Anatomic Clinical Pathology: A pathologist is a specialized type of physician who studies a vast variety of natural diseases which include surgical pathology, autopsy pathology and diagnostic cytology, and who works in a hospital, a laboratory or a private setting. Pathologists are concerned with the diagnosis of disease based on the gross and microscopic examination of cells and tissue.
Anesthesiology: Anesthesiology is the practice of medicine dedicated to the relief of pain and total care of the surgical patient before, during and after surgery.
After completing four years of medical school, anesthesiologists (MD or DO) enter a four-year anesthesiology residency training program. Fellowships in an anesthesia subspecialty and in education or research may also be taken for an additional year. While anesthesiologists have been known primarily as physicians who administer anesthesia during surgery, they also provide medical care and consultations in other situations in addition to the operating room.
The anesthesiologist’s role may be a perioperative ("peri" meaning "all-around") who provides medical care to each patient throughout his or her surgical experience. This may include medical evaluation before surgery, consulting with the surgical team, providing pain control and support of life functions during surgery, and supervising care after surgery and medically discharging the patient from the recovery unit.
Anesthesiologists, as part of the spine team, frequently diagnose and treat patients suffering from acute and chronic pain syndromes. Some anesthesiologists complete pain fellowships and concentrate their practice on doing injections (such as epidural steroid injections). They may practice in a variety of settings, such as a pain management clinic or an integrated spine care center. Typically, other medical practitioners (primary care or specialists) refer patients to them.
Basic/Applied Research: Spine research is ongoing in the basic sciences relative to the spine and in clinical situations where studies are applied to the care of the spine and patients with spine problems. Spine specialists: MDs, DOs, PhDs from all specialties often participate in research. Most spine specialists involved in research provide patient care as well.
Chiropractic Care: Chiropractors, also known as doctors of chiropractic or chiropractic physicians, diagnose and treat patients whose health problems are associated with the body's muscular, nervous and skeletal systems, especially the spine.
Chiropractic education consists of four academic years of chiropractic training, as well as a one-year internship at a college clinic. Successful completion of two levels of National Boards is required for chiropractors and a third level for those who use physiologic therapeutics in their practice. Part IV is often used for state licensing and tests knowledge of diagnostic imaging, chiropractic technique and case management.
The chiropractic profession holds that spinal or vertebral dysfunction alters many important body functions by affecting the nervous system, and that skeletal imbalance through joint or articular dysfunction -- especially in the spine -- can cause pain and/or dysfunction.
As with all health care practitioners, chiropractors follow a standard routine to secure the information needed for diagnosis and treatment. When the source of pain involves musculoskeletal structures, chiropractors manually manipulate or adjust the spinal column. Many chiropractors also use water, light, massage, ultrasound, electric and heat therapy, and may apply supports such as straps, taping and braces. They may also counsel patients about wellness concepts such as nutrition, exercise, lifestyle changes and stress management, but do not prescribe drugs or perform surgery. When appropriate, chiropractors consult with and refer patients to other health practitioners.
Some chiropractors specialize in orthopedics, sports injuries, neurology, nutrition, internal disorders and/or diagnostic imaging.
Critical Care: Critical Care is the specialized care of patients whose conditions are life-threatening and who require comprehensive care and constant monitoring, usually in intensive care units.
Emergency Medicine: Emergency medicine focuses on the immediate decision-making and action necessary to prevent death or any further disability. It is primarily hospital emergency department based, but with extensive prehospital responsibilities for emergency medical systems. The emergency physician provides immediate initial recognition, evaluation, care and disposition of a generally undifferentiated population of patients in response to acute illness and injury. The care provided by the emergency physician is episodic in nature and involves a full spectrum of physical and behavioral conditions. (Source: American Board of Emergency Medicine)
General/Family Practice/Primary Care: Primary care physicians typically include family practice doctors, internists, obstetricians, gynecologists and pediatricians (as well as chiropractors and doctors of osteopathy). As back pain is extremely common, these doctors often have extensive experience in treating acute lower back pain and muscle strains.
