Ortho Q&A

[longhaul3]

How many different procedures do you do as a spine surgeon?

Spine surgery is a pretty creative field. If you present a case to 10 spine surgeons you'll get 11 different opinions from do nothing to multi-level corpectomies. It's all about patient selection.

The basics are decompression and stabilization. Decompression can be from the front or back (ACDF, microdiscectomy, laminectomy, laminoplasty, +/- facetectomy, foraminotomy) and some can be done open vs. MIS. You may also need to do a corpectomy to decompress the spine from a big tumor or whatever. Stabilization can be just posterior fusion (open PSIF, perc screws) or with interbody fusion (ALIF, OLIF, XLIF, TLIF, etc.). Some of these can be done open vs. MIS as well.

The art comes in figuring out from the history, exam, and imaging what combination of the above the patient needs and what the chances are that the surgery will help. Everyone has back pain. You can look at spine imaging of anyone over 40 and make a case for a 1-level TLIF with PSIF. It's a sweet case. The problem is it will only help if the patient has the right symptoms, and if they don't get better you will be stuck with them forever and end fusing them from T10-pelvis and dealing with broken and infected hardware when they never should have had surgery in the first place.

---

Members don't see this ad.

 

[DrOrthoSpineMD]

happy to keep this going if people are interested.

 

[MilesDavisTheDoctor]

Can you talk about what patient outcomes for different procedures look like?

 

[Darrow O'Lykos]

happy to keep this going if people are interested.

Thank you! I asked this previously but you may not have seen it:

Hi! Thanks for doing this!

Are there any particular fields of research in spinal surgery you are interested in that you'd like to continue through your practice? What are some of the specific, major focuses of active research in spinal surgery?

 

[numbersloth]

For scoliosis and spine deformities, do these patients generally get seen by an ortho or a neurosurgeon?

 

[Lebron's hairline]

I've recetly started doing Neurosurgery research. If I end up applying for ortho for residency, will the neurosurgery research still look good on the application or would I need to do ortho specific research? It's in spine so there may be some overlap

 

[DrOrthoSpineMD]

Thank you! I asked this previously but you may not have seen it:

To be honest, i'm not super interested in research. but there is always alot of research being done regarding outcomes and emerging technologies (robotics, navigation etc)

 

[DrOrthoSpineMD]

For scoliosis and spine deformities, do these patients generally get seen by an ortho or a neurosurgeon?

Both, where I train both neuro and ortho do deformity

 

[manhattalorian]

What are some of the most far out stories you've heard on what/where ortho surgeons have worked? Even beyond professional sports. Any really cool stories? Thanks!

 

[HopeIsStrength]

How long is the average procedure that you do on your OR days and how many procedures do you tackle in a single OR day? Also was spine fellowship as taxing mentally/physically as residency?

 

[penguin169]

Super interested in ortho, but don't want to wait another 6+ years before having a kid. I know female + having a kid + residency will be extremely difficult but have you seen this in your training? Any thoughts?

 

[DrOrthoSpineMD]

How long is the average procedure that you do on your OR days and how many procedures do you tackle in a single OR day? Also was spine fellowship as taxing mentally/physically as residency?

Deformity cases can be between 3-8 hours. Degen cases between 30 minutes-4-5 hours generally (rough estimate, some longer some shorter.

I've done as few as 1 case and as many as 5 spine cases in a single OR day.
I've done 15+ hand cases in a single OR day as well back in residency.

For me, spine is definitely mentally harder but not as physically draining as joints or trauma. I used to hurt all over after long joints/trauma days.

 

[DrOrthoSpineMD]

Super interested in ortho, but don't want to wait another 6+ years before having a kid. I know female + having a kid + residency will be extremely difficult but have you seen this in your training? Any thoughts?

Happens all the time. Don't let this be a deciding factor. I know of a few female residents having children in residency. Also fathers take paternity time now too! times are changing...dont let this limit you.

 

[FischerCat]

Just a few thoughts about life after residency...residency is hard no matter how you cut it. Hours are long and there is a lot to learn. It can also be stressful on performing well, reading in addition to other life events.

I had 2 kids during residency, 1 in fellowship, made almost every wedding but definitely missed out on some other things.

In PP right now doing arthroplasty. Lifestyle all depends on the job you take. I am not a partner (yet), but I generally see patients 3 days a week 8-4, 2 OR days and call q18 with 2.5 trauma guys that take care of all the operative stuff. Yup, you read that right, q18 with a PA first call. Lot of variety in job set up out there...just have to find the right one.

 

[Opomfrog]

how much call do you need to take a week?

 

[DrOrthoSpineMD]

how much call do you need to take a week?

right now in fellowship I take a week of call at a time (only spine call) every 4th week. It sounds horrible to be on call for 4 weeks straight but spine call where I am is pretty reasonable.

