PAs are highly trained medical professionals who work collaboratively with neurosurgeons to ensure comprehensive care. They bring a wealth of knowledge and are capable of performing numerous tasks in neurosurgery. By understanding more about neurosurgical physician assistants you can make informed decisions that enhance your healthcare experience, treatment, and outcomes. 

What Are the Primary Roles of Physician Assistants in Neurosurgery? 

Physician Assistants (PAs) are invaluable assets in neurosurgery practices. Their roles extend beyond supporting neurosurgeons to ensuring the efficient delivery of patient-centered care. PAs are trained to perform a variety of tasks that allow neurosurgeons to focus on the more complex aspects of a neurosurgery. Neurosurgery PAs often conduct patient history reviews, perform physical exams, and assist during surgical procedures. Their proficiency allows them to take on responsibilities that bridge patient care and enhance your treatment experience.

Clinical Responsibilities

Physician Assistants (PAs) in a neurosurgery practice play a pivotal role in patient care, often acting as the first point of contact for patients. Their clinical responsibilities are extensive and varied, ensuring comprehensive care throughout your treatment. PAs can perform detailed patient histories, conduct thorough physical examinations, and develop initial assessments, which are critical in formulating an effective treatment plan. They are also adept at interpreting diagnostic tests, such as MRIs and CT scans, enabling them to provide accurate information to both the neurosurgeon and you the patient.

Surgical Assistance

In the operating room, the presence of PAs translates into increased surgical efficiency. Their extensive training allows them to assist neurosurgeons with surgical procedures, handle preoperative and postoperative care, and ensure the seamless flow of operations. This support is invaluable, as it enables neurosurgeons to focus on the most complex aspects of surgery while PAs manage essential tasks such as suturing, wound closure, and patient monitoring. The result is a more streamlined surgical process, which can contribute to reduced operating times and improved outcomes.

Supporting Clinical and Administrative Duties

Beyond direct patient care, PAs significantly contribute to the clinical and administrative operations of a neurosurgical practice. They are involved in tasks such as compiling patient histories, coordinating treatment plans, managing documentation, completing prescriptions, and triaging patient questions and needs. By assuming these responsibilities, PAs alleviate some of the non-urgent and administrative duties placed on neurosurgeons. This allows neurosurgeons  to dedicate more time to complex patient needs. This balance enhances the overall efficiency and effectiveness of neurosurgical services, benefiting both practitioners and patients.

Patient Education and Support

Educating patients and their families is another crucial aspect of a PA’s role. They are instrumental in explaining complex medical terms and procedures in a way that is understandable and comforting. This educational support empowers patients to make informed decisions about their health care. PAs ensure continuity of care by being readily available to answer questions, manage follow-up appointments, and provide reassurance and guidance throughout the treatment process. Their presence allows for more personalized attention, as they can dedicate ample time to communicating with patients, addressing concerns, managing expectations, and managing compliance with treatment plans. Their ongoing support fortifies the patient-doctor relationship, enhancing trust and satisfaction within a neurosurgery practice.

How Do Physician Assistants Enhance My Care? 

Bridging Potential Gaps in Care

Physician Assistants (PAs) are instrumental in bridging potential gaps in care, particularly in specialized fields like neurosurgery. By working alongside neurosurgeons, PAs ensure that patients receive continuous and comprehensive care. Their ability to perform routine examinations, follow-up appointments, and initial assessments allows neurosurgeons to focus on more complex patient cases. This collaboration not only optimizes time but also enhances the quality of care for patients, ensuring that their needs are met promptly and efficiently.

Communication and education are the cornerstones of effective healthcare. PAs work closely with neurosurgeons to ensure each patient receives comprehensive and coordinated care. By acting as a liaison between you and the neurosurgeon, PAs facilitate open dialogue, addressing any concerns you might have, and ensure that your treatment plan is clearly understood. Their ability to communicate complex medical information in an accessible way will enhance your satisfaction and empower you with the knowledge needed to make informed decisions. 

Enhancing Treatment Efficiency

PAs play a vital role in enhancing the efficiency of medical treatments. They are trained to perform various medical procedures and prescribe medications, which streamlines the treatment process. By handling these tasks, PAs help improve the efficiency of a practice, allowing for a smoother and more effective patient care experience. Their involvement in postoperative care and monitoring further aids in reducing complications and promoting quicker recovery times for patients.

