Is it appropriate advice for the orthopedic surgeon to tell pt to go to neurosurgeon? because the issue appears to be too close to c-1 and brain stem? is cranial--cervical joint domain of neurosurgeon or orthopedic surgeon?

There : There is overlap in the "domain" for orthopedic spine specialists and neurosurgeons. Some doctors feel more comfortable with certain levels of the spine than others. This is likely based on the experience and training that the physician has. Ultimately, if your ortho doc has suggested that you go to a neurosurgeon, then he/she does not feel qualified to manage the problem and thus i would take their advice!

Here : Here is my just another person response: " hmm, my problem is near my brain stem. Good idea to have a person who specializes in brains work on me." here is my physician response: "your surgeon is wise to refer a patient who may require more specialized care." your question is a good one.

There : There is an overlap between neurosurgery and orthopaedic spine surgery. Sometimes there is further specialization or experience that makes one or the other better for the patient.

Traditionally : Traditionally the case has been for neurosurgeons to handle spine issues closer to the brain. That said, there are a number of combined neurosurgical-orthopedic spine fellowship programs that turn our experts from both disciplines. Sounds like your orthopedist gave an unbiased opinion, something we should all strive for.

The : The craniocervical area of the spine should be regarded with the utmost care and concern. There are many conditions that require the expertise of a compationate, caring, knowledgeble and experienced surgeon.This surgeon needs to have sound and mature judgement and to be fully aware of his or her own capabilities gathered by successes or failures, and approval by patients and peers. Only once, if all of these factors are carefully considered then it is the domain of a particular surgeon with the experience of treating cranial-cervical conditions. I as an orthopaedic spine surgeon feel that this is within the domain of a neorosurgeon with all of the credentials as mentioned.