Becker's Spine Review

25 Thought Leadership Will neurosurgeons take over spine? By Laura Dyrda and Marcus Robertson I t has become more common over the past few de- cades 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 neu- rosurgeons 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 resi- dents to perform procedures that in the past were — and cur- rently, in most of the world, still are — in the hands of orthopedic surgeons. This includes adult and even pediatric deformity sur- gery, 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 surger- ies performed among neurosurgery residents was 433.8, compared with 119.5 for orthopedic surgeons, according to data from the Accreditation Council of Graduate Medical Ed- ucation 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 back- grounds. "I personally think that the ideal pathway should be a com- bined training program that provides a more holistic ap- proach, 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.n was interested in academic neurosurgery, but probably not in the most common and usual sense. Although I have more than 100 peer-reviewed publications and well over 200 presentations, I would consider myself less a neurosurgeon-scientist (as I do not have a laboratory) than a cli- nician-scientist. I strive to mentor residents and fellows and hopeful- ly offer an example of how to treat patients, family and staff. I seek to make operative decisions based on what I would recommend to a family member, not on what enhances my reputation in a meeting, presenta- tion, or research paper. My goal is to teach the next generation to be compassionate physicians first and neurosurgeons second. My focus in research has evolved as well, emphasizing how patient experience and communication affect healthcare. Furthermore, being in a 'privademic' setting that combines business aspects of private practice and academia creates flexibility and independence with- out the usual constraints of a university academic program. is setting also allows me to express my opinions without the fear of retribution; on the clinical side, we function as a private practice, with everyone having an equal vote. is emphasis on self-determination has always been a strength of Barrow. e hybrid structure of the institution tends to attract indepen- dent-minded people and, in my opinion, great leaders in each subspecialty. Finally, I also wanted to carry on the traditions demonstrated to me by my mentors, Robert Spetzler, MD, and Volker Sonntag, MD. eir ded- ication to education, research, residents, family, leadership and decency has inspired me throughout my career. I hope to continue that legacy. David Essig, MD. Northwell Health (New Hyde Park, N.Y.): From an employment standpoint, I was looking for a position that allowed me to treat a variety of pathologies among a diverse patient popu- lation. I wanted access to academic opportunities, including access to teaching, research and colleagues who could assist me in the care of complex patient cases. Finally, I was seeking a geographic locale that allowed me to have easy access to family and friends, as well as recreational opportunities. Miki Katzir, MD. University of Nebraska Medical Center (Omaha): As the director of surgical spine oncology at the University of Nebraska Medical Center, Fred and Pamela Buffett Cancer Center, the focus of my practice is surgical resection of spine tumors. UNMC and the Fred and Pamela Buffett Cancer Center is the only NCI-designated cancer center in Nebraska. Aviva Abosch, MD, PhD, the neurosurgery department chair at UNMC, recruited me aer graduating from my fellowship at the Ohio State Uni- versity James Cancer Hospital Solove Research Institute in Columbus. e moment I started the interview process, I was thrilled to meet the excellent team from medical, neuro, radiation oncology and neurosur- gery that I'm about to join. Treating cancer patients was always my goal and luckily today, metastatic or primary spine cancer does not mean the end of the road for patients. I love the Midwest; the people, the culture and the family friendly envi- ronment all played a major role in my decision to choose Omaha as my family's new home. In my second year here, thanks to the many friends we have here in and outside the hospital, I truly feel that we made the right choice. n

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