Primary care physicians have a noninvasive (nonsurgical) approach and often utilize prescription medications to help reduce pain and inflammation, as well as the services of physical therapists to assist in maintaining range of motion and muscle tone. Often, they may order a variety of spinal diagnostic procedures to more fully investigate the potential causes of persistent back pain and neck pain and refer patients to a specialist for further diagnosis and treatment when necessary.
Geriatric Medicine: The branch of medicine concerned with the diagnosis, treatment and prevention of disease in older people and problems specific to aging. Also called geriatrics.
Musculoskeletal Oncology: Musculoskeletal oncology specialists are physicians who diagnose and treat benign and malignant tumors of the musculoskeletal system. Oncology, at its most basic level, involves the diagnosis and treatment of cancer.
Neurology: A neurologist is an MD or DO who specializes in diagnosing and treating disorders of the nervous system, including diseases of the brain, spinal cord, nerves and muscles (such as strokes, epilepsy, headaches, Alzheimer's, multiple sclerosis, Parkinson's, and various forms of pain). Neurologists may serve as a consultant to other physicians as well as providing long-term care to patients with chronic neurological disorders.
Neurologists are trained to perform a detailed examination of all the important neurological structures in the body. This includes the nerves of the head and neck, the muscular strength and movement, sensation, balance testing, ambulation and reflex testing. Importantly, an examination by a neurologist can be helpful in distinguishing a primary neurological problem (eg, multiple sclerosis) from a musculoskeletal disorder.
Neurologists rely on the clinical examination along with certain other commonly used tests (such as CT scans and MRI/MRA scans). These tests can provide detailed anatomic pictures of the brain, spinal structures and the blood vessels. A neurologist can also perform a lumbar puncture (spinal tap) to obtain cerebrospinal fluid for analysis. Some neurologists interpret EEG (electroencephalography) used in the evaluation of seizure disorders, or perform EMG/NCV (electromyography/nerve conduction velocity testing) which is used to diagnose nerve and muscle problems.
Neurologists use many forms of medication to treat problems involving the nervous system. They may send patients to other specialists for some forms of treatment. A neurologist may refer a patient to a surgeon for a surgical evaluation, but does not perform surgery.
Neuropathology: Neuropathology is the study of diseases of the nervous system, and is a medical subspecialty within the specialty of anatomical pathology. A physician who specializes in neuropathology, usually by completing a fellowship after a residency in anatomical or general pathology, is called a neuropathologist. In day-to-day clinical practice, a neuropathologist is a consultant for other physicians.
Neuroradiology: Neuroradiology is the field within radiology that specializes in the use of radioactive substances, X-rays and scanning devices for the diagnosis and treatment of diseases of the nervous system. Neuroradiology involves the clinical imaging, therapy and basic science of the central and peripheral nervous system, including but not limited to the brain, spine, head and neck, interventional procedures, techniques in imaging and intervention, and related educational, socioeconomic and medico legal issues.
Neurosurgery: Neurosurgeons are MDs or DOs who complete a five- or six-year residency that focuses on the surgical treatment of patients with neurological conditions. Neurosurgeons are trained in the diagnosis and treatment of disorders of the brain, spine, spinal cord, nerves, intracranial and intraspinal vasculature.Both orthopedic surgeons and neurosurgeons complete training to do most types of spine surgery. There are only a few instances in which one specialty tends to be better trained for specific conditions. For example, orthopedic surgeons do spine deformity surgery (eg, scoliosis) and neurosurgeons do surgery for intradural (inside the thecal sac) tumors.
In recent years, spine surgery has become increasingly specialized within the orthopedic and neurosurgical professions, and often a surgeon will focus a majority of his or her practice on spinal surgery. It is thought that the increasing level of specialization and focus on the spine has contributed to enhancements in surgical technique, which in turn has led to overall improved success rates and reduced morbidity (for example, reduced postoperative discomfort, faster healing time).
Orthopedic surgeons and neurosurgeons perform the overwhelming majority of spine surgery and frequently extend their general orthopedic or neurosurgical training by participating in a spine fellowship. These spine fellowships accept a select group of physicians who have completed four to seven years of a surgical residency and are either board certified or board eligible in their respective specialties and provide additional training in performing spine surgery. Fellowships may be six months to 12 months or longer and a varied in terms of focus.