What Training Do Physician Assistants Receive? 

Education and Training

The expertise of the Physician Assistants is a product of education, training, and experience. PAs have completed master’s programs followed by specialized clinical rotations, including neurosurgery. Dr. Kalra spends extensive time training, educating, and shaping their approach to provide the high level of neurosurgical care patients deserve and have come to expect from Kalra Brain & Spine. This training equips them with the knowledge to manage a wide range of neurological conditions and treatments. They are also adept at interpreting diagnostic tests, developing treatment plans, and providing post-operative care. Rest assured, PAs are trained to identify when a case requires a neurosurgeon’s expertise, ensuring you receive appropriate and timely care. This specialized knowledge means that you can rely on PAs for initial consultations, follow-up appointments, and routine care. PAs ensure continuity, quality, and timely care is provided even if a neurosurgeon is in the operating room.

Physician assistants (PAs) are trained professionals who play a crucial role in the healthcare system. Their journey begins with a solid foundation in medical sciences, typically culminating in a bachelor’s degree followed by a master’s degree from an accredited PA program. These programs, which span approximately 27 (twenty-seven) months, are designed to equip PAs with the knowledge and skills necessary to deliver high-quality medical care. The curriculum is includes both classroom instruction and clinical rotations in diverse medical specialties, ranging from general surgery to neurology. During clinical rotations, PAs gain invaluable hands-on experience under the supervision of seasoned physicians, honing their diagnostic skills and learning to manage patient care effectively. 

Certification and Continuing Education

To maintain their credentials, PAs must pass the Physician Assistant National Certifying Exam (PANCE) for state licensure, and engage in continuous professional development. This commitment to ongoing education ensures that PAs remain current with the ever-evolving medical landscape. They are required to complete 100 (one-hundred) hours of continuing medical education (CME) every 2 (two) years and pass a recertification exam every 10 (ten) years.

This dedication to lifelong learning not only enhances the PA’s expertise but also directly benefits patients, who receive care informed by the latest medical advances. In a dynamic medical speciality like neurosurgery, this continuous updating of knowledge is vital for ensuring optimal patient outcomes. 

Can Physician Assistants Prescribe Medications?

Yes, Physician Assistants (PAs) hold the ability to prescribe medications. Their prescriptive authority, however, is determined by state regulations and the specific medical setting in which they operate. Physician assistants are able to prescribe medications in all 50 (fifty) states and must register with the DEA. Generally, PAs are empowered to prescribe medications, as long as they operate under the supervision of a licensed physician. This supervisory relationship ensures that PAs can provide comprehensive care while maintaining high standards of safety and efficacy in treatment. This ability also allows PAs to effectively manage postoperative recovery and chronic neurological conditions.

Does My Diagnosis, or Diagnostic Work Up Determine if I Will See a PA?

Often times your diagnosis, and completed diagnostic workup impact if you will initially see a PA or neurosurgeon. At Kalra Brain & Spine patients will need to exhaust conservative treatment modalities, have confirmed pathology via diagnostic studies, have their quality of life impacted, make the decision they want to proceed with surgery, and have a thorough review of their treatment history with examination. From here Dr. Kalra will review all your information, educate you on treatment options, and together help determine what treatment is best for your individual case. 

If you are referred to a neurosurgeon and have not done physical therapy, started anti-inflammatory medications, or had diagnostic workup these are often the starting points of conservative treatment for spinal pathology. PAs are often the first point of contact for new, or undiagnosed symptoms. They are well equipped to evaluate your condition, develop a care plan, and coordinate your initial treatment timely. This will hopefully start you on your path to pain relief and recovery as the majority of back and neck pain resolves with conservative treatment and time. Also, most insurance companies require specific care pathways of conservative treatment before they will approve and pay for additional treatment such as an MRI or EMG. For example, most insurance companies require 6 (six) to 8 (eight) weeks of documented physical therapy and medications without relief before approving an MRI. 

