Neurosurgery spine vs orthopedic spine

[opabiniafan]

Just an M1 interested in spine trying to get a feel of the land -- was wondering what, if any, the differences between doing a nsgy residency vs an orthopedics residency + spine fellowship would be if one is planning on doing spine (apart from the obvious that ortho spine doesn't touch the dura). Is there any bias in the private practice landscape for one training path over the other? What about bias for academics/hospital hiring? I know nsgy gets far more spine exposure during residency than ortho, does the difference in exposure get evened out during fellowship for those from ortho? Are there any practical considerations in direct regards to training (in my mind ortho residency is, to some degree, less demanding than nsgy residency)? What about for career optionality in attendinghood?

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[mmmcdowe]

The orthopods will claim that it does but I think it is Case by case. I did close to a thousand spine cases in residency despite being a cranially oriented trainee and my spine heavy classmates probably pushed 2000. Others at less spine heavy training institutions probably did not have that level of experience. I think more than who gets more experience it is more a matter of a very different set of principles that guide what you do. Orthopedic surgeons are going to have a much better biomechanical background, whereas neurosurgeons are going to be heavily weighted towards CNS and PNS considerations. If you're doing deformity, it probably doesn't matter except orthopedic surgery will get you there potentially potentially slightly faster. If you are interested in the stuff that lives within the spinal canal then you are probably better off doing neurosurgery because most orthopods steer clear of CSF unless unintentional. The pediatrics spine world is still dominated by Ortho, but that is changing too a little.