For generations, the path to becoming a spine surgeon began with a choice: orthopedics or neurosurgery. Jeffrey Mullin, MD, a neurosurgeon at Williamsville, N.Y.-based University at Buffalo Neurosurgery, sees a future in which that choice matters considerably less.
Across operating rooms, training programs and professional societies, the two branches of spine surgery are increasingly converging. Orthopedic and neurological surgeons are treating many of the same conditions, adopting many of the same technologies and, particularly in complex spine care, learning from one another.
The result could be a subtle but consequential shift in how the field defines itself: less by where surgeons trained and more by the work they actually do. Dr. Mullin, who specializes in complex spine surgery, has spent much of his career at the intersection of the two disciplines. He trained at Cleveland Clinic, where its Spine Institute exposed him to orthopedic and neurological spine surgeons, and later completed a fellowship under Christopher Shaffrey, MD, the chief of the spine division at Durham, N.C.-based Duke University, who specializes in both orthopedic and neurological surgery.
That background gave him an early look at a model the broader field is increasingly embracing: spine surgeons working alongside one another without allowing their original training pathway to define the boundaries of their practice.
“My day to day is a lot closer to an orthopedic spine surgeon than it is to my endovascular surgery colleagues,” Dr. Mullin said.
‘We’re more alike than we aren’t’
For Dr. Mullin, the erosion of that divide became particularly apparent through his involvement with spine societies. He pointed to the Scoliosis Research Society, where orthopedic and neurological surgeons routinely discuss the same questions around deformity, pelvic parameters, bone health and fusion.
“That was where I really started saying, ‘Hey, we’re more alike than we aren’t,’” he said.
The convergence does not mean the two training pathways are interchangeable. Each brings strengths that can broaden how spine surgeons approach patients.
Neurosurgical training typically provides greater exposure to neurological examinations, intradural work, spinal cord tumors and cerebrospinal fluid leaks, Dr. Mullin said. From orthopedic colleagues, he has learned more about bone healing and fusion, as well as the evaluation of hip and sacroiliac joint pathology, particularly important when symptoms attributed to the spine may have another source.
Even the rise of endoscopic spine surgery reflects that cross-pollination. Dr. Mullin pointed to orthopedics’ experience with arthroscopy as one foundation that has helped advance endoscopic techniques in spine.
Complex deformity may be one of the clearest examples of that convergence. Orthopedic and neurological surgeons may bring different foundations to these cases, but increasingly, they are working toward the same goals, Dr. Mullin said.
For patients undergoing major deformity procedures, that convergence has a practical purpose: more standardized care and, ultimately, better outcomes.
Collaboration is moving beyond the OR
The shift is also becoming institutional. Multidisciplinary spine conferences are another entry point for collaboration, giving orthopedic and neurological surgeons a forum to review cases and learn how the other approaches the same problem. Dr. Mullin called them a “gateway drug” to working more closely together.
He experienced that model during his training at Cleveland Clinic, but the shift extends beyond academic centers. Orthopedic practices are bringing in neurological spine surgeons, while neurosurgical groups are doing the same with orthopedic spine surgeons.
Professional societies are increasingly bridging that divide, too. Dr. Mullin coordinated a symposium for the Congress of Neurological Surgeons’ annual meeting in collaboration with the Scoliosis Research Society, bringing together leading orthopedic and neurological spine surgeons. He sees the partnership as part of a broader movement among spine organizations toward a field less constrained by its traditional specialty boundaries.
Technology is providing another common language. Dr. Mullin has increasingly incorporated navigation into his practice and has also used robotics. Surgeons may differ over how heavily to rely on those tools, but he sees their adoption as another area in which orthopedic and neurological spine surgery are advancing together. The deeper question is whether training will eventually catch up.
Could spine eventually have its own residency?
Today, surgeons still reach spine through two markedly different routes.
Neurosurgery residents spend years learning cranial, vascular and other neurological procedures in addition to spine. Orthopedic residents rotate through joints, sports medicine, hand surgery and other subspecialties before those pursuing spine generally concentrate their training during fellowship. Dr. Mullin does not expect either pathway to disappear. But he can envision a third.
“There’s always been rumblings about spine residency or spine training,” he said. Rather than spending years training extensively in areas they will not ultimately practice, future physicians could theoretically enter a residency built specifically around spine care.
“There’s probably going to be, at some point in the future, a spine residency,” Dr. Mullin said. “It intuitively makes sense to me.”
Whether medical education ever moves that far remains uncertain. Creating an independent training pathway would require changes beyond any individual hospital or spine program, and Dr. Mullin emphasized that existing orthopedic and neurosurgical routes are likely to remain.
The more immediate transformation may be happening without any formal restructuring at all. After several years in practice, he said, many surgeons already stop emphasizing whether they began in orthopedics or neurosurgery. They simply identify as spine surgeons.
Medicine has made similar transitions before. Dr. Mullin pointed to plastic and vascular surgery, specialties physicians historically entered after general surgery but that later developed integrated residency pathways of their own. The original route becomes less important than the specialty in which a physician ultimately practices.
Ten years from now, Dr. Mullin expects orthopedic and neurosurgical training programs will still produce spine surgeons. What may fade is the instinct to define those surgeons primarily by where they started. “I think people are already starting to do that,” he said. “It should just become more and more standardized.”
The orthopedic-neurosurgery distinction may not need to formally disappear for spine surgery to move beyond it. The field may already be becoming something simpler: spine surgery.
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