Physician assistants are trained to handle a broad range of healthcare issues. They work under the supervision of neurosurgeons, allowing them to diagnose, treat, and manage patient care in various capacities. PAs are adept at performing routine examinations, ordering and interpreting diagnostic tests, and developing treatment plans. They are well-equipped to handle follow-up appointments, manage ongoing care, and address patient concerns, often expediting the treatment process.

In contrast, neurosurgeons are specialists trained to address complex conditions affecting the brain, spine, and nervous system. They perform intricate surgical procedures and provide care for conditions such as brain tumors, spinal cord injuries, and other neurological disorders. Their expertise is indispensable in cases requiring surgical intervention or when advanced diagnostic procedures are necessary.

Conclusion

Patients often wonder if seeing a physician assistant instead of a neurosurgeon might affect the quality of care they receive. PAs are well-equipped to handle many aspects of patient care and work under a neurosurgeon’s direct supervision. This collaboration ensures that any complex cases or situations that require their expertise are promptly escalated. Additionally, PAs enhance the overall efficiency of your care, often resulting in shorter wait times for consultations and follow-up appointments. PAs play a valuable role as pivotal partners to neurosurgeons, by embracing their roles you empower yourself with a broader spectrum of care.

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified, spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery for the treatment of spinal pathologies. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Kalra Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physicians colleagues from 2017-2025. If you have unanswered questions about your spinal pathology, need a second opinion, or to obtain the neurosurgical treatment you need contact Kalra Brain & Spine at (972) 905-9226 or request an appointment on our website. 

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When Should I Consider Spine Surgery for Neck or Back Pain?

You Have Exhausted Non-Surgical Treatments

If you have had ongoing, debilitating pain for months despite trying multiple non-operative treatments, you may be a candidate for spine surgery. Imaging studies like MRIs can identify pathology such as herniated discs, spinal stenosis, or degenerative disc diseases that may be the source of your pain. If your daily activities and ability to work or enjoy life are limited, spine surgery may be an option for relief.

After You Have Given Your Injury or Condition Time 

A significant portion of back and neck pain will resolve on its own over a few weeks to few months time frame with conservative treatment. Spine surgery is typically only considered if non-surgical options like lifestyle modifications, physical therapy, medications, and injections, fail to provide adequate relief. Being patient is often difficult when you are in pain, but it is often needed to fully heal from many spinal conditions and injuries. Surgery can be considered for persistent, severe pain or disability that significantly impacts your quality of life. Only you know how bad your pain is, and the decision to proceed with surgery should be yours. There are times when spine surgery is absolutely essential to prevent further injury or permanent damage, however most spine surgery is elective. 

You Have a Potential Surgical Diagnosis 

You have exhausted non-surgical treatments and given adequate time for healing. You have not achieved relief and have a diagnosis that may benefit from surgical intervention. The most common spinal pathologies that can potentially benefit from surgery include: 

• • Herniated, bulging, or ruptured discs pressing on nerves or your spinal cord
  • Spinal stenosis (narrowing of the space for nerves or spinal cord) 
  • Degenerative disc disease
  • Spondylolisthesis (vertebral slipping)
  • Spinal instability 
  • Scoliosis
  • Vertebral factures
  • Spinal tumors

The type of surgical procedure that is recommended depends on your specific condition and symptoms. Surgical spine procedures aim to decompress pinched nerves, stabilize the spine or both.

Am I a Candidate for Spine Surgery?  

Symptoms Persist Despite Conservative Treatments

Spine surgery is typically only recommended after non-surgical treatments have been exhausted without providing adequate relief. Conservative approaches like physical therapy, medications, lifestyle modifications, and epidural steroid injections, and or facet injections are usually attempted first for a minimum of six to twelve weeks. If your symptoms persist or worsen despite these efforts, then you may be a candidate for spine surgery. Common indications include chronic neck or back pain, radiating arm or leg pain, numbness, weakness, or loss of function that severely impacts your daily activities and quality of life. 