When I am in practice I'll be taking q6 (or so) general ortho call. optional spine call.
and every 6th weekend

 

[DrOrthoSpineMD]

fellowship ending in a month! happy to answer any further questions.

Good luck to all the new residents/interns that just started!

 

[Schwifty]

How far did you live from your hospital during residency? Would 30-40 minutes be considered too far?

 

[DrOrthoSpineMD]

How far did you live from your hospital during residency? Would 30-40 minutes be considered too far?

During residency we covered many different hospitals. I lived 10 minutes to the nearest one, 20 from the furthest.
30-40 would be tough if you are doing home call. Otherwise I think its doable.
Fellowship we cover 1 hospital. I live 15 minutes from it.

 

[Doc mu]

fellowship ending in a month! happy to answer any further questions.

Good luck to all the new residents/interns that just started!

How do you see the future of spinal fusion? i just took a peak at some spine studies and it looks like it's study after study bashing it's effectiveness in spinal stenosis and such diseases

Plus i also could not find many studies comparing spine surgeries with sham surgeries to make sure it is not placebo, did i not search thoroughly enough or is there a lack of such studies?

 

[DrOrthoSpineMD]

How do you see the future of spinal fusion? i just took a peak at some spine studies and it looks like it's study after study bashing it's effectiveness in spinal stenosis and such diseases

Plus i also could not find many studies comparing spine surgeries with sham surgeries to make sure it is not placebo, did i not search thoroughly enough or is there a lack of such studies?

Spine fusion works for appropriate indications such as degen spondy thats dynamic, unstable spines after trauma or tumor, deformity correction. I dont think it should be the primary surgery in spinal stenosis without other conditions (spondy, degen scoli etc). - even then it would be case by case.

sham surgery vs spine surgery study? I've never heard of such a study...

 

[Miles Gloriosus]

How do you see the future of spinal fusion? i just took a peak at some spine studies and it looks like it's study after study bashing it's effectiveness in spinal stenosis and such diseases

Plus i also could not find many studies comparing spine surgeries with sham surgeries to make sure it is not placebo, did i not search thoroughly enough or is there a lack of such studies?

Sham surgery studies are super super rare. I think you read the one study at the Houston VA that was done >20 years about knee scopes for arthritic knees. The fact that the study was done in the first place was questionable and not likely to be repeated, especially not for spine stuff

 

[Doc mu]

Sham surgery studies are super super rare. I think you read the one study at the Houston VA that was done >20 years about knee scopes for arthritic knees. The fact that the study was done in the first place was questionable and not likely to be repeated, especially not for spine stuff

Why is that? How else can we know the surgery is any better than placebo? Vertebroplasty, meniscectomy, knee scoping for arthitis...etc were only taken down after they showed no improvement over placebo

 

[Doc mu]

Spine fusion works for appropriate indications such as degen spondy thats dynamic, unstable spines after trauma or tumor, deformity correction. I dont think it should be the primary surgery in spinal stenosis without other conditions (spondy, degen scoli etc). - even then it would be case by case.

sham surgery vs spine surgery study? I've never heard of such a study...

I meant a type of study where in one arm patients get the real things and in the other arm the doctor pretends patients are getting the real thing to ascertain that the surgery is better than just placebo, such trails were the reason vertebroplasties and many other surgeries are barely done anymore, i fear many spinal surgeries may go down that road in the future

 

[DrOrthoSpineMD]

Attending now for 4ish months at a PP job. Happy to keep this going if interested.

 

[Dunkthetall]

Attending now for 4ish months at a PP job. Happy to keep this going if interested.

How’s life compared to fellowship? Heard the first few years after training can be longer/more intense since you’re still establishing yourself.

 

[Gargle]

Attending now for 4ish months at a PP job. Happy to keep this going if interested.

How did job search go? Did you find it challenging/stressful or was it a pretty smooth process? Was it easy to compare different offers?

How would you describe your fellowship application experience? Since there are fewer and fewer people at each step (medical school --> residency --> fellowship), did you find the process more or less random than residency applications? Did you and your co-residents end up at programs that made sense in hindsight? I've also heard there are more hand shake agreements for fellowship (i.e. We'll rank you if you rank us) than for residency - did you find that to be true?

 

[Dr. Anonymouss]

How’s life compared to fellowship? Heard the first few years after training can be longer/more intense since you’re still establishing yourself.

How is attending lifestyle compared to residency? Could you maybe comment on if it is possible to have a more family friendly lifestyle as an attending in ortho granted you are willing to take a pay cut or willing to work in less desirable locations...

 

[DrOrthoSpineMD]

How is attending lifestyle compared to residency? Could you maybe comment on if it is possible to have a more family friendly lifestyle as an attending in ortho granted you are willing to take a pay cut or willing to work in less desirable locations...

How is attending lifestyle compared to residency? Could you maybe comment on if it is possible to have a more family friendly lifestyle as an attending in ortho granted you are willing to take a pay cut or willing to work in less desirable locations...

