Introduction to spine surgeon referrals
For patients who are candidates for spinal surgery, the next obvious step is for them to ask their treating physician for a referral to a spine surgeon. However, getting a referral to an appropriate spine surgeon may not always be as straightforward as it may sound. The difficulties are due to several issues, including:

• There are many peripheral factors that often impact the referral (other than simply who is the best spine surgeon to do a patient’s surgery)

• Many patients are not sure what type of surgeon is best qualified to perform a particular type of back surgery

• Due to lack of objective information, it may be difficult for patients to evaluate and determine who is the best spine surgeon.

This article addresses the above issues and provides guidance to help patients play a proactive role in finding, evaluating and deciding on a spine surgeon prior to having back surgery.

Influences on spine surgeon referrals
There are several factors that may affect which spine surgeon a patient is referred to, including:

• Market forces. Health care in the US is a business and there are often market factors (such as financial incentives) that influence a physician’s referral pattern.

• Insurance. Many patients are enrolled in managed care programs and there may only be a select number of spine surgeons in the program who are available to do spine surgery. Not using one of the contracted spine surgeons can result in steep financial consequences.

• Large practices. Many physicians are part of a large multi-specialty group practice or network and they may be financially or otherwise encouraged to refer patients to a spine surgeon within their own practice or network.

• Personal factors. Some physicians may be more inclined to support a local spine surgeon - especially if they live and work in a small community - and some physicians may favor referring patients to spine surgeons whom they know personally.

One problem referring physicians have is that there is no good way for them to absolutely evaluate the competence of a spine surgeon. Typically, physicians use the same criteria as the general public to evaluate surgeons – that is, word of mouth and anecdotal data.

A spine surgeon’s reputation is developed over time and is based mainly on word of mouth and anecdotal data. Referring physicians can get a sense of whether or not a certain spine surgeon has a high or low complication rate, and what their success rate has been. There is, however, no source (such as a database) that allows a heads up comparison of one spine surgeon to another.

Types of spine surgeons
Both an orthopedic surgeon and a neurosurgeon may have been extensively trained in and be qualified to perform most types of spine surgery.  While an orthopedic surgeon is likely to have done fellowship training in orthopedic spine surgery and a neurosurgeon in neurosurgical spine surgery, most of the residency training is similar for both specialties.  For the most part, the qualifications of the surgeon to do spine surgery are more driven by the amount of training in spine surgery and the amount of the surgeon’s practice devoted to spine surgery (for example, vs. brain surgery for neurosurgeons, or vs. hip surgery for orthopedic surgeons), rather than by whether or not the surgeon is a neurosurgeon or orthopedic surgeon.

In some specific instances, either a neurosurgeon or an orthopedic spine surgeon may be the more appropriate choice.  For example, an orthopedic surgeon is more capable of doing spine deformity surgery (such as surgery for scoliosis and other large spinal deformities), whereas a neurosurgeon can better treat intradural tumors, i.e. tumors that are inside the central nervous system.