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Neurosurgery Residency prepares Neurosurgeons for spine surgery

Currently, there are several paths to become a spine surgeon in North America.

The most common paths are:

1) an orthopedic residency followed by a spine fellowship


2) a neurological surgery residency

Post graduate neurosurgical spine fellowships do exist and are useful and important for those surgeons pursuing an academic career or those seeking subspecialized training in a particular aspect of spinal surgery. A dedicated spine fellowship also allows post graduate neurosurgeons exposure to different clinical philosophies and approach management to spinal disorders.

There has been some confusion regarding the role of fellowships for neurosurgeons interested in spine and a perception that some sort of added credential is required for hospital privileges or community acceptance of the neurosurgeon’s expertise.  This is despite the fact that in 1995, the Council of Spine Societies (AAOS, AANS, NASS and others) issued a statement regarding the fact that residency trained neurosurgeons are spine specialists upon completion of their residency.  Here are some facts, drawn from the 2016-2017 ACGME case requirements and case logs that may help put this issue to rest.

The Orthopaedic Residency Review Committee requires that orthopedic residents be exposed to 15 spine cases during their residency.  In reality, the average orthopedic resident participates throughout residency in 79 spine cases with 8 of these cases involving spinal instrumentation.  In contrast, the Neurosurgical Residency Review Committee requires that neurosurgical residents be exposed to 240 spine cases.  In reality, the average neurosurgery resident is a senior or lead surgeon on 411 spine cases throughout residency with well over half of these cases involving instrumentation (a more exact figure is not possible due to how neurosurgical cases are reported to the ACGME).  Obviously, there is variability in training opportunities and resident interest in both orthopedic and neurosurgical training programs.  That said, current orthopedic spine fellowship guidelines call for the fellow to participate in 200 spine cases during a fellowship year.  A neurosurgical resident interested in spinal surgery will finish with a spine experience which is several fold that of an adequately trained orthopedic surgeon completing an approved spine fellowship.  Indeed, the most productive neurosurgical residents with interest in spine are reporting well in excess of 1000 cases as lead or senior surgeon (the max last year was 1,246 spine cases).

In addition to surgery on the vertebral column, discs and neuroforamina, neurological surgery residency trains neurosurgeons to operate inside the dura of the cervical, thoracic, lumbar and craniovertebral junction spine. Neurosurgeons are trained to repair congenital anomalies of the spinal dura such as meningoceles, remove intradural tumors such as intrinsic spinal cord tumors, metastatic tumors, schwannomas, meningiomas and ependymomas, as well as treat vascular malformations such as dural arteriovenous fistulas or spinal cord cavernous malformations.

ABNS Position Statement:

It is the position of the ABNS, AANS, CNS as well as the AANS/CNS Section on Disorders of the Spine and Peripheral Nerves that residents who complete accredited neurosurgical residency programs are spine surgeons.  Post graduate fellowships are useful for the acquisition of unique or focused surgical expertise and skill sets, the development of an academic pedigree, and for pushing the field ahead through scientific research.

Download a printable version of this statement here

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American College of Surgeons: Committee on Trauma decision on MOC, CME requirements

Neurological Surgeons participating in the American Board of Neurological Surgery  MOC satisfy the American College of Surgeons COT continuing educational requirements necessary to participate in Level 1 Trauma Center coverage.  No additional trauma related CME are required.  The ABNS considers trauma and emergency neurological practice and principles part of every  diplomates “core knowledge”.  The ABNS will use their MOC/continuous certification process to update and educate our diplomates on these emergency neurological surgery principles as new evidence based data evolves.

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Diagnostic Cerebral Angiography considered “major” procedure

As of Spring 2018 the ABNS Directors, after soliciting advice from several stakeholders, decided to include diagnostic cerebral angiography as a “major” procedure.  As a result, these will be included as part of the required major case total for primary certification.

  If you enter diagnostic cerebral angiogram data into POST, please note the following:

  •  Patient demographic data and medical history data are entered, as with any case
  • In the diagnostic section, if the cerebral angiogram yielded a positive result, choose the appropriate pathology(ies) identified  from the pull down menu. If the diagnostic angiogram yielded a negative or equivocal result, choose the most appropriate “other” category and write your suspected diagnosis in the text box provided.

For example:

CT scan with hemorrhage suggested possible aneurysmal SAH.

One could choose in the procedure category: Cranial-Vascular-Hemorrhage (Y)- SAH- Other Hemorrhagic vascular pathology (text-Suspected Aneurysmal SAH)

  • In the procedure section, diagnostic angiogram  is available in the cranial and spine major categories. Please choose the appropriate option 
  • Under imaging and testing,  please list any studies that were performed prior to the diagnostic cerebral angiogram and were relevant to your decision to perform that procedure (e.g., head CT with findings suspicious for vascular pathology)
  • In the image upload section, please provide select images from the diagnostic angiogram along with any select images from studies that may have influenced your decision to perform the procedure (e.g., CT with SAH and suggestion of PCOM aneurysm)
  • Non-surgical management and Surgical outcomes data are entered as with any other case, with the exception that we do not expect the inclusion of “late” outcomes in all diagnostic angiograms
    1. If late outcomes are unavailable, choose No to follow up available, other for why, and enter: not required  for diagnostic angiogram
    2. If the patient did have late follow up and the results of that follow up were relevant to the findings and/or performance of the diagnostic procedure, you are encouraged to provide that data 

 Please note:

  • The ABNS will reevalute this decision in the Fall, the way to track this procedure at time of submission may change.
  • The ABNS may require additional information from individuals for whom diagnostic angiograms comprise a large percentage of their overall practice.

Feel free to contact the ABNS with any questions

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Joint Credential In Pediatric Neurological Surgery

In order to maintain a recognized focused practice in Pediatric Neurological Surgery all ABPNS Diplomates are required to participate in the annual continuous certification (CC) program hosted by the ABNS (see detailed scenario below).

When the General & Emergency Principles of Neurosurgery Cognitive Learning Tool plus the Pediatric Principles of Neurosurgery Cognitive Learning module are completed then both the pediatric neurological surgery core principles and general neurological core principles satisfy the requirement for:

  • ABNS/ABPNS CC certification
  • ABNS/ABPNS CC  Focused Practice  in Pediatric Neurological Surgery dual credential

Commencing on July 1, 2017, physicians who wish to obtain both (a) an initial certification in general neurological surgery issued by the ABNS; and (b) an additional initial certification in pediatric neurological surgery, which certification shall be issued jointly by the ABNS and the ABPNS (except in cases where the physician received residency training in Canada), must meet the following requirements:

Process for Additional Certification in Pediatric Neurological Surgery

All ABPNS certificates are time-limited.


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