Choosing a spine surgeon is one of the most consequential medical decisions a patient makes. The wrong choice can mean a procedure that does not address the problem, a complication that could have been avoided, or a surgery that makes things worse. Here is a practical guide to evaluating your options.
Training matters more than reputation
All board-certified spine surgeons completed residency training in either orthopedic surgery or neurosurgery. But residency alone does not make a complex deformity surgeon. Fellowship training — an additional one to two years of subspecialty training after residency — is where surgeons develop expertise in specific areas like spinal deformity, minimally invasive techniques, or revision surgery.
If your problem is a simple herniated disc, a well-trained general spine surgeon without fellowship training can handle it well. If your problem is adult scoliosis, a complex revision, or multilevel deformity — you need a fellowship-trained deformity specialist. The difference in outcomes between these two surgeons for complex cases is significant.
Volume and experience
Ask how many procedures of your specific type the surgeon performs per year. For complex deformity surgery, a high-volume surgeon who performs fifty or more scoliosis corrections per year will have better outcomes than a general spine surgeon who performs five. This is not an insult to the lower-volume surgeon — it is a simple truth about procedural medicine. Volume builds the pattern recognition and technical refinement that improves outcomes.
What to ask at your consultation
Ask the surgeon directly: What is the surgical plan? What are the risks specific to my anatomy? What happens if the surgery does not work? What is your experience with revision surgery if this procedure fails? A surgeon who gives clear, honest answers to all of these questions — including the last one — is a surgeon worth trusting.
Be cautious of any surgeon who dismisses your questions, guarantees outcomes, or pressures you to proceed quickly. Complex spine surgery should never feel rushed.
Get a second opinion
For any surgical recommendation involving fusion, deformity correction, or revision surgery, a second opinion from a fellowship-trained specialist is not just reasonable — it is advisable. A second opinion from a surgeon with deeper training may confirm the original recommendation, modify it, or offer an alternative you were not aware of. Most good surgeons will tell you to get one.
Dr. Enguidanos welcomes second opinion consultations. He will review your imaging and give you his honest independent assessment of your options — including whether surgery is the right choice at all.