One of the important arenas of medical practice is the field of neuromedicine and neurosurgery. Both these specialities are associated with treatment of diseases associated with the nervous system in our body. The domain of practice is related to diseases of nerves, brain and spinal cord. Nervous system is an important organ system in our body. It is through which one perceives the level of cognition, locomotion and more importantly the sensations of taste, emotion and pain.
The system also acts to transmit impulses to the muscles of the heart, intestine, urinary bladder and all over the somatic and other visceral structures in our body. Hence the normal functioning of nervous system is a key attribute for an individual’s survival. However, the nervous system is challenged by various diseases which are either organic or develop from various injuries. Such injuries may occur accidentally or might be work related musculoskeletal disorders (WMSDs). The broader field of practice for both the specialities fall under Neurology.
Neurophysicians are those clinical practitioners who treat neurological diseases through use of medicine and non-surgical interventions. The field they specialize are treatment of dementia (act of forgetfulness or loss of memory) which may be age related or disease related, stroke, epilepsy and management of neuromuscular pain. One of the important areas they intervene is the management of neuropathic pain which occurs due to diabetes or WMSDs. They prescribe various medications but they do not perform any surgical interventions to treat such diseases. The speciality of neuromedicine often overlaps with Psychiatry (mental disorders caused by disorders in nervous system), Pulmonology, Physical medicine and Cardiology. Neurophysicians are associated with both acute and chronic management of neurological conditions. For example, neurophysicians are involved in the treatment of meningitis (a serious infection that occurs in the meninges, which are the protective coverings of the brain) and stroke that may lead to paralysis. They have clear cut practice demarcations with neurosurgery.
Neurosurgeons are those clinical practitioners who treat neurological diseases through use of medicine and surgical interventions. When the surgical intervention is the recommended mode of approach for treatment of neurological challenges, neurosurgeons are the most desired speciality. These practitioners intervene both acute and chronic problems. For example, acute forms include burr-hole surgery or craniotomy to eliminate out blood from subdural spaces. Thus subdural hematoma is treated by neurosurgeons. Further, spinal cord injuries are also treated by neurosurgeons. Here lies an overlap and clash of practice with neurophysicians.
A neurophysician would tried to provide conservative treatment towards subdural hematoma and it is also recommended that if the hematoma is bilateral and no further neurological deficits occur, patient may be managed by wait and observe policy from the CT scan or MRI reports. However, when the hematoma is unilateral or when the subdural hematoma is very pronounced surgical intervention have to be ensured. In case of disc prollapse (earlier called slipped disc), neurosurgeons will intervene. However, the pain occurring from the compression of nerves beneath the vertebra (referred to as radiculopathy) due to disc prollapse will be managed by neurophysicians.
A comparison of both the specialities is briefed below:
| Features | Neurophysicians | Neurosurgeons |
| Disease Speciality covered | Neurology ( diseases of nervous system including brain and spinal cord) | Neurology ( diseases of nervous system including brain and spinal cord) |
| Domain of practice | Medications and Non-surgical treatment | Surgical treatment and medications |
| Treats acute and chronic neurological diseases | Yes | Yes |
| Overlapping Specialities | Pulmonology, cardiology, physical medicine, psychiatry and neurosurgery | Primarily neurophysicians and psychiatrists |
| Treats Infective diseases of nerves | Yes | No |
| Exclusive practice domain | Stroke, epilepsy and dementia | Treatment of spinal cord or brain injury |
| Remuneration ( not sacrosanct) | Lower than neurosurgeons | Higher than neurophysicians |