When Should I See an Orthopedic Surgeon Following an Injury?

When does a patient need to see an orthopedic spine surgeon following a traumatic injury to the neck/back following a car crash or work accident?

The general answer is after about 6 weeks of conservative care, including physical therapy/chiropractic treatment.

How to Choose the Right Spine Surgeon When looking for a qualified spine surgeon to treat your injuries, you need a Board-Certified spine surgeon who is fellowship trained in specifically orthopedic spine surgery. A spine surgeon can also be a fellowship trained neurosurgeon. Neurosurgeons are an excellent choice for treating spine injuries, but they do not have training in orthopedic type injuries to the extremities, like the shoulder and hip. And that is a potential problem. When diagnosing and treating acute neck and back complaints, an Orthopedic Spine Surgeon is the better choice.

Acute Injuries Vs. Complicated Injuries When discussing acute injuries to the neck and back, I am specifically talking about patients that are not admitted to the hospital after a trauma like a car accident or fall. Patients that are directly admitted to the hospital usually have major obvious injuries and are taken care of immediately.

Acutely injured patients are those that are discharged home from the emergency room or injury center or those that do not seek immediate medical attention for their injuries. These types of patients usually end up in some type of therapy for their neck and back, such as physical therapy or chiropractic treatment. When should these types of patients see a spine surgeon? The first thing to understand is that most of these acutely injured patients get better with conservative care within about 6 weeks. These patients do not need to see a spine surgeon. Of course, if the treating doctor has any concerns that the patient’s injury could be surgical, it is appropriate for them to get a consultation with a spine surgeon to confirm the treatment plan. This would be up to the referring physician or chiropractor.

If the patient is not getting better, when should the referral be made? The general answer is after about 6 weeks of conservative care, including physical therapy/chiropractic treatment. If in 6 weeks the patient has no improvement in their neck or back pain, there may need to be some intervention to prevent the pain from becoming chronic. A spine surgeon can add options to the treatment plan. These options are usually not surgical but may involve different types of focused injections or alternate physical therapy recommendations, depending on the problem.

Missed Injuries Missed orthopedic injuries refers to when a patient has an injury that has gone untreated because it was missed when diagnosing the patient during first examination. This is where the orthopedic part of an orthopedic spine surgeon comes into play. Many times, a patient will come to my clinic with a neck problem and have an additional shoulder injury causing some or most of their neck pain. The correct diagnosis is made by a trained orthopedic exam of the shoulder. Similarly, back pain with groin pain may actually be a hip problem, again correctly diagnosed by an orthopedic exam of the hip. A complete examination of the musculoskeletal system by a well-trained orthopedic spine surgeon will help pick up these types of associated injuries. An orthopedic spine surgeon can diagnose and treat orthopedic injuries as well as address injuries to the neck and back at the same time.

Learn more about Whiplash Injuries here!

At 6 weeks a referral should be made. Outside the ideal 6-week referral window, a patient should be referred to an orthopedic spine surgeon before an injury becomes chronic and more difficult to treat. Generally, an injury becomes chronic at 6 months. Therefore, if a patient has not seen an orthopedic spine surgeon by 6 months with complaints of continued pain, they should get an appointment as soon as they can. Generally speaking, the patient can still get better after 6 months for most injuries. But if they are not better by 6 months, it is a disservice to the injured patient for them not to hear of other possible interventions for their pain. The patient may choose to have no further treatment, but they should know their options and make an informed choice. That is what an orthopedic spine surgery referral is for.

After an acute injury at work or car accident where the patient is not getting better by 6 weeks, he/she should see an orthopedic spine surgeon around that 6-week period, and certainly before 6 months. The goal is to get a patient back to their life and back to work as soon as possible. A qualified orthopedic spine surgeon can do this by making the appropriate treatment recommendations for the entire spine and musculoskeletal system at the right time.