Frequently Asked Questions Regarding Spine and Neck Surgery

How do I tell if my physician is qualified?

Is there a board certification in minimally invasive spine surgery or endoscopic spine surgery?

There is no official board certification in minimally invasive spine surgery. However, all doctors performing endoscopic spine surgery should be board certified. Traditionally, spine surgeons have training and board certification in neurological surgery or orthopedic surgery. These surgeons in many cases went on to obtain additional training in spine surgery techniques, usually as part of a formal year long fellowship. A fellowship is a term to define formal training beyond a basic residency. It’s important to note that while a spine surgery fellowship implies competency in spine surgery it does not imply competency or skill in all spinal techniques or in endoscopic spine surgery.

Over the last 15 years there have been tremendous advances in medicine. The utilization of new technology has allowed for the development of small precision instruments, small high resolution cameras and sophisticated x-rays. This has further fueled innovation by allowing physicians to create new and innovative means of solving surgical problems. As a result, physicians skilled in the use of image guided techniques have adopted these new procedures and have entered the field of minimally invasive spine surgery. These physicians usually come from the fields of interventional pain management or radiology and have corresponding board certification in those fields. These doctors may be focusing their practice on minimally invasive spine procedures and may not practice in the field of their board certification at all, much like how a board certified orthopedic surgeon who performs spine surgery may not perform any general orthopedic procedures. As these image guided procedures have evolved we are now seeing some traditionally trained spine surgeons enter this field as well.

Since there is no board certification available the most important question to ask is “what training, competency or experience does my physician have in performing the proposed procedure?” Fellowship training is important, but not if the physician only rarely performs the procedure. Also, some fellowship trained physicians may not have had any training in the proposed procedure during their fellowship. Ask where they learned the procedure. Was it a formal training program or a weekend course? Even surgeons who have completed spine surgery fellowships and are board certified in neurological surgery or orthopedic surgery may have only completed a weekend training course before offering endoscopic surgery procedures.

Dr. Rappard is boarded in radiology and has passed his board certification in neuroradiology. Dr. Rappard completed an additional 2 years of training in neurointerventional surgery-the use of imaging to perform minimally invasive brain and spine procedures. Neurointerventional surgery is an advanced specialty that evolved from radiology and neuroradiology before being joined by neurological surgery and neurology. It takes 8 years of training beyond medical school to become qualified in neurointerventional surgery. Dr. Rappard then completed an additional year of training dedicated to endoscopic spine surgery. Today, Dr. Rappard dedicates his practice to the performance of minimally invasive endoscopic spine procedures and spine research. Dr. Rappard is active in spine medical societies and routinely presents his results at major medical society meetings.

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