Research Assessment #3:

Date: October 20, 2017

Subject: Neurosurgery

MLA Citations: Staff, Mayo Clinic. Brain Aneurysm. Mayo Clinic, Mayo Foundation for Medical
Education and Research, 1 Sept. 2015, www.mayoclinic.org/diseases-conditions/brain-
aneurysm/basics/definition/con-20028457.

Written by Gerald E. Rodts, Jr., MD and Lawrence G. Lenke, MD. Neurosurgeon or Orthopedic
Surgeon? Does It Matter? SpineUniverse, www.spineuniverse.com/treatments/surgery/neurosurgeon-or-
orthopedic-surgeon-does-matter.

Lumbar Spinal Fusion (Arthrodesis). WebMD, WebMD, www.webmd.com/back-pain/spinal-fusion-

arthrodesis.
Analysis:

During my interview, I realized that I needed to understand more of the neurosurgery terms. My
first interviewer, Nancy, talked about an aneurysm. I have knowledge on this topic, but I need to learn
more. A brain aneurysm is a bulge or ballooning in a blood vessel in the brain. It looks like a berry on a
stem and is very dangerous. If it ruptures, blood leaks into the brain which can lead to a brain stroke.
Most often a ruptured brain aneurysm occurs in the space between the brain and the thin tissues covering
the brain. I found that aneurysms are life threatening. In fact, when I watched a video on Botched, plastic
surgeons found that this woman had an aneurysm, when she came in to get her nose fixed. The doctors
immediately called a neurosurgeon, which I thought was very interesting. The doctors quickly found out
that something was wrong with her, just based on her symptoms. This taught me not only about
aneurysms, but that doctors need to detect other problems that are not in your specific specialty.

I learned that neurosurgeons deal with spine and the brain. I never really considered the spine to
be a part of a neurosurgeons specialty. I taught that orthopedic spine surgeons particularly deal with the
spine, but I learned that there are differences between them. Only neurosurgeons deal with a specific
area called the Dura. Also, the spinal tumors that fall within the brainstem and the brain would fall under a
neurosurgeon. Both neurosurgeons and orthopedic spine surgeons deal with spine surgeries, so patients
can go to either when they have spinal problems, unless it is tumors.

I learned about a specific type of surgery for the spine that was mentioned called lumbar spine
fusion, during my interview. Lumbar spinal fusion is surgery to join, or fuse, two or more vertebrae in the
low back. Spinal fusion may be done by itself or along with surgery to remove bone and tissue that are
narrowing the spinal canal and squeezing the spinal cord and/or the spinal nerves. Fusion is done to keep
the spine stable after a broken spine or a tumor that affects the spine. I learned how people who are
hunched over fusion surgery and get rods inserted that help spread the bones apart, so they are not
hunched over.

Overall, I have learned a lot through this research experience. I used my insight after my first
interview, so I could learn more about the things I lacked knowledge in. This research will definitely be
more useful in future interviews.
 Neurosurgeon or Orthopedic Surgeon?
Articles:

Does it Matter?
Written by Gerald E. Rodts, Jr., MD and Lawrence G. Lenke, MD

If I need to be evaluated for a spinal problem, or, if I need spinal surgery, should I see a neurosurgeon or
an orthopedic surgeon?
It is important for patients to realize that both neurosurgeons and orthopedic surgeons perform spine
surgery. Today, there is an emerging field of "spine surgery" that incorporates both specialties.

In the future, there may be a well-defined medical specialty of "spine specialists"

