The evolution of partnership between neurosurgeons and orthopedic spine surgeons.
Today, growing numbers of both neurosurgeons and orthopedic surgeons choose to specialize in spine surgery and are increasingly being referred to—and refer to each other as—“spine surgeons.” One day there may even be a well-defined medical specialty of “spine specialists” comprised of members of both specialties and defined by its own board certification, but this is not yet the reality.
Trained in spine
Neurosurgeons trained in the US gain experience in the diagnosis, nonsurgical and surgical treatment of spinal disorders in a six-or-seven year residency training program, during which time they will have assisted in hundreds of spinal procedures. To gain more advanced training, they may choose to do a post-graduate fellowship in spine surgery.
Orthopedic surgeons in training are also exposed to spine surgery during their four-or-five year residency program. If the resident attends an institution where there are orthopedic surgeons specializing in spine surgery, then he or she, may be exposed to a quantity of spine surgeries similar to that of a neurosurgery program. Orthopedic surgeons wanting to obtain further training may pursue a post-graduate fellowship in spine surgery.
Continued learning
A post-graduate fellowship will involve more specialized training in advanced spinal surgery techniques including spinal fusion, minimally invasive techniques, and complex spinal reconstruction.
Both neurosurgeons and orthopedic surgeons who specialize in spine surgery are capable of dealing with many of the same procedures including disc herniations, disc degenerations, spinal stenosis, spine fractures, spondylolisthesis, bone tumors of the spine, and so on.
Only neurosurgeons, however, receive training during their residency to undertake procedures on the dura, meaning that certain conditions still fall under their exclusive domain, including: spinal cord tumors, arachnoid cysts, and spina bifida, to name but a few. Similarly, both pediatric and adult scoliosis and other spinal deformities are still treated primarily by orthopedic spine surgeons.
Currently in the United States, neurosurgeons are certified by the American Board of Neurological Surgery, and orthopedic surgeons by the American Board of Orthopedic Surgery. There is currently no spine certification process that is recognized by the parent board, the American Board of Medical Specialties.
Common ground found
The Cleveland Clinic in Cleveland, Ohio, has one of the most respected spinal health programs in the United States due to its success in joining neurosurgeons and orthopedic spine surgeons with other spine specialists to work together on patient care and research.
Edward Benzel, MD, chairman of its Department of Neurosurgery and Medial Co-director of the Cleveland Clinic Spine Research Laboratory, remembers a time some thirty years ago when conflict between neuro- and orthopedic spine surgeons was “rampant and omnipresent” and attributes its start to the moment when neurosurgeons began performing spine instrumentation procedures, once the exclusive domain of orthopedic spine surgeons.
Over the years, the battles diminished as both sides realized they shared common ground. A fellowship developed, one that Benzel recalls existed for many years at the Cleveland Clinic and that eventually coalesced there in the late 1990s into a “formative structure” based on collegiality and cooperativeness.
In an article in Becker’s Spine Review, Benzel explains that the basis for the Clinic’s ongoing success was the establishment, over a five-year period, of one department to sit between the orthopedic surgery and neurosurgery departments.
This department, now called the Center for Spine Health, shared revenue between the two departments on a 50/50 basis and it established a separate research laboratory, employed a separate administrator, and kept a separate pocketbook. All of these steps, he says, “helped to unite as one.”
“The key to our success gets back to…great partnerships. The administrative key is having the same pocketbook. We aren’t in competition with each other because of our fundamental training (orthopedic surgeon versus neurosurgeon). What matters is simply the provision of quality care. That’s the bottom line,” Benzel says.
Collaboration improves research
According to Adam Bartsch, PhD, director of the Cleveland Clinic’s Spine Research Laboratory, collaboration between the Clinic’s neurosurgeons and orthopedic spine surgeons makes a researcher’s life easy.
“Generally speaking, orthopedic spine surgeons have interaction with sports health providers and the neurosurgeons work more with neurologists and radiologists. We really want to do almost any project related to the head, neck or spine—and we have a team that is posed to ‘pull it off’ every time.
“From the research side,” Bartsch continues, “the structure of the collaboration is great for fundraising and fund seeking because of the broader net we can cast.”
Edward Benzel believes having neurosurgeons and orthopedic surgeons work together brings unique skills sets and backgrounds to the middle. Although the creation of a separate residency training program for spine surgery has been suggested, he says that what is unique about the Clinic’s training program is that both specialties have a chance to work hand-in-hand with surgeons from the other specialty. According to him, the close collegial and financial relationship allows the Clinic to provide better care and do better research.
Benzel believes the program in place at the Clinic will become more commonplace in US hospitals. “As physicians learn to deal with the political and economic barriers they face in individual practices or in their institutions, they will gravitate toward a more collaborative care model.”
Best of both worlds
The 20-year partnership of Jack Stern, MD, PhD, and Seth Neubardt, MD, who together perform more than 200 spine surgeries a year at a private hospital in White Plains, New York, offers an example of how two specialists with distinct yet overlapping backgrounds can share a medical practice that works to optimize their patients’ clinical experience.
Seth Neubardt, an orthopedic spine surgeon with a combined orthopedic-neurological spine fellowship in spine surgery describes their partnership as follows: “Orthopedic surgeons typically specialize more with fusion surgery and implants…[whereas] neurosurgeons have been more involved with the nerves and tumors of the nerves, so we each come with a little bit of different experience.” By having a neuro- and orthopedic spine surgeon work together, he believes patients “have the best of both worlds.”
His colleague, Jack Stern, a neurosurgeon specializing in surgery of the spine, seconds that opinion.
“We complement each other in a really interesting way. It’s great assurance [for patients] when you’ve got two very well experienced surgeons working together, with four hands working as two.
“That equation means that our patients do better, there’s greater safety, and much more experience in the operating room.” Stern believes their partnership exhibits, “a paradigm that is now being emulated in many places in the United States.”
It’s representative of what some physicians are calling a “terrific, productive collegiality [that is] developing between orthopedic surgeons and neurosurgeons who wish to devote their careers to the advancement of spine care.” Former competitors now “look at each other as colleagues with the same interests.” The result of this friendship and professional association, they conclude, “will be of great benefit to patients.”
Laughter is the best medicine: Neurosurgery vs Orthopedic Surgery
Regardless of how similar the training and skills of the orthopedic and neurosurgeons may be, in all human endeavors there will always exist a little room for discord, as this cartoon on YouTube humorously points out.
LINK
Website of Neuro-Ortho spine team Dr Seth Neubardt and Dr Jack Stern