Orthopedic Surgery: Orthopedic surgeons are either Medical Doctors or Doctors of Osteopathy who have completed a five-year residency focused on the surgical treatment of musculoskeletal conditions. Orthopedic surgeons are trained in the diagnosis and treatment of spinal disorders, arthritis, sports injuries, trauma and fractures.
Both orthopedic surgeons and neurosurgeons complete training to do most types of spine surgery. There are only a few instances in which one specialty tends to be better trained for specific conditions: e.g. orthopedic surgeons do spine deformity surgery (eg, scoliosis) and neurosurgeons do surgery for intradural (inside the thecal sac) tumors.
In recent years, spine surgery has become increasingly specialized within the orthopedic and neurosurgical professions, and often a surgeon will focus a majority of his or her practice on spinal surgery. It is thought that the increasing level of specialization and focus on the spine has contributed to enhancements in surgical technique, which in turn has led to overall improved success rates and reduced morbidity (for example, reduced postoperative discomfort, faster healing time).
Orthopedic surgeons and neurosurgeons perform the overwhelming majority of spine surgery and frequently extend their general orthopedic or neurosurgical training by participating in a spine fellowship. These spine fellowships accept a select group of physicians who have completed four to seven years of a surgical residency and are either board certified or board eligible in their respective specialties and provide additional training in performing spine surgery. Fellowships may be six months to 12 months or longer and a varied in terms of focus.
Osteopathy: Osteopathic Physicians, also known as Doctors of Osteopathic Medicine or Doctors of Osteopathy (DO) diagnose and treat all illnesses and injuries and emphasize preventive care with special emphasis on the need for the body's systems to be in correct relationship with one another and the importance of the neuro-musculoskeletal system (nerves, muscles, bones, and joints).
Treatments commonly include manipulative therapy, medication and all other therapies when needed. Osteopathic physicians can be licensed in all 50 states for the full practice of medicine. Most states require licensed DOs be graduates of an approved school of osteopathic medicine and have completed a 12-month internship with an approved hospital program.
In addition to primary care-focused doctors of osteopathy, some DOs are specialized in an area of medicine (as are some Medical Doctors) and may become board certified by completing a 3 to 4 year residency within the specialty area, such as orthopedic surgery, neurosurgery, physiatry, or anesthesiology.
Pain Management Medicine: Pain Management Medicine is the systematic study of clinical and basic science and its application for the reduction of pain and suffering; the blending of tools, techniques and principles taken from the discrete healing art disciplines and reformulated as a holistic application for the reduction of pain and suffering; and a newly emerging discipline emphasizing an interdisciplinary approach with a goal of reduction of pain and suffering.
Pediatrics: Pediatrics is the branch of medicine concerned with the care and development of children and with the prevention and treatment of children's diseases. Pediatrics became a medical specialty in the mid 19th century. Before that time, the care and treatment of childhood diseases was included within such areas as general medicine and obstetrics (and midwifery).
Physical Medicine & Rehabilitation (PM&R) / Physiatry:
A physiatrist is a Medical Doctor or Doctor of Osteopathy who specializes in Physical Medicine and Rehabilitation (PM&R). Physiatrists are nerve, muscle, bone and brain experts who treat injury and illness, decreasing pain and restoring active lifestyles. In other words, they specialize in the alleviation of physical disability which may arise from any number of medical conditions. Physiatrists are trained in a wide variety of medical and interventional treatments of the spine and musculoskeletal system and may also perform minor surgical procedures. Physiatrists may practice in rehabilitation centers, hospitals or private practice, and often practice as part of an integrated spine treatment center.
After medical school, physiatrists complete four years of residency training including one year of general medicine internship and three additional years of specialty training. Many physiatrists choose one or more years of additional fellowship training in a subspecialty area, including spine and musculoskeletal medicine. Board certification in physical medicine and rehabilitation requires passing written and oral examinations administered by the American Board of Physical Medicine and Rehabilitation (ABPM&R). Physiatrists are also eligible for subspecialty certification in Pain Medicine, Spinal Cord Injury and Electrodiagnostic Medicine.
