Why Do Neurosurgeons Not Like Chiropractors?

The dynamic between neurosurgeons and chiropractors is often complex, largely stemming from fundamental differences in their approaches to healing, educational backgrounds, and scopes of practice. This divergence can lead to misunderstandings, professional skepticism, and differing opinions on optimal patient care, particularly concerning spinal and neurological conditions.

Fundamental Differences in Approach

One of the primary reasons for the rift between medical doctors, including neurosurgeons, and chiropractors is the fundamental differences in their approaches to healing. Neurosurgeons are medical specialists focused on the diagnosis and surgical treatment of diseases and disorders of the brain, spinal cord, and peripheral nervous system. Their approach is heavily rooted in Western biomedical models, emphasizing pathological diagnosis, pharmacological intervention, and surgical correction when necessary.

Chiropractors, conversely, primarily focus on the relationship between the spine and nervous system, believing that proper spinal alignment facilitates the body's natural healing processes. Their main therapeutic tool is manual adjustment and manipulation of the spine and other joints. While both professions aim to alleviate pain and improve function, their underlying philosophies regarding health, disease, and intervention methods can vary significantly.

Divergent Training and Education

The educational pathways for neurosurgeons and chiropractors are vastly different, contributing to their distinct perspectives:

• Neurosurgeons undergo extensive medical education and specialized training. This typically includes:
  • Four years of undergraduate study.
  • Four years of medical school (M.D. or D.O. degree).
  • A one-year surgical internship.
  • Six to eight years of specialized neurosurgical residency training, including complex anatomy, physiology, neurology, and advanced surgical techniques.
  • Often, additional fellowship training in specific sub-specialties.
  • They are licensed to perform surgery, prescribe medication, and diagnose a wide range of medical conditions.
• Chiropractors complete a Doctor of Chiropractic (D.C.) degree program, which typically includes:
  • Undergraduate coursework, often with a focus on science.
  • Four to five years of chiropractic college, covering basic sciences, chiropractic philosophy, diagnosis, and adjustment techniques.
  • While their curriculum includes anatomy, physiology, and pathology, it differs significantly from medical school, particularly in pharmacology, surgery, and advanced medical diagnostics.
  • Their license permits them to diagnose and treat conditions primarily related to the musculoskeletal system, mainly through manual therapy.

These disparities in training naturally lead to different diagnostic tools, treatment priorities, and risk assessments for patients.

Scope of Practice and Patient Care

Concerns often arise regarding the scope of practice and how each profession manages specific patient conditions, especially those involving the spine and nervous system.

• Neurosurgeons' Perspective: Neurosurgeons often encounter patients with severe spinal or neurological conditions (e.g., tumors, herniated discs with significant nerve compression, spinal instability, fractures) that require precise medical diagnosis and potentially surgical intervention. From a neurosurgical viewpoint, chiropractic adjustments might be seen as inappropriate or even risky for certain underlying pathologies that could be worsened by manipulation or require immediate medical attention. There's concern about misdiagnosis or delayed diagnosis of serious conditions that might present with musculoskeletal pain but are actually neurological emergencies.
• Chiropractors' Role: Chiropractors primarily treat musculoskeletal conditions, often providing conservative care for back pain, neck pain, and headaches. While many chiropractors advocate for co-management and referral to medical specialists when necessary, the potential for patients to seek chiropractic care for symptoms that are indicative of serious neurological issues can be a point of contention for neurosurgeons.

Evidence-Based Medicine vs. Traditional Practice

The medical community, including neurosurgeons, places a strong emphasis on evidence-based medicine (EBM), which relies on rigorously tested and peer-reviewed scientific research to guide clinical decisions. While research supporting chiropractic care for common musculoskeletal issues like low back pain has grown, some traditional chiropractic concepts and practices have historically lacked robust scientific evidence, leading to skepticism among medical professionals. This gap in perceived scientific validation can contribute to the divide.

Collaborative Challenges and Patient Safety

The lack of consistent integrated care models between neurosurgery and chiropractic can also contribute to the professional rift. Effective collaboration often requires mutual understanding, respect for each other's expertise, and clear referral pathways.

For patients with complex spinal or neurological issues, neurosurgeons prioritize:

• Accurate and timely diagnosis: Utilizing advanced imaging (MRI, CT scans) and neurological evaluations.
• Appropriate intervention: Whether it's medication, physical therapy, or surgical correction.
• Patient safety: Ensuring that any treatment does not exacerbate an underlying condition or delay necessary, potentially life-saving, medical intervention.

Concerns about patient safety, especially if a chiropractor attempts to treat conditions beyond their expertise or fails to recognize red flags indicating a serious medical problem, can be a significant factor in a neurosurgeon's apprehension.

Key Differences Between Neurosurgeons and Chiropractors

In conclusion, the friction between neurosurgeons and chiropractors largely stems from distinct philosophical foundations, differing educational models, and variations in perceived scope of practice, especially concerning the diagnosis and treatment of serious spinal and neurological conditions.