What is the difference between neurology and neurosurgery?

If you suffer from chronic and intractable headaches, your Family Doctor will probably recommend a consultation in a nervous system disease center. Then you will probably wonder what is the difference between neurology and a neurosurgery clinic.  For the general public willing to be educated in medical issues and for you who has a symptom probably related to your nervous system, the differences and similarities between neurology and neurosurgery may be confusing. In brief:

  • The key professional in a neurology clinic is a neurologist, and in a neurosurgery one, it is a neurosurgeon. Of course, nurses, physiotherapists, psychologists, radiologists, laboratory technicians, and many other professionals are indispensable for both types of clinics, but what is distinctive between them is the type of medical doctor. 
  • Both are medical specialties, that is, they require a medical doctor degree.
  • In both, their focus of attention is the nervous system.
  • Both use similar or closely related diagnostic tools.
  • In the field of neurology, treatments are fundamentally pharmacological and behavioral, whereas, in neurosurgery, treatments are invasive, that is, they require surgical procedures. The neurosurgeon also has clinical training and often examines and indicate drugs to the patient. The contrary is not the case; neurologists do not practice brain or spine surgery.
  • Importantly, a given disorder may require both, neurological and neurosurgical treatments.

Firstly, I will tell you which class of medical doctor is a neurologist and a neurosurgeon, and which are the academic requirements for each specialty.

How do you become a neurologist?

  1. You need a bachelor’s degree. You have many options: degree in neuroscience, biology, chemistry, humanities, general psychology, and others. This may take 2 or 3 years.
  2.  Then you must get a medical degree in a medical school. It will take 4 years as an average.
  3. After an internship (lasting approximately two years) you will enter a residence in neurology that can last 3 or 4 years. At this moment, you are a specialist in general neurology. 
  4. Once you have a neurologist’s degree you may start working in a general section of a neurology clinic. Frequently, after a period of variable duration, you may start a fellowship in a specific area of neurology such as those described below. It will be your sub-specialty.    

Which are the main fellowships in neurology? 

There are many differences in the neurology’s fellowship program among diverse institutions but in general, these are the main classes and their focus of attention: 

  • Behavioral neurology and neuropsychiatry: it prepares you to manage the care of adults with degenerative disorders with cognitive deficits.
  • Epilepsy: it trains you in medical and surgical treatments for patients with treatment-resistant seizures.
  • Headache medicine: it provides skills for treating severe cases of migraines that require special interventions. 
  • Movement disorders: this refers to an extensive field devoted to assisting people who have abnormal movements associated with diverse illnesses, such as Parkinson’s disease, Huntington chorea, Tourette’s syndrome, tics, drug-induced abnormal movements, and others. 
  • Neurocritical care: it trains neurologists in managing neurological patients that need intensive care, for example after brain surgery, traumas,  intractable ictus, and many others. 
  • Neurohospitalist: it prepares trainees to direct academic and clinic medical centers, among other clinical programs.
  • Neuroimmunology: a conspicuous program is devoted to training neurologists in clinical and research on multiple sclerosis,  but other neurological disorders are the focus of interest in diverse academic centers. 
  • Neuromuscular medicine: there are numerous neurological disorders in this fellowship program, but a prominent branch is the treatment and research of Myasthenia Gravis.  
  • Neuro-Oncology: it is focused on treating brain tumors and cancer’s effects in the brain.
  • Sleep medicine: the trainees learn bioelectrically-based techniques, behavioral and pharmacological treatments to manage a wide range of sleep disorders in children and adults.  
  • Vascular neurology: this sub-specialty prepares neurologists in the management of people at risk for stroke complications and trauma sequelae. 

How do you become a neurosurgeon?

The path to becoming a neurosurgeon is undoubtedly the longest among all the medical specialties, lasting 12-15 years. 

  1. Similarly to your fellow neurologist, you will need a bachelor’s degree. Your best options are neuroscience, biology, and nervous system anatomy.
  2.  You must get as well a medical degree in a medical school, that takes 4 years as an average.
  3. After a regular internship of two-year duration, you will enter a residence training lasting between 4 and 7 years. At this moment, you are a specialist in general neurosurgery. 
  4. As with most general medical specialists, you will take a sub-specialty fellowship among the following programs.

Which are the main fellowships in neurosurgery?

  • Pediatric neurosurgery: whereas the is considerable overlap between pediatric and adult neurosurgery, the state of the art in this specialty requires sub-specialty training. In both, adult and pediatric surgery the main topics are the following
  •  Cerebrovascular and endovascular neurosurgery.
  • Spine and skull surgery with minimally invasive techniques. 
  • Functional neurosurgery.

Which are the main neurological disorders

Below, I will show you a list of disorders that are the usual focus of the neurological specialty. Besides, I will add a brief explanation in some of them.   

