Spine Training

This is a GENERALIZATION....of all the aspects of orthopaedics...it seems as if the residents get to do the least in a spine case....this only makes sense....low margin for error...and highly specialized trainig....

so in general it really dosent matter where you go....you will likely actually get to operate the least on spine....

I am sure someone will say they have seen a resident do an ant cervical fusion....but in general you are suckin and holdin hook in spine cases....

I will disagree with my perpetual friend (who usually has good posts),

Here at Case, we get a lot of spine. I hate spine, so I'd venture to say we get too much. So much so that I think I could fumble my way through an ACDF, ACCF, and do a good job with most posterior lumber cases (decompressions, discectomies, and PSF with instrumentation). Give me about 18 hours and I truly think that I could drop a lung and do an anterior thoracic disk. . . .no promises that the patient could walk post-op though. There are times when one particular attending makes us fumble through cases to the point where I want to give the kerison up just so we can get the case done so I can go home. Ask some of our PGY-2's that have done ENTIRE cervical corpectomies. . . .skin to skin!!!! But spine is one of the things that we're known for.

So there are programs where you can do boat loads of spine. I think most of our Chiefs come out of here being able to do a good job at bread and butter spine. We get 3 fellows/year here and you can tell which ones had a good spine experience in residency. These guys are off an running from day one (i.e. Jefferson guys). With that said, fellowships aren't for doing the simple stuff. You do fellowship to learn how to do the big wacks (complex deformity, traumatic spine, etc.)

In closing, don't be too set on one particular subspecialy going into residency. Pick your residency based on the place that's going to get you the best OVERALL training. The rest will take care of itself. Hope this helps.

I agree with BoneJock (I also hate spine). I have done what I consider way more spine than I will ever be able to put to use as a practitioner. The majority of spine is done by people who have done a fellowship and do only or mostly spine. That is just the envirionment these days. One of our spine guys here has you putting in pedicle screws when you are a pgy2. I feel that I could do basic lumbar fusions, disks, lami's, maybe even a TLIF if someone put a gun to my head (the only time I would WANT to
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Pick a place that seems well rounded, b/c you certainly may change your mind (despite my dread of doing spine cases now, when I was a pgy2 I thought that I was gonna be a spine guy. Ohhhh, how times have changed......)

Best spine training is probably at Jefferson in Philly. I doubt any program comes close to their volume. Also look at Pitt...residents get to do a lot of spine as chiefs. Others include Wisconsin (Zdeblick), Rush, Emory, Beaumont. Sounds like Case residents get lots of exposure as well from above post.

Totally agree with Micky, I did a rotation at Jeff, and did two weeks of spine within their rotation. Although they have three fellows in spine there are typically about four rooms of spine going on any given day (not including neuro) I am not a big fan of spine myself, but of the programs I saw for spine, theirs is the one to beat. On any spine rotation there is typically an intern two PGY2s to man floors/ ER, and two seniors, and three fellows to split up the OR and office. There are a ton of OR cases, and lots of outpatient office exposure as well. Oh by the way, they get all of the spine trauma for the Philly area. The weak points of their program are trauma (they go to Lehigh) and tumor (they have none). If you can live with that, and are determined to do spine, Jeff might be the program for you.