Physiatrists diagnose and treat both acute and chronic spinal disorders and pain. They can order and interpret all types of spine imaging (X-ray studies, CT scans, myelogram, MRI scans, bone scans) and perform specialized nerve tests (EMG, NCV, SSEP) to help assess the location and severity of nerve damage. All patient information including history, examination, imaging and electrodiagnostic testing is corroborated for precise localization of the pain generating structure. Physiatrists are also trained to recognize when spinal pain emanates from other structures such as the hip or internal organs.
Physiatrists provide comprehensive medical management of spinal conditions. They are specially trained in the optimal use of physical and occupational therapy for spinal and other musculoskeletal conditions. They coordinate and monitor individualized therapy programs specific to the spinal diagnosis and evaluate appropriateness of previous therapies. Physiatrists may identify physical and occupational therapists with special expertise to maximize therapy outcomes. Some physiatrists are specially trained to perform injection treatment of the spine to deliver medication specifically to the structure causing pain. Finally, physiatrists promote an active and healthy lifestyle to prevent further recurrences of spinal problems.
Physical/Occupational Therapy: Physical therapy is a direct form of patient care that can be applied in most disciplines of medicine. Objectives of physical therapy are prevention of disability and pain, restoration of function and relief from pain, promotion of healing and adaptation to permanent disability. Physical therapy is a vital part of the total care for patients who have problems of temporary or permanent disability. The physical therapist (PT) selects appropriate tests to evaluate and quantitatively measure the patient's problem. Then, in consultation with the referring physician, an appropriate rehabilitation plan is developed.
The PT uses numerous modalities and procedures to expedite healing, and instructs the patient in a home program. There may be follow-up visits for re-evaluation and update of the home exercise program.
Occupational Therapy is concerned with restoring useful physical functionality following disabling accidents and sickness. The goal of occupational therapy is to assist the patient in achieving the maximum level of independent function.
The primary tool of the occupational therapists is the active involvement of the patient in therapeutic tasks and activities which, while improving function, help the patient learn to apply the newly restored or impaired function in meeting the demands of daily living.
Psychiatry/Psychology:
Psychiatry is a medical specialty practiced by physicians with an MD or DO degree. Psychiatrists treat patients with mental, emotional or behavioral disorders. Psychiatrists may use therapy, medication, hospitalization or a combination of these treatment options in the care of their patients.
Psychology is concerned with human behavior and related mental and phsychological processes.
Radiology: Radiology is the branch of medicine that uses ionizing and nonionizing radiation for the diagnosis and treatment of disease.
Radiologists are MDs or DOs who are usually board certified, that is, they have taken and passed an examination and are approved to practice in the field of radiology by either the American Board of Radiology (for a medical doctor) or the American Osteopathic Board of Radiology (for an osteopathic doctor). A radiologist can also subspecialize.
Rheumatology: A rheumatologist is an MD or DO who specializes in the diagnosis and treatment of arthritis and other musculoskeletal diseases (involving joints, muscles and bones).
After four years of medical school and three years of training in either internal medicine or pediatrics, rheumatologists complete two to three years in specialized rheumatology training. Most rheumatologists who treat patients become board certified by the American Board of Internal Medicine.
Rheumatologists diagnose and treat a wide variety of chronic musculoskeletal diseases, including osteoarthritis, rheumatoid arthritis, musculoskeletal pain disorders, fibromyalgia, certain autoimmune diseases, osteoporosis, and tendonitis. Many types of rheumatic diseases are difficult to identify, and rheumatologists are trained to accurately diagnose musculoskeletal disorders so that appropriate treatment can begin early.
Rheumatologist sometimes act as a consultant to advise another physician about a specific diagnosis and treatment plan, and sometimes leads the patient’s treatment and may include a team approach to treatment involving as physical therapists, psychologists or other specialists.
Sports Medicine: Sports Medicine involves the evaluation and treatment of injuries incurred in the course of athletic activities. It is a subspecialty of orthopedics and utilizes concepts for injury prevention, diagnostic procedures, minimally invasive treatment procedures and advanced rehabilitation specifically geared toward athletes and active individuals.
Trauma Surgery: Trauma Surgery is the area of surgery devoted to treatment of traumatic disorders. These vary from blunt trauma associated with motor vehicle accidents or falls to penetrating trauma associated with stab wounds and gunshots.