As a resident logging cases near the end of my training at a large academic program, does anyone else feel like there is an overemphasis of spine in our residency training? Almost half of the cases are spine, and the minimum requirements favor spine over open vascular, tumor, functional, peripheral nerve, epilepsy, hydrocephalus, and trauma combined. Why is this? Most medical students entering neurosurgery are not seeking to become spine surgeons (admittedly many do switch). What value is there to having senior residents do round after round of ALIF, XLIF, T10-Pelvis, and corpectomies they will never do again? This seems like a total misallocation of our training hours in the OR for those not pursuing spine.
Nationally, 70% of all neurosurgery case volumes are spine. The vast majority of jobs in neurosurgery are NOT in academics, where the proportion of spine volume ranges from 60-100%. Complex cranial cases are concentrated at a small number of academic places among a small handful of surgeons. These requirements reflect that most cases in neurosurgery are spine, and most residents are going to have jobs doing mostly spine.
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Bear in mind that cranial cases are often longer on average than spine, so factor that into your considerations. Yes you have to do less aneurysms, but you can do 2-3 microdiscs with turnover in the same amount of training time.
As a resident interested in spine I’d say if I were your coresident I’d gladly trade you an aneurysm for 3 spine cases. Like my patients to have symptom improvement and actually walk out of the hospital vs sitting in the Neuro ICU for several days and then questioning whether they should’ve had the surgery because they can’t tell if they’re better but rather have to trust our interpretation of their post procedure imaging to evaluate for occlusion.
We should all be able to do an ACDF, PCDF, lamis/discectomies, TLIF.
Even as someone who is interested in a cranial subspecialty, I’d gladly take the above cases weekly.
