How important is it to receive training in SCS, intrathecal pumps, kyphoplasty, vertebroplasty, discograms, etc during fellowship training? There is incredible variability in the number of these procedures performed in each training program. Some programs perform almost zero implants and instead refer them all to neurosurgery. These programs seem to infer that the complications and lifestyle associated with these procedures make it easier to refer out. Also implied is the lack of reimbursement to help offset the costs of these procedures. Are these difficult to learn through workshops if not learned during fellowship?