I went through this a few years ago, when neuro was still early match. Basically, you both interview in cities where there are multiple programs (i.e. Boston, Chicago, etc.). You then have an honest conversation about where you both want to end up, because you don't want to early match into a city where your spouse has no acceptable options. You then make your early rank list, and wait. Once the early match list comes back, you will be narrowed-down (obviously) to one city. Your partner (and you, if you have to rank a prelim) then make your standard match list, both of you ranking highest all of the acceptable programs in the city in which you ranked early. And there you go. As long as your spouse is not a horrendously poor candidate, things should work out fine.
Honestly, I think this is easier and more transparent than the couples match.
