Dr. Ramin Abdolvahabi Describes a Neurosurgeon's Duties

Well as neurosurgeons, we not only deal with the brain, but we also deal with spines. One of the big questions that comes up-always is being asked is, "what is the difference between a neurosurgeon doing a spine?" And really at the end of it, it's just a matter of training. Neurosurgeons are trained to do spine from their second year of residency all the way through and I'll tell my patients for example that 4th and 5th year of my residency, we were not doing that much spine anymore because we were done doing spine. We had done so many cases in spine that we would now just switch to brain and aneurisms and the tumors the majority of the time but an orthopedic surgeon has to do 5 years of joints, knee, hip, shoulder, and then one year fellowship in spine. So there is a slight difference in training. Having said that, there are certain things that are done in spine, for example, tumors of the spine. There are very very few orthopedic surgeons that do tumors of the spine. The majority of that is done by neurosurgeons. As far as small cases, such as a simple disc herniation, micro-discectomies, cervical fusions...two big cases such as fusions of the lumbar spine, what they call a "trans thoracic approach" to the thoracic spine and complex spinal surgery-that's what neurosurgeons do. Basically it's from the simplest to the most difficult and it's done by neurosurgeons.
There are many different minimally invasive procedures that are done. One of the most simple ones that nobody considers minimally invasive would be repair of compression fractures, the fractures of lumbar spine due process before for that repair we used to do a very large operation, now we do it through 2 pin holes and with a cement in about 15 to 20 minutes as opposed to an operation that usually would take 6 to 7 hours and would involve putting a chest tube in the patient or getting 2 surgeons involved, that has gone by the wayside. Nowadays, (prime example) I just did a case today that involved 2 bones in the thoracic spine engulfed by a tumor and with thoracic surgeon, I did the first portion of it; anteriorly replaced the bones and for the posterior portion, going from the back, putting pedicle screws in. I have 4 little incisions and it took me literally 45 minutes to do, whereas before, it used to be a 4 and 1/2 hour operation, lots of blood loss. So there are many ways to do minimally invasive, but not everybody's a candidate for minimally invasive, it should not be done on everybody. It has room and it should be done appropriately.
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