Diagnostic Imaging Confirms Need for Surgery

Imaging studies such as an MRI, or CT are essential for diagnosing the underlying spinal condition or pathology causing your symptoms. Conditions that may warrant surgery may include spinal stenosis, herniated discs, degenerative disc disease, spondylolisthesis, spinal instability, bone spurs, or spinal deformities. Dr. Kalra will review images, your symptoms and neurological examination to determine what is generating your pains. Dr. Kalra will then present his opinion and your potential treatment options. Together you will decide if and when to proceed with surgery. 

You Have Realistic Expectations and Are Motivated

Spine surgery outcomes are optimized when patients have a clear understanding of the risks, benefits, recovery process, and realistic goals. You may be a good candidate if you are motivated to improve your situation, can comply with post operative restrictions, and have the ability and support system for rehabilitation. Dr. Kalra will ensure you understand the procedure, have reasonable expectations about reducing pain and symptoms, and are mentally prepared for the road ahead. A positive mindset greatly improves outcomes. 

What Spinal Conditions May Require Surgery? 

Herniated Discs

One of the most common reasons patients consider spine surgery is a herniated disc. Your spinal discs act as cushions between the vertebrae, but injury or degeneration can cause them to bulge out and press on nerves or your spinal cord. This compression leads to pain, numbness, tingling, and weakness in the affected areas. Surgery aims to remove or repair the damaged material to relieve pressure on the nerves and spinal cord. A microdiscectomy is a minimally invasive procedure to access and remove the the portion of herniated disc.   

Spinal Stenosis

Spinal stenosis refers to the narrowing of spaces in the spine that put pressure on the spinal cord and nerve roots. It can occur in the neck (cervical stenosis) or lower back (lumbar stenosis). Causes include overgrowth of bone causing bone spurs, herniated discs, or thickened ligaments. Symptoms like numbness, weakness, and cramping pain in the legs or arms may not respond well to conservative treatments. Surgical options aim to decompress the area by removing bone, disc material, overgrowth of bone, herniated discs, or thickened ligaments. Surgical options to relieve spinal stenosis may include laminectomies, foraminoties, or facetectomies. 

Degenerative Disc Disease 

The discs between your vertebrae can degenerate and break down overtime due to injury and age related changes. As your discs lose hydration and height, it can lead to instability, compression, and irritation of the nearby nerves. Along with pain, it can cause numbness, tingling, and muscle weakness. Surgical options like spinal fusion are considered to treat degenerative disc disease when conservative treatments fail to provide relief. During the fusion the damaged discus is removed and the adjacent vertebra are fused together with bone grafts or implants. This eliminates motion and prevents nerve compression at that level. 

Spondylolisthesis 

Sondylolisthesis occurs when one vertebra slips forward over the one below it. It can be caused by a defect present at birth or degeneration and arthritis over time. The displaced bone can pinch nerves, causing lower back pain that radiates down the legs. Laminectomies and spinal fusions are common surgical treatments to stabilize the slipped vertebra and decompress the pinched nerves. More severe slips may require more complex reconstructive surgery. Determining if spine surgery is appropriate depends on various factors like symptom severity, condition progression, and failure of conservative care. Careful evaluation by an experienced spine surgeon is essential to understand all treatment options. 

What Are The Most Common Types of Spine Surgery? 

Microdiscectomy, Discectomy

One of the most commonly performed spinal procedures is a microdiscectomy or discectomy. This surgery aims to relieve pressure on the nerve roots caused by a herniated disc in your spinal column. During the minimally invasive microdiscectomy, a small portion of the damaged disc is removed through a small incision to decompress the nerves. 

Laminectomy, Laminotomy 

If you suffer from spinal stenosis, a narrowing of the spinal canal that compresses nerves, your surgeon may recommend a laminectomy or laminotomy. These procedures create more space for the spinal cord by removing portions of the lamina, the bony arch protecting the spinal canal. A laminotomy is less invasive, only removing a small part. 

Foraminotomy, Facetectomy

Procedures like foraminotomies and facetectomies enlarge the opening of the foramen where nerve roots exit the spinal column. This alleviates compression caused by bones spurs, arthritis, or herniated discs that are pinching nerves. During a foraminotomy, your surgeon will remove bone of soft tissue that is obstructing the foramen. A facetectomy involves removing part of the facet joint. 