I wanted to live in the midwest. I definitely did not take a pay cut. My lifestyle so far is pretty good. I am home most days by 5 with the occasional call/add on case. Otherwise I'm only on call 1 out of every 6 weekends. I am able to work out in the AM and see my kid before heading to work. And I am able to come home and see him and eat dinner with the fam every night.
No complaints in regards to lifestyle.

 

[DrOrthoSpineMD]

How did job search go? Did you find it challenging/stressful or was it a pretty smooth process? Was it easy to compare different offers?

How would you describe your fellowship application experience? Since there are fewer and fewer people at each step (medical school --> residency --> fellowship), did you find the process more or less random than residency applications? Did you and your co-residents end up at programs that made sense in hindsight? I've also heard there are more hand shake agreements for fellowship (i.e. We'll rank you if you rank us) than for residency - did you find that to be true?

Job search was good! I had a region i wanted to be in and was able to find a job through an old co-resident. But my fellowship directors kept sending jobs my way that they would hear about. Helped my co-fellows land jobs.

Fellowship interviewing was pretty cool because you'd see almost all the same people at every program. Was kind of nice to make friends and meet people that way. Ortho is a small world, you'll recognize faces all the time.

 

[DrOrthoSpineMD]

How’s life compared to fellowship? Heard the first few years after training can be longer/more intense since you’re still establishing yourself.

The first couple of months were super stressful. I was ready all my old notes for cases etc. Now as I get more comfortable and in the swing of it I feel much more comfortable. I think I'm >50 cases in so far and feeling more and more confident as the days pass! Definitely some things still make me very nervous...but I imagine as I do more cases that'll get better.

 

[Dr. Anonymouss]

I wanted to live in the midwest. I definitely did not take a pay cut. My lifestyle so far is pretty good. I am home most days by 5 with the occasional call/add on case. Otherwise I'm only on call 1 out of every 6 weekends. I am able to work out in the AM and see my kid before heading to work. And I am able to come home and see him and eat dinner with the fam every night.
No complaints in regards to lifestyle.

This is good to hear, thanks!!

 

[rainfall9786]

I'm in the middle of dedicated, studying for Step1. This was a nice read. Thank you

 

[Dr. Anonymouss]

I'm in the middle of dedicated, studying for Step1. This was a nice read. Thank you

wow that's super early. My dedicated starts February 15th and I thought that was early

 

[Gilakend]

I wanted to live in the midwest. I definitely did not take a pay cut. My lifestyle so far is pretty good. I am home most days by 5 with the occasional call/add on case. Otherwise I'm only on call 1 out of every 6 weekends. I am able to work out in the AM and see my kid before heading to work. And I am able to come home and see him and eat dinner with the fam every night.
No complaints in regards to lifestyle.

Your lifestyle sounds pretty great. What is your opinion on the commonly regurgitated "don't do surgery if you can see yourself doing ANYTHING else" or "if the OR is your favorite place in the world do surgery, if it's your favorite place in the hospital do anesthesia?". And why?

When I see it on here or see other med students saying it, I don't think much of it. But after hearing residents and attendings on my surgery rotations echo similar things I'm wondering how true it actually is.

Applying this year and between ortho vs something else. I love ortho, love the people, enjoy the work. But I could see myself doing a millions jobs other than ortho. I could see myself digging ditches, being a welder, or doing anesthesia. It's literally just a job. I love the OR, but I love my family and hobbies more. I feel like when I hear these statements I don't know if I'm just not the surgery type or if I just have a vastly different perspective than a lot of people. Granted this is generally coming from general surgeons, not ortho. But just curious to get another attendings thoughts.

 

[Dunkthetall]

Your lifestyle sounds pretty great. What is your opinion on the commonly regurgitated "don't do surgery if you can see yourself doing ANYTHING else" or "if the OR is your favorite place in the world do surgery, if it's your favorite place in the hospital do anesthesia?". And why?

When I see it on here or see other med students saying it, I don't think much of it. But after hearing residents and attendings on my surgery rotations echo similar things I'm wondering how true it actually is.

Applying this year and between ortho vs something else. I love ortho, love the people, enjoy the work. But I could see myself doing a millions jobs other than ortho. I could see myself digging ditches, being a welder, or doing anesthesia. It's literally just a job. I love the OR, but I love my family and hobbies more. I feel like when I hear these statements I don't know if I'm just not the surgery type or if I just have a vastly different perspective than a lot of people. Granted this is generally coming from general surgeons, not ortho. But just curious to get another attendings thoughts.

You know, I was wondering about this myself. I really want to go into a surgery field, but I think the field of medicine in general is awesome, so I could see myself doing a lot of things. Like most of my experience comes from family medicine, and while it’s not anywhere near the top of my list of specialties, I’d tolerate it at worst haha.