  • Amyotrophic lateral sclerosis: In arms or legs, twitching and cramping of muscles, difficulties for control speech, swallowing, or breathing.  
  • Alzheimer’s disease: it shows as memory loss and severe behavioral disturbances, usually in the elderly, but may occur in middle-aged. 
  • Aneurysm: it refers to a localized enlargement of an artery due to a weakening of the artery wall. An aneurysm rupture is a serious condition that can be potentially lethal.
  • Back pain: it is one of the most common medical symptoms, and may be due to muscles or bones dysfunctions. 
  • Bell’s palsy: facial paralysis.
  • Birth defects of the brain and spinal cord: there are many types, some of them are lethal, but others may improve when treated.
  • Brain injury: a very frequent disorder. The neurologist most of the time can solve this issue, otherwise, he must work along with the neurosurgeon.
  • Cerebral palsy: it affects the ability to move and keep balance. It is the most common motor problem in childhood.  
  • Chronic fatigue syndrome: it is a complex disorder characterized by severe fatigue and it is generally related to an underlying medical condition.    
  • Concussion: it is the result of a direct knock to the head or spine.  It may produce immediate or delayed symptoms. 
  • Dementia: as in Alzheimer’s disease, there is a progressive loss of memory and other mental functions. It has many causes and may be reversible.
  • Disk disease of the neck and lower back: an extremely common problem. It may be spontaneous or induced by trauma. It often improves with medication and physiotherapy.
  • Dizziness and vertigo: they are common and distressing symptoms. There is an arsenal of drugs and behavioral treatments.
  • Epilepsy: it is the quintessential disorder in a neurological clinic. It has many causes and is usually treated with anticonvulsant drugs 
  • Guillain-Barré syndrome: it is a potentially lethal disorder in which the immune system reacts against the own peripheral nervous system. When lethal, it produces respiratory arrest.
  • Headaches and migraines: they are at the top of the causes of consultation in the neurology clinic. It may be highly disabling when it is not properly treated.
  • Multiple sclerosis: it affects the brain, spinal cord, the optic nerves, causing problems with vision, equilibrium, balance, muscle control, and many other body functions.
  • Muscular dystrophy: it causes weakness and loss of muscle mass.
  • Neuropathy and neuralgia: these are affections of the peripheral nerves causing pain and weakness. Some of them such as the trigeminal neuralgia are medical emergencies.   
  • Neuromuscular and related diseases: it comprises several related disorders producing variable degrees of muscle damage, weakness, and paralysis. 
  • Parkinson’s disease: is a common and disabling disease. The neurologists have an extensive set of drugs and invasive techniques to assist this afflicted clinical population. 
  • Stroke: it is an area where considerable progress has been reached. Patients that were condemned before to an incapacitating life, may now prevent or have a fast and timely preventive treatment. 

Which are the most common reasons for needing neurosurgery?

These are impressive surgical processes that require sophisticated human and technical pieces of equipment. Below is a list of common disorders that require neurosurgical treatment, along with a brief description of relevant issues.

  • Bleeding on the brain: it has many causes, for example, the rupture of a cerebral aneurysm, a fissure in a brain vessel due to severe high blood pressure, head traumatisms, and others.  
  • Brain and spinal tumors: surgery is often here a  life-saving procedure.
  • Diverse spinal conditions: fastened spinal cords, discs herniations, and osteoarthritis.
  • Injuries: in the head, neck, or spine.
  • Intractable seizures: a significant proportion of patients with epilepsy do not improve with drug treatments and a neurosurgical procedure is then recommended. 
  • Movement disorders and Parkinson’s disease: as discussed above for other conditions, when patients with abnormal movements do not improve after optimal drug trials, neurosurgery is the next option. Considerable progress has been reached in this field. 
  • Chronic pain: Despite potent pain relievers, there are lesions in the brain or peripheral nerves than produce severe and intractable pain. Neurosurgical procedures reduce pain in a significant proportion of patients.
  • Obsessive-compulsive disorder: obsessions and compulsions may be so disabling, that radical treatment is indicated. In these cases, diverse neural pathways are interrupted, producing considerable improvement in most cases. 
  • Hydrocephalus: this serious condition refers to the accumulation of cerebral spinal fluid in the brain, which increases pressure in the neural tissue and induces considerable damage.  The neurosurgeon sets a draining system, usually for life, that restores brain pressure.  

Do neurologists and neurosurgeons work together?

Most patients are firstly evaluated by the neurologist, who determines the diagnoses. Sometimes, the patient is immediately referred to the neurosurgeon, for example, subjects with brain injury, brain bleeding,  tumors, acute hydrocephalus, spine fractures, and others. After surgery, patients keep controls with both specialists.

In other conditions, the neurologist starts pharmacological trials and tests which often are effective enough to control the disorder and prevent going into surgery. 

Which are the average salaries for a neurologist and a neurosurgeon?

In the United States, the average annual salaries for a neurologist and a neurosurgeon are $ 258,200 and $ 613,600 as of August 27, 2020.  Neurosurgeons are the best-paid doctors in all countries.

Numerous common and rare bodily symptoms are related to dysfunctions of the brain or spine. Now you know the differences and similarities between neurology and neurosurgery to make an informed selection. Both are medical specialties focused on treating nervous system diseases. Neurosurgeons do brain, spine, and peripheral nerve surgeries, whereas neurologists use pharmacological and behavioral treatments.  

References (in addition to linked text above):

Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 GBD 2016 Neurology Collaborators Lancet Neurol. 2019; 18(5): 459–480. DOI: 10.1016/S1474-4422(18)30499-X.