For decades, orthopedic surgeons and neurosurgeons have often approached spine care from different training pathways, different departments and sometimes different philosophies.
At Nashville, Tenn.-based Vanderbilt University Medical Center, leaders say some of the best spine care happens when those distinctions disappear. Once a week, orthopedic spine surgeons and neurosurgeons gather in the same room to review cases, debate treatment plans and challenge each other’s thinking.
The conversations are candid. Opinions differ. Surgical plans change. And, according to Scott Zuckerman, MD, assistant professor of neurological surgery and orthopedic surgery at Vanderbilt University Medical Center and co-director of the Vanderbilt Spine Outcomes Lab, that is precisely the point.
“Every week, a case is tweaked or a plan is changed because of each other’s input,” Dr. Zuckerman said. “We’ll share opinions, we’ll agree, we’ll disagree.”
In an era when healthcare organizations are increasingly focused on multidisciplinary care, Dr. Zuckerman believes true collaboration goes far beyond organizational charts or committee structures. When orthopedic surgeons and neurosurgeons work together consistently, he said, the benefits extend across nearly every aspect of spine care.
“Everything’s better when the two sides work together,” he said. “Most important, patient care is better, research is better, training is better and, lastly, surgeon individual happiness is better.”
For Vanderbilt, that philosophy has become a defining part of the spine program’s culture.
Moving beyond the ortho-versus-neuro divide
Historically, orthopedic surgeons and neurosurgeons have often treated many of the same spinal conditions while training in separate departments and developing distinct professional cultures.
Dr. Zuckerman said his own appreciation for collaboration began during residency while working alongside the late Vanderbilt spine surgeon Clint Devin, MD. “He would welcome neurosurgeons with open arms,” Dr. Zuckerman said. “I learned a great deal about spine from him.” The experience left a lasting impression.
Later, during fellowship at New York City-based Columbia University, he trained alongside leaders in both orthopedic surgery and neurosurgery who reinforced the same message: Spine care improves when specialists stop operating in silos.
Today, that philosophy shapes daily life at Vanderbilt. Orthopedic surgeons and neurosurgeons routinely discuss cases, collaborate on research projects, share clinical space and seek each other’s opinions both in clinic and in the operating room.
“We talk and text about cases all the time,” Dr. Zuckerman said. “We do all our research together.” Rather than functioning as separate groups, he said, the teams operate as a single spine community.
The simple habit that makes collaboration work
For all the attention healthcare receives for technological innovation, Dr. Zuckerman believes one of the most powerful drivers of collaboration is remarkably simple: being physically present together. Every week, orthopedic and neurosurgical spine faculty, fellows and residents meet face-to-face to review complex cases and discuss outcomes. According to Dr. Zuckerman, there is no meaningful substitute for those conversations.
“There is no substitute for just being together physically in the same room,” he said. “It’s not virtual. It’s not online. It’s being in the same room, looking each other in the eye and talking about cases.”
The meetings are not designed to showcase perfect outcomes. Instead, they create space for surgeons to discuss uncertainty, seek advice and openly examine complications.
“We all have complications,” Dr. Zuckerman said. “That humanizes everyone. It brings everyone down to earth, and it also says, ‘Hey, we’re all in this together.’” For him, that openness is what transforms collaboration from an institutional goal into a genuine culture.
Trust develops when physicians feel comfortable sharing difficult cases, admitting mistakes and asking colleagues for help. And over time, that trust translates into better decision-making for patients.
How collaboration influences outcomes
The impact extends beyond weekly conferences. Dr. Zuckerman said Vanderbilt’s collaborative model has also helped strengthen research efforts and identify opportunities to improve outcomes.
One example has been bone health optimization before complex spinal deformity surgery. Working alongside colleagues in rheumatology and endocrinology, spine surgeons analyzed patient outcomes after implementing a more aggressive approach to improving bone quality before surgery.
“We looked at our data and once we started the Bone Optimization Clinic, our complications significantly decreased,” Dr. Zuckerman said.
The program has also studied opioid use before and after surgery. Researchers found that one of the strongest predictors of successfully discontinuing narcotic medications after surgery was reducing opioid use before surgery begins.
“We’re asking good clinically focused questions,” Dr. Zuckerman said. “Then implementing those findings routinely in the OR and clinic.”
For him, the research mirrors the same principle that drives the clinical program: bringing different perspectives together often leads to better answers.
Building collaboration from scratch
As more health systems attempt to create multidisciplinary spine programs, Dr. Zuckerman believes many leaders focus too heavily on organizational structure and not enough on relationships. His advice is surprisingly straightforward.
Start by getting to know each other as people.
“Go out for coffee. Go out for dinner,” he said. “We’re all surgeons on the surface, but we’re people below that.”
The second ingredient is patience. “You don’t become friends overnight,” he said. “These relationships take time to develop and take time to cultivate.” Only after those relationships begin to form, he said, can the formal structures truly succeed.
Weekly conferences matter. Shared research matters. Joint clinical programs matter. But the foundation is trust.
In an industry constantly searching for the next breakthrough technology or operational model, Dr. Zuckerman believes one of the most effective ways to improve spine care may be far more fundamental.
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