Trends in Spine Surgery Training During Neurological and Orthopedic Surgery Residency: A Ten-Year Analysis of ACGME Case Log Data

Abstract

Abstract INTRODUCTION Spine surgery training in the United States currently involves residency training in neurological or orthopedic surgery. Due to different core residency surgical requirements, volume of spine surgery procedures may vary between the two residencies. METHODS The Accreditation Council of Graduate Medical Education resident case logs for both orthopedic surgery and neurological surgery were reviewed for exposure to spine surgery procedures for the graduating years of 2009 to 2018. RESULTS The average number of spine surgery procedures performed during that 10-yr period was 433.8 for neurosurgery residents and 119.5 for orthopedic surgery residents (P < .01). From 2009 to 2018, neurosurgery residents saw an increase of 26.5% in spine surgery procedures from 389.6 to 492.9 procedures whereas orthopedic surgery residents saw a decrease of 41.3% from 141.1 to 82.8 procedures. The 10-yr average percentage of total spine procedures of all total surgical cases was 33.5% for neurosurgery residents compared to 6.2% for orthopedic surgery residents (P < .01). This percentage decreased both for neurosurgery residents (35.8% in 2009 to 31.3% in 2018) and orthopedic surgery residents (7.2% in 2009 to 4.9% in 2018). Neurosurgical residents performed on average 3.6 times more total spine procedures than orthopedic surgery residents, a number that increased from 2.8-fold in 2009 to 6.0-fold in 2018. CONCLUSION Case volume of spine surgery procedures vary greatly with higher rates for neurological and lower for orthopedic surgery residencies, with an enlarging increasing discrepancy over time. Although case volume alone cannot solely determine quality of training, it is one measure to assess opportunities to develop optimal spine education around a certain accepted volume of surgical patient care. The results found here may help to explore various needs and differences between residents seeking to pursue careers in spine, and the role of spine surgery fellowships currently and in the future.