Spinal Fusion  

For more severe spinal conditions or instability, spinal fusion surgery may be recommended to permanently connect two or more vertebrae. This immobilizes the fused section to prevent painful movement and further degeneration. Metal implants are used to hold the vertebra together as the bone grafts fuse over time. 

Disc Replacement 

An artificial disc replacement surgery removes a damaged spinal disc and replaces it with a artificial disc implant. This preserves flexibility and movement at that level compared to a fusion. Disc replacements are most commonly performed in the neck (cervical) and currently indicated for up to two levels or discs. 

How Do I Find the Right Spine Surgeon? 

When considering spine surgery it is critical to choose an experienced, reputable spine surgeon you feel comfortable with. The right surgeon will throughly answers all your questions and educates you on what to expect before, during, and after surgery. Here are a few other items to consider when selecting the right surgeon for you:

• • Experience and specialty training
  • Patient satisfaction ratings and outcomes
  • Perspective on non-surgical versus surgical treatments
  • Communication style explaining procedures and recovery

Should I See a Neurosurgeon or Orthopedic Surgeon For Spine Surgery? What is the Difference Between Each Surgeon? 

Neurosurgeons and orthopedics surgeons both perform many types of spine surgery. Spine surgery is often associated with orthopedic surgeons due to the bony spinal column. Neurosurgeons perform brain, spine, and peripheral nerve surgeries. They regularly operate on the spine and in and around the delicate structures that your spinal column protect, such as your spinal cord and nerve roots. Although both are qualified to perform spine surgery, each surgeon’s training is different:

Orthopedic surgeons are trained on the bone, muscles, and ligaments. Their medical training typically consists of all aspects of orthopedic surgery including: sports medicine, joint replacement, fractures, and spine. Their medical training consists of: 

• • Four (4) years of medical school
  • Five (5) years of residency
  • One (1) year in spine fellowship to become orthopedic spine surgeon

Neurosurgeons are trained on the brain, spinal cord, and nervous system. Their training consists of brain, spine, peripheral nerve pathology and surgical treatment. Roughly fifty (50%) of a neurosurgeon’s surgical training is spent on spine surgery, so some neurosurgeons do not pursue a fellowship. Neurosurgeons medical training consists of:

• • Four (4) years of medical school
  • Five to seven (5-7) years of residency
  • One to two (1-2) year fellowship in spine or brain surgery, typically focusing on advanced, complex, or specific surgical skill sets 

Which Type of Spine Surgeon is Right For Me? 

Surgeon training is a component of determining which spine surgeon is right for you. Some additional questions to consider when selecting your spine surgeon are: 

• • Are they board certified?
  • Did they complete a fellowship? 
  • How many spine surgeries have they done? 
  • How many spine surgeries have they done for your specific condition?
  • How much of their practice is dedicated to your specific condition? 
  • Do they educate and assist with your decision making on treatment?
  • Are they open to you seeking a second opinion?
  • Have they offered and exhausted conservative treatments? 
  • Do they put you at ease with their thoroughness and confidence? 
  • Do they have good bedside manner?
  • Has their staff been helpful and their follow up timely?

How Should I Prepare for My Upcoming Spine Surgery? 

If you have decided spine surgery is your best treatment option you most likely are experiencing mixed emotions, excited for relief but also nervous. These are completely normal emotions when preparing for spine surgery. But there are things you can do to get your body optimally ready for the surgery and set yourself up for the best recovery. The months or weeks leading up to your surgery are crucial preparation time. From specific exercises to quitting smoking, the steps you take now can make a huge difference in healing and preventing potential complications down the road. Refer to our previous blog article “Preoperative Optimization: Preparing for Spine Surgery” for detailed information to help you prepare for your upcoming spine surgery. 

At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board-certified spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive spine surgery. Dr. Kalra is known for his bed side manner and has stated “One of the most important things we do at Karla Brain & Spine is to make sure our patients have all the information they need about their condition and treatment options so they can make an informed decision about their health care.” Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physician colleagues from 2017-2023. If you have unanswered questions about a recommended spine surgery, need a second opinion, or would like to obtain the neurosurgical treatment you need call Kalra Brain & Spine at (972) 905-9226 or request an appointment on our website.

