Spine Surgeons and Chiropractors Collaborate for Better Spine Care

March 2025
Chiropractors often collaborate with other health care professionals. They share their neuromusculoskeletal (nMSK) expertise and hands-on treatment in hospital and clinical settings where patients may benefit from non-surgical care. A recent development within a renowned surgical fellowship program is now strengthening collaboration between spine surgeons and chiropractors at the educational level.
The Citywide Spine Fellowship Program, offered through the University of Toronto Spine Program, is enhancing its training for future spine surgeons by introducing the Non-Operative Spine Course.
“For the very first time in December 2024, we included the non-operative course within the Program.” explains Dr. Carlo Ammendolia, chiropractor, director of the Spine Clinic & Spinal Stenosis Program at Mount Sinai Hospital, and clinician scientist at U of T Department of Surgery. “It was very well received.”
This course is particularly important because most patients who see a spine surgeon will not end up needing surgery. A very small percentage of patients with spine related pain are considered surgical candidates. The majority require non-surgical care, such as manual therapy, exercise rehabilitation, and patient education – areas where chiropractors have thousands of hours of education and hands-on training.
“It’s a good idea for surgeons to know what options are available beyond surgery and what the evidence around those options are,” says Dr. Ammendolia. “Because surgeons don’t perform surgery on all their patients, they need to be informed about non-surgical alternatives.”

Spine Care as a Team Sport

This course emphasizes spine care as a collaborative effort; it’s a team sport. While surgery is sometimes necessary, it’s only one of several options available to patients. The course emphasizes that chiropractors, physiotherapists, and other health care providers play a crucial role in spine care.
“There are many facets involved in care, from surgery to non-surgery,” Dr. Ammendolia explains. “This course highlights non-surgical options for patients, with chiropractic care being a very common one.”
Chiropractors, for example, use a combination of manual therapy, therapeutic exercise, and education to help patients recover from spine-related conditions. By introducing these concepts to surgeons, the program is fostering a more collaborative and interdisciplinary approach to spine care.

What Happens When Surgery Isn’t the Answer?

Spine surgeons often meet patients who are experiencing back, leg, or arm pain. After a thorough assessment, the surgeon may determine that surgery is not the best course of action.
“Often, the surgeon will tell the patient, ‘Unfortunately, you’re not a surgical case. It’s best that you seek non-surgical options,’” says Dr. Ammendolia. “And then the patient may ask, ‘So what are you recommending?’”
Surgeons in the program are now better equipped to answer that question thanks to this new educational initiative. This course provides spine surgeons with evidence-based rationale to recommend chiropractic treatment, structured rehabilitation programs, or other non-operative approaches when appropriate. “Patients can leave that office knowing there are other options available to them,” says Dr. Ammendolia.

A Step Toward Better Patient Care

The course is not just about education — it’s about changing the way spine care is delivered. It’s promoting a patient-centered, evidence-based approach by bringing surgeons and chiropractors together. This ensures patients receive the best care for their condition – whether that involves surgery or not. In terms of feedback, 100% of participants surveyed recommended the course for future spine fellows.
“At the end of the day, it shows that we’re working together,” says Dr. Ammendolia. “Surgeons are now recognizing chiropractors as experts in non-operative care, and that’s an important step forward for improved patient centred care…the right treatment for the right patient at the right time.”