From my previous posts:
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I know a lot of neurosurgeons that do most of what constitutes a community spine practice without having done a spine fellowship. All of the neurosurgery residents at my institution who are planning on doing community NS after finishing will do simple degenerative spine. This includes ACDFs, lumbar laminectomies, microdiscectomies, etc. Yes--it's mostly degenerative cases, but that's what most of spine surgery is. This is very common--it may not be the case at the tertiary care center that you are at, but I assure you that in the community, neurosurgeons are doing spine left-and-right without fellowships.
As far as complex deformity, extensive hardware, management of pseudarthroses and other complicated spinal cases, I only know of the ortho guys doing this, but everywhere I've been, the orthopaedics service has been the stronger spine service and did all of the complex cases.
I've never met a neurosurgeon who knew anything about scoliosis surgery. Deformity is just not their thing.
I still hold that if you do a neurosurgery residency, you can go out and do most community spine cases. You may want to strangle yourself after doing all the clinic it takes to get 3 cases booked, but you can do it.
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This is from this months JBJS. It is a good read if youre interested in spine.
Enjoy,
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When patients try to identify a spine surgeon, they run into a conflict. There are two basic paths to spine surgery. The ABOS recognizes spinal surgery as a component of its requirement for certification in orthopaedic surgery. Spinal surgery also falls into the domain of the American Board of Neurological Surgery. The challenge is in the actual practice of spinal surgery. Some orthopaedic surgeons exclusively do spinal surgery, and some, perhaps the majority, do no spinal surgery. Similarly for neurosurgeons, most do some spinal surgery, but not all do spinal surgery. Also, for the orthopaedic spine surgeons and neurological spine surgeons, there are types of cases that some do and that others do not and vice versa. Therefore, it is a confusing environment for patients as well as for referring physicians, who need to know what kind of spine problem to refer to what kind of surgeon.
In the past, there was a typical relationship between neurological surgeons and orthopaedic surgeons, in which neurosurgeons would do spinal decompression and orthopaedic surgeons would do spinal stabilization. Often, in such cases, the orthopaedic and neurological surgeons worked as cosurgeons. What has happened more recently, because of a variety of factors, is that it is now common for orthopaedic surgeons to do decompressive surgeries, and it is more common for neurosurgeons to do spinal stabilization surgeries. There are certain classic boundaries, such as the treatment of intradural tumors being done only by neurosurgeons and scoliosis or spinal deformity surgery being done only by orthopaedic surgeons, but those boundaries are being crossed in both directions. So, this establishes the dilemma faced by both the patients and the medical community.....
.....In the recognition of real-world forces, it is clear that orthopaedic chairmen and neurosurgery chairmen do not want to give up the revenue stream associated with spine surgery. There is a requirement for this education process in both fields, but there is also a desire to have at least some control of or access to this revenue steam. This has made it difficult to move forward on a content-based approach in general.
With the development of newer generations of neurosurgeons and orthopaedic spine surgeons, previous stereotypical thoughts about skill sets from the parent-discipline training may no longer apply. There have been fellowship programs that accept both orthopaedic surgery and neurosurgery-trained residents. There have even been combined orthopaedic-neurosurgery spine surgery services developing across the country with combined fellowship programs. I personally believe that both disciplines are strengthened when the two efforts are brought together. The neurosurgical understanding of intradural processes, as well as handling of problems such as dural leaks, exceeds that of the conventional orthopaedic training. Similarly, the orthopaedic training and teaching about overall musculoskeletal function and, specifically, the understanding of bone biology as well as instrumentation bring much to the table as well.
So the dilemma that must be resolved remains. How does the patient identify who is a spine surgeon? Is he or she the person who simply appends that logo to his or her name in the yellow pages? How does a referring physician identify who is a spine surgeon? He or she is not necessarily an orthopaedic surgeon or a neurosurgeon. If organized medicine is unable to help make this definition, then there will be rogue efforts outside organized medicine that may obviate the role of the ABMS. This may or may not be a good thing, but a definition is needed whether we establish it within organized medicine or have it established for us.
From:
Keith H. Bridwell, MD, Christopher D. Harner, MD, David W. Polly, Jr., MD and Peter J. Stern, MD
Subspecialty Certification: Current Status of Orthopaedic Subspecialty Certification
The Journal of Bone and Joint Surgery (American). 2006;88:2081-2090.
© 2006 The Journal of Bone and Joint Surgery, Inc.