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At Kalra Brain & Spine in Frisco, Texas, Ricky Kalra, M.D. is a board certified spine fellowship trained neurosurgeon who specializes in conservative management, second opinions, and minimally invasive cervical spine surgery. Following Dr. Kalra’s fellowship training he completed an additional six months of training in Germany to learn advanced spine procedures and new technologies coming out of Europe. He also received advanced training and has achieved superior outcomes utilizing cervical disc replacement technology for his patients. Dr. Kalra has been recognized as a D Best Neurosurgeon in Dallas by his physicians colleagues from 2017-2023. 

What Are The Most Common Causes of Neck Pain? 

The most common cause of neck pain is muscle strain that typically resolves in days but can last up to six weeks for more significant strains. Musculoskeletal strain describes injury to the muscle, ligaments, tendons, or bones. This occurs when one of these structures are stretched too far and tears. Most neck pain will subside on its own or with over the counter treatment such as rest, ice, and medications. Sleeping with your neck in an awkward position or being hunched over your computer for hours can both result in neck pain. Other common causes of neck pain include: 

• Degenerative conditions (osteoarthritis)
• Nerve or spinal cord compression (herniated discs) 
• Injuries or trauma (motor vehicle accidents)
• Diseases (rheumatoid arthritis)

When Should I Be Concerned About My Neck Pain? 

Neck pain can result in significant discomfort and pain. Most neck pain can be managed or controlled with conservative non-invasive treatments. You should be concerned about neck pain and seek immediate medical attention if it is so severe you can not manage it or if you have any of the following symptoms that accompany severe neck pain:

• Significant pain and numbness, tingling, or weakness in one or both hands or arms 
• Fever and headache
• Chest pain
• Chronic swollen glands
• Extreme instability of head or neck

If you experience the above symptoms neck surgery may be necessary. Neck surgery or cervical spine surgery is most commonly performed for three main reasons. The first reason is a pinched nerve or impingement on the spinal cord that may require decompression surgery. The second reason for cervical spine surgery is when a tumor or mass develops at the base of the skull or in the cervical spine that requires removal. The third reason cervical surgery may be performed, is when a patient is experiencing spinal instability and fusion surgery is recommended. With improved minimally invasive surgical techniques, pain control, and technological advancements cervical fusion is no longer a must for cervical spine surgery patients.

How is Cervical Disc Replacement Different From A Cervical Fusion? 

 The surgical procedure for an Anterior Cervical Discectomy and Fusion (ACDF) involves an incision on the front of the neck and removal of the diseased disc. The cervical disc is then replaced with a surgical cage.  A metal plate is secured to the vertebral body above and below the where the cervical cage was placed.  The metal plate will provide stability of the vertebral bodies while a boney fusion is formed. Over the course of six months to one year a solid fusion mass  will form providing stability of the vertebral bodies. Anterior cervical disc replacement (ACDR) surgery requires an incision to  be made on the front of the neck and the diseased disc is removed. Instead of then fusing these bones together Dr. Kalra inserts an artificial disc that allows this space to remain open creating a more natural anatomic structure that functions like your natural disc. Although the two surgeries have similarities, the main difference is post operative cervical range of motion or neck mobility and the recovery time of a cervical disc replacement is much less than the cervical fusion.  

What Are The Benefits of Anterior Cervical Disc Replacement Compared to Anterior Cervical Disc Fusion? 

While there are potential benefits to a cervical disc replacement not all patients are candidates for this procedure. Some potential benefits include:

• Quicker recovery
• Reduced risk of adjacent segment disease
• Reduced risk of future surgery
• Greater range of cervical motion 

If you have struggled with neck or back pain and you have tried lifestyle modifications, physical therapy, medications, pain management and it is not improving it may be time to see a neurosurgeon. If you have been told you need a neck or back surgery Dr. Kalra advises you and his patients to seek a second opinion. There are many new ideas, techniques, and technologies that may help you avoid a complex spine surgery or unnecessary pain. Remember, less than ten percent of people that experience neck or back pain need spine surgery. If you are interested in learning more about cervical disc replacement, need a second opinion, or to obtain the neurosurgical treatment you need call Kalra Brain & Spine at (972) 905-9226 or schedule an appointment on our website.   

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