Subspecialization of Spine Care and Education at Neurosurgical Residency Programs in Canada: A 20-Year Follow-Up Survey

OBJECTIVE: Subspecialization within neurosurgery has accelerated over the past two decades. In 2003, a survey of Canadian neurosurgery program directors indexed contemporary attitudes and practices regarding spine subspecialization and resident education. The present study conducts a follow-up survey with the aim to explore the current landscape of spine specialization and education and elucidate how these aspects have changed over time. METHODS: A 30-question survey was electronically distributed to program directors at all 14 Canadian neurosurgery residency programs. Questions addressed program structure, faculty instrumentation capabilities, spine-specific infrastructure and program director opinions on spine training objectives and subspecialization. RESULTS: All 14 program directors returned complete surveys. Of 220 total teaching faculty, 50.5% are capable of simple spine instrumentation and 29.1% are capable of comprehensive instrumentation. All programs report dedicated spinal neurosurgeons, and 5/14 programs (35.7%) have spine surgeons who restrict their practice exclusively to spine. Six respondents (42.9%) agree that comprehensive spine instrumentation should be a required competency for residents; 8 respondents (57.1%) disagreed. We proposed that spine neurosurgery should be a subspecialty distinct from cranial neurosurgery: 5/14 respondents agree (35.7%), 8/14 respondents disagree (57.1%) and one respondent was neutral (7.1%). CONCLUSIONS: There has been progressive subspecialization of spine care within neurosurgery. Some disagreement exists between program directors with respect to the level of competence which should be expected of trainees. The recent move to standardize spine fellowships by the Royal College may serve as a catalyst for redefining the boundaries between residency and fellowship training.