All neurosurgeons are trained in treating every kind of spinal condition; herniated discs, fractures, tumors, infections, etc. Some think of spinal surgery as orthopedics. Orthopedic spine surgeons are fellowship-trained after completing general orthopedic residency. Neurosurgeons learn spine surgery during their entire residency.
Doctors who do spine surgery operate from the top of the neck to the bottom of the spine, which ends at the sacrum. The sacrum is really a part of the pelvis and neurosurgeons do not do a lot of surgery there. The five vertebrae between the last rib and the sacrum make up the lumbar spine and that is where most surgical problems occur – usually due to pain from a herniated disc. Disc herniations also occur in the neck, the seven vertebrae from the skull to the first rib-bearing vertebra. The rib-bearing vertebrae make up the thoracic spine, where tumors and infections are more common surgical problems than herniated discs.
Disc herniations are ten times more common in the lumbar area than in the neck. A problem becoming more common is lumbar spinal stenosis, where a combination of arthritic facet joints, bulging discs, and thickened ligaments combine to constrict the space within the spinal canal around the nerves. Surgery is often needed to relieve stenosis when people can’t walk without pain or develop weak, numb legs.
Stenosis can also occur in the neck, where it is more dangerous because of the presence of the spinal cord. The spinal cord ends at the last rib, so in the lumbar spine there is no spinal cord to worry about. Therefore, surgery for stenosis or herniated discs is more dangerous in the neck because if the spinal cord is injured it affects arms and legs and breathing. Some neck surgery (anterior cervical) must be done from the front of the neck, because the spinal cord cannot be retracted if one goes in through the back.
The risks of spine surgery are paralysis or death, although that is rare. Infection or leakage of spinal fluid are two of the more common complications, followed by post-operative bleeding and nerve damage. Failure to relieve pain can be considered a risk, but spine surgery is not always successful. Anterior cervical spine surgery has special risks, such as postoperative bleeding that could cause suffocation, damage to nerves to the vocal cords, and perforation of the esophagus.