Throughout the 1980s, 1990s and 2000s there was a factional competition between neurosurgeons and orthopaedic surgeons.

The cause: a perceived turf war over the treatment of spinal conditions.

Historically, degenerative spinal conditions and associated pain and discomfort had been the preserve of neurosurgeons. After all the conditions materialised as nerve pain – the focal point of all neurosurgery.

Orthopaedic surgeons concerned themselves with joints: knees, hips, hands, bones.

So why were they now doing spinal surgery