defined by its own board certification. This is not currently the case. Currently, neurosurgeons seek board
certification from the American Board of Neurological Surgery and orthopedic surgeons seek certification
from the American Board of Orthopedic Surgery. There is no certification process at the present time that
is recognized by the "father" board, the American Board of Medical Specialties. It is very important that
patients make sure that their doctor is certified by the appropriate board. This ensures that the doctor has
met the highest standards set by his or her peers and passed both oral and written examinations.
Neurosurgeon Training
All neurosurgeons trained in the United States (and many places abroad) gain experience in the
diagnosis and nonsurgical and surgical treatment of spinal disorders during a six or seven year residency
training program (after medical school). When physicians graduate from an accredited neurosurgery
training program, they usually have assisted in many hundreds of spinal procedures. If they wish to gain
even more advanced training, they may elect to do a post-graduate fellowship in spine surgery. This
intensive, focused training is typically one or two years after residency training. Though most patients
think of neurosurgeons as "brain surgeons", it may be interesting to know that the majority of operations
performed by neurosurgeons across the country are spine surgeries. In large group practices and
certainly in academic (university-based) neurosurgery departments, there are some neurosurgeons that
specialize in brain surgery and do very little spine surgery. In these settings, they will have a colleague
who specializes in spine surgery.
All orthopedic surgeons are also exposed to spine surgery during their four or five year training
program. Some orthopedic residencies are at institutions where there are one or more orthopedic
surgeons who specialize in spine surgery. At these institutions, orthopedic residents in-training may be
exposed to a volume of spine surgeries comparable to many neurosurgery programs. In some orthopedic
training programs, the emphasis is on trauma or joint surgery or on sports medicine. As in neurosurgery,
some orthopedic surgeons who wish to specialize in spine surgery and gain further training may pursue a
post-graduate (after residency) fellowship in spine surgery.
Both Can Specialize in Spine Surgery
Though things were different many years ago, today there are a large number of both orthopedic
surgeons and neurosurgeons who specialize in spine surgery. More and more, we are referring to each
other as "spine surgeons" as the distinction between us is becoming nonexistent. Both neurosurgeons
and orthopedic surgeons specializing in spine surgery are skilled in taking care of disc herniations, disc
degenerations, spinal stenosis, fractures of the spine, slippage of the spine (spondylolisthesis), scoliosis,
bone tumors of the spine, etc. For younger patients, there is a subset of spine specialists that is devoted
to the pediatric patient (usually defined by patients below age 15 or so).
Differences
There are a few areas where there still is a difference. Only neurosurgeons are trained during
their six or seven year residency to perform procedures inside the lining of the spinal canal called the
dura. Thus, spinal cord tumors, arachnoid cysts, syringomyelia, Chiari malformation, spinal cord
arteriovenous malformation, diplomyelia or diastematomyelia, tethered spinal cord, spina bifida or
myelomeningocele, lipomyelomeningocele, tumors at the junction of the base of the skull and upper
cervical spine, nerve root tumors, and a few other diagnoses still fall under the domain of the
neurosurgeon. Similarly, both pediatric and adult scoliosis and other spinal deformities are still primarily
treated surgically by orthopedic spine specialists.
Sharing the Same Interests
Perhaps the most exciting news to report is that there is a terrific, productive collegiality
developing between orthopedic surgeons and neurosurgeons who wish to devote their careers to the
advancement of spine care. We no longer look at each other as competitors; rather, we look at each other
as colleague with the same interests. Many international scientific organizations now open their doors to
physicians from both specialties such as the North American Spine Society, the Scoliosis Research
Society, the Cervical Spine Research Society, and others. This friendship and professional association of
orthopedic surgeons and neurosurgeons will be of great benefit to patients.
Patients Have Choices
Currently, a patient does not have to settle on a neurosurgeon who does "mostly brain surgery
and a little bit of spine surgery" or an orthopedic surgeon who does mostly "joint surgery and a little bit of
spine surgery." A patient today can seek consultation with either a neurosurgeon or an orthopedic
surgeon appropriately trained in residency and, possibly, in a post-graduate fellowship in spine surgery
who has devoted his or her practice to spinal disorders. In other words, they take care of spine problems
day to day, week to week, month to month, and year to year. The old walls separating these two
specialties have been broken down by the shared goal of advancing the field of spine care. Don't be
afraid to ask your surgeon about his or her training, practice focus, experience with whatever operation
has been recommended, and whether you the patient have been presented all of the options that exist
(regardless of whether your surgeon performs all of them or not). Don't be afraid to speak up. It's your
body, your spine. Physicians place great value on educating patients to the best of their ability so that
satisfactory decisions can be made and acceptable treatment initiated.

Lumbar Spinal Fusion (Arthrodesis)

Surgery Overview
Lumbar spinal fusion is surgery to join, or fuse, two or more vertebrae in the low back.
Spinal fusion is major surgery, usually lasting several hours. There are different methods of spinal fusion.
Bone is taken from the pelvic bone or from a bone bank. The bone is used to make a bridge
between vertebrae that are next to each other. This bone graft helps new bone grow.
Metal implants are usually used to hold the vertebrae together until new bone grows between
them.

What To Expect After Surgery

You will need to be watched in the hospital for a few days after surgery.
Bed rest is not usually needed while you recover at home.
Your doctor may recommend that you wear a back brace while you recover.
Rehabilitation can take a long time. It includes walking, riding a stationary bike, swimming, and similar
activities.

Why It Is Done
Spinal fusion may be done by itself or along with surgery to remove bone and tissue that are narrowing
the spinal canal and squeezing the spinal cord and/or the spinal nerves.
It may be done as a follow-up after surgery that was done to treat problems such as spinal stenosis,
herniated discs , injuries, infection, and tumors.
Spinal fusion was first used to treat fractures or other problems. It is now also used to treat age-related
spinal problems and spinal stenosis.

Definition
By Mayo Clinic Staff

A brain aneurysm (AN-yoo-riz-um) is a bulge or ballooning in a blood vessel in the brain. It often looks like
a berry hanging on a stem.
A brain aneurysm can leak or rupture, causing bleeding into the brain (hemorrhagic stroke). Most often a
ruptured brain aneurysm occurs in the space between the brain and the thin tissues covering the brain.
This type of hemorrhagic stroke is called a subarachnoid hemorrhage.
A ruptured aneurysm quickly becomes life-threatening and requires prompt medical treatment.
Most brain aneurysms, however, don't rupture, create health problems or cause symptoms. Such
aneurysms are often detected during tests for other conditions.
Treatment for an unruptured brain aneurysm may be appropriate in some cases and may prevent a
rupture in the future.