Currently, there are several paths to become a spine surgeon in North America.
The most common paths are:
1) an orthopedic residency followed by a spine fellowship
2) a neurological surgery residency
Post graduate neurosurgical spine fellowships do exist and are useful and important for those surgeons pursuing an academic career or those seeking subspecialized training in a particular aspect of spinal surgery. A dedicated spine fellowship also allows post graduate neurosurgeons exposure to different clinical philosophies and approach management to spinal disorders.
There has been some confusion regarding the role of fellowships for neurosurgeons interested in spine and a perception that some sort of added credential is required for hospital privileges or community acceptance of the neurosurgeon’s expertise. This is despite the fact that in 1995, the Council of Spine Societies (AAOS, AANS, NASS and others) issued a statement regarding the fact that residency trained neurosurgeons are spine specialists upon completion of their residency. Here are some facts, drawn from the 2016-2017 ACGME case requirements and case logs that may help put this issue to rest.
The Orthopaedic Residency Review Committee requires that orthopedic residents be exposed to 15 spine cases during their residency. In reality, the average orthopedic resident participates throughout residency in 79 spine cases with 8 of these cases involving spinal instrumentation. In contrast, the Neurosurgical Residency Review Committee requires that neurosurgical residents be exposed to 240 spine cases. In reality, the average neurosurgery resident is a senior or lead surgeon on 411 spine cases throughout residency with well over half of these cases involving instrumentation (a more exact figure is not possible due to how neurosurgical cases are reported to the ACGME). Obviously, there is variability in training opportunities and resident interest in both orthopedic and neurosurgical training programs. That said, current orthopedic spine fellowship guidelines call for the fellow to participate in 200 spine cases during a fellowship year. A neurosurgical resident interested in spinal surgery will finish with a spine experience which is several fold that of an adequately trained orthopedic surgeon completing an approved spine fellowship. Indeed, the most productive neurosurgical residents with interest in spine are reporting well in excess of 1000 cases as lead or senior surgeon (the max last year was 1,246 spine cases).
In addition to surgery on the vertebral column, discs and neuroforamina, neurological surgery residency trains neurosurgeons to operate inside the dura of the cervical, thoracic, lumbar and craniovertebral junction spine. Neurosurgeons are trained to repair congenital anomalies of the spinal dura such as meningoceles, remove intradural tumors such as intrinsic spinal cord tumors, metastatic tumors, schwannomas, meningiomas and ependymomas, as well as treat vascular malformations such as dural arteriovenous fistulas or spinal cord cavernous malformations.
ABNS Position Statement:
It is the position of the ABNS, AANS, CNS as well as the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves that residents who complete accredited neurosurgical residency programs are spine surgeons. Post graduate fellowships are useful for the acquisition of unique or focused surgical expertise and skill sets, the development of an academic pedigree, and for pushing the field ahead through scientific research.