The Demise of a Division of Orthopaedic Spine

Some thirty years ago, while I was being recruited for an orthopedic spine position in a major mid-western city, I was told of an old battle cries between the warring factions pf Neurosurgery and Orthopaedic surgery:

“The only surgeons who should operate near a neurological structure are neurosurgeons!”

“The only surgeons who should operate near a boney structure are orthopedic surgeons!”

Fortune smiled and I was not offered the position.

Then a southern gentleman of a neurosurgeon told me in all seriousness:

“We neurosurgeons take care of all the spinal injuries and then we may call you orthopedists to come and stabilize the spine, though I must tell you that I don’t believe in spinal instrumentation.” I turned that job down, as I had previously decided that I would only work in a hospital where neurosurgery and orthopedics shared spine trauma call, collaborated and operated together.

Since those two episodes thirty years ago, I have worked towards a goal of having a special specific American Board of Medical Specialties recognized specialty of spine surgery. The American Board achieved this distinction in California in 1999.

I have enjoyed such a rewarding partnership with neurosurgery as a professor of orthopedics at a world recognized department of orthopedics in a progressive western state for the past 29 years.

I thought those ‘Hatfields and the McCoys’ types of feuds between neurosurgery and orthopedics were fortunately over.

Unfortunately, not so, as I recently learned that the division of orthopaedic surgery, in a famous Category 1 trauma hospital, had been abolished and that all spine patients were under the care of neurosurgery. As a consequence, the quality of the orthopedic resident training program has been decreased by this draconian decision.

Let’s hope that common sense will eventually prevail so this great trauma hospital can return to the 21st century.

Finally, with respect to feuds between specialties: –

“Those who cannot remember the past are condemned to repeat it.”

(George Santayana)


-Anthony Dwyer, M.D.


(The opinions stated in this blog are those of the author Dr. Anthony Dwyer and not necessarily those of the American College of Spine Surgery.)

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