Will neurosurgeons take over spine?


It has become more common over the past few decades for orthopedic surgeons to subspecialize in spine surgery, and now at least one neurosurgery program is gaining momentum in the space.

There are 4,956 neurosurgeons in the U.S., according to the CMS Physician Care National Downloadable File data cited in a January 2021 World Neurosurgery article. Some of those neurosurgeons are focused on brain and nerve conditions, while others have begun narrowing their practice to spinal disorders.

"The field of spine surgery will be completely taken over by neurosurgery [in the next decade]," Sergio Mendoza-Lattes, MD, of Durham, N.C.-based Duke Spine Center, told Becker's. "We are training an increasing number of neurosurgery residents to perform procedures that in the past were — and currently, in most of the world, still are — in the hands of orthopedic surgeons. This includes adult and even pediatric deformity surgery, trauma surgery and surgery for degenerative disorders."

Orthopedic spine surgeons typically spend five to six years in residency without a fellowship requirement, although many do pursue fellowships. On the other hand, neurospine surgeons typically have six to seven years in residency and one to two specialized fellowships. In residency, neurosurgeons spend around 60 percent to 70 percent of their time devoted to spine surgery, according to a 2021 report from Atlantic Brain & Spine.

Over a 10-year period, the average number of spine surgeries performed among neurosurgery residents was 433.8, compared with 119.5 for orthopedic surgeons, according to data from the Accreditation Council of Graduate Medical Education for graduates from 2009 to 2018, as published in a September 2019 article in Neurosurgery. During that period, neurosurgery residents had a 26.5 percent increase in spine procedures whereas orthopedic surgery residents reported a 41.3 percent decrease in spine procedure volume.

Neurosurgical residents on average performed 3.6 times more spine procedures during residency than orthopedic surgery residents, and 33.5 percent of all surgical cases performed during neurosurgery residency were spine procedures.

Despite training differences, a 2015 article published in Spine found there weren't statistically significant differences in outcomes for spinal fusion among orthopedic surgeons and neurosurgeons, although neurosurgeons did report fewer operations requiring blood transfusions.

Dr. Mendoza-Lattes sees the benefit of both training backgrounds.

"I personally think that the ideal pathway should be a combined training program that provides a more holistic approach, including the understanding of hip disease, shoulder disease, peripheral nerves and many overlapping disease processes that are in the differentials of many patients seen daily in the spine clinic," he said.

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