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Spine vs cranial, why did you go the route that you did
#1
See post title. Want to hear from the more senior guys why they picked spine over cranial and vice versa. I like both but not sure yet
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#2
Spine cause I like money and good hours and less thinking just doing.
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#3
Patients don't die. And when surgeries are well indicated, you get to share in the joy of improving someone's quality of life.
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#4
I’m not a spine hater. Relative to cranial there is arguably more complex decision-making and opportunities for creativity, and cases can be low stress and fun. But (non-oncologic) spine is not microsurgery. When done well, cranial neurosurgery is art. If you want to be constantly pushing yourself and striving to do surgeries that only a small minority of individuals can do, cranial is the way to go.
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#5
Spine is more diverse than people give credit for, a lot of technology/robotics, cool approaches, MIS and there’s much more finesse and nuance to it than people outside of the field realize. Spine onc and spine trauma lead to some gnarly cases and complex decision making. Big industry component if that’s your jazz, will never struggle for volume. Long as indications are right you really help people out. Downsides are SCI and crazy nonoperative back pain pts in clinic.

Cranial depends what we’re talking. Skull base has crazy approaches, extremely intricate anatomy and requires great dexterity and patience under the scope, but with that comes way more potential to fuck someone up. You get good with the endoscope and pituitaries are fun cases. Much less “macro” than spine. Intraparenchymal work however is not exceedingly difficult and patients tolerate these cases much better. More science if that’s your thing re malignant tumors. Downside are GBM/HGG and the inevitable not insignificant complications you’ll give people.

Comes down to if you like more orthopedic style, hardware placemen/tactile feedback vs microscopic dissection, tedious bony drilling, and navigating around eloquent anatomy. I like both, and am in privademuc and have 60/40 split spine/cranial. As I age my body’s tolerance for big spine cases (having your neck bent down for hours is not ideal) is waning. Now it’s nicer to sit in the chair upright under the scope these days.
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#6
Also need to be honest with yourself during residency. You’ll know whether or not you have the hands for microsurgery. Some residents it just clicks and they get it, some have noticeable tremor or don’t have the fine motor skills to be delicate enough to not cause harm. Yes with repetition you improve but.. be honest with yourself.
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#7
(04-09-2022, 06:13 PM)Guest Wrote: Also need to be honest with yourself during residency. You’ll know whether or not you have the hands for microsurgery. Some residents it just clicks and they get it, some have noticeable tremor or don’t have the fine motor skills to be delicate enough to not cause harm. Yes with repetition you improve but.. be honest with yourself.

could not agree more. (safe) microsurgery is not for everyone.
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#8
(04-09-2022, 07:49 PM)Guest Wrote:
(04-09-2022, 06:13 PM)Guest Wrote: Also need to be honest with yourself during residency. You’ll know whether or not you have the hands for microsurgery. Some residents it just clicks and they get it, some have noticeable tremor or don’t have the fine motor skills to be delicate enough to not cause harm. Yes with repetition you improve but.. be honest with yourself.

could not agree more. (safe) microsurgery is not for everyone.

How many personal statements have we read of aspiring “academic open vascular/skull base” surgeons who end up private practice spine? Reality is not everyone can be Al mefty or spetzler. There are “skull base” surgeons who should absolutely not be doing those cases.. but ego is the enemy
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#9
I can't speak for Al Mefty but Spetz practiced surgical skills in the anatomy lab all the way to the end of his career. My experience is that "hands" are an overrated concept that surgeons with good skills use to exceptional-ize themselves and surgeons with bad skills use to excuse themselves. Innate ability to use your hands is vastly secondary to the innate ability to drive yourself to practice. If you aren't doing rat vessel to vessel anastomoses and other microsurgical practice techniques and also justifying your microsurgical technical ineptitude via "hands" then you're full of it. I had a resident recently tell me that I made throwing vessel sutures under scope "look easy". It isn't easy, it is one of the most miserably fucking hard things to do and if I do it better than I once did it's because of the big pile of dead rats in the hospital garbage dump.

What is true is not every trainee has access to the practice opportunities that allow them to develop "hands".
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#10
This.
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