):

• Discectomy – removal of the damaged portion of a herniated disc
• Kyphoplasty – vertebral augmentation for compression fractures
• Spondylodesis – joining together two or more vertebrae, also called spinal fusion
• Laminectomy – removal of part of the laminal arch to relieve pressure in the vertebral canal

How do you know it’s time to see a spine specialist and not your primary care provider? If you experience any of the following symptoms, it might be time to ask for a referral (25).

• Back pain or neck pain that lasts more than three months (chronic pain)
• Pain with an unknown cause
• Radiating pain (pain that travels down your leg or your arm)
• Weakness, tingling, or burning in your arms, hands, legs, or feet
• Traumatic injury (car crash, fall, etc.)
• Pain that makes the activities of daily life (ADLs) difficult
• Trouble controlling your bladder or bowels
• Any of the above symptoms accompanied by a fever over 101° F

Your primary care physician is well-equipped to handle basic aches and pains. But if you’re experiencing symptoms consistent with more complex spinal conditions, such as pain that travels down one leg, pain that gets worse over time instead of getting better, or pain following a traumatic injury, consulting a spine specialist can be a good option. There are a variety of doctors who specialize in treating spinal conditions – from osteopaths to physiatrists to neurosurgeons. The kind of specialist you choose will depend on the severity of your condition and your personal treatment goals.