Spine training after residency

[MilesDavisTheDoctor]

Do most neurosurgeons who decide to go out into the community and practice spine surgery do a fellowship after residency? My understanding is that you get so much spine training during residency that this may not really be necessary whereas almost all orthopods do the fellowship because their training isn't as focused on spine.

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[Mortal_Lessons]

No. For community practice, no need for a spine fellowship. You can focus your additional cases in residency on spine and feel comfortable doing bread n' butter spine in the community. If you want advanced training or your program did not expose you adequately to minimally invasive or other techniques such as deformity, then additional training would be a wise choice. Orthopedic surgeons can't practice spine these days without a spine fellowship - it is night and day between orthopedics and neurosurgery.

 

[kitsunepixie]

No, no fellowship needed, unless you want to do scoliosis.

 

[longhaul3]

Not unless you want to do complex or other academic spine.

Ortho has no idea what they're doing when it comes to spine. Most neurosurgery sub-is know more about spine than senior ortho residents. (Edit: I mean the residents, obviously there are some famous deformity surgeons who are ortho trained)

 

[MilesDavisTheDoctor]

@longhaul3 Is this really true lol? It seems like a lot of the world leaders in spine that I know of like Riew Lenke and Cammisa are orthopods and not all really focused on deformity. Once both are done training I have to assume the quality between ortho spine and neuro spine is pretty much identical right?

 

[longhaul3]

Maybe "no idea" was harsh, but I haven't met many ortho residents who know much about spine. We have occasional joint spine conferences and it shows. Not a knock on them, it's just a much bigger part of our training than theirs.

 

[Anti-PD1]

Agree with above.

Orthopedic literally means ortho-pedic, straight-children. They founded scoliosis surgery. Orthos are good at bone work and alignment. But the difference between ortho spine and neurosurgery spine surgeons is obvious in the first imaging study ordered. They look at X-rays for bony alignment. We look at MRIs for nerve or cord impingement first. They spend the rest of their residency doing joints and fractures. All bloody work. We spend the rest of our residency dissecting aneurysms and resecting tumors. We bring that level of care to the spine.

That can be good and bad. I know orthos that zip through spine cases, and neuros who take more time. But you can find efficiency on both sides.

Neuros spend 50-70% of their residency on the spine. Orthos spend 10-20%. That's why they do fellowships. But the market is sometimes looking for "fellowship-trained" spine surgeons, so some neuros do fellowships for that reason as well. Many neurosurgery programs are moving to a model where their 12-month elective time is during PGY7, so you can do a fellowships, possibly CAST-accredited, during that year and save yourself a year of life.

 

[neusu]

Most neurosurgeons don't need a fellowship in spine to do community spine.

 

[DrOrthoSpineMD]

i would agree that orthopedics definitely NEEDS a fellowship to do spine surgery. 2 weeks into my spine fellowship and I've learned more spine than 5 years of residency. But thats also because this is all I'm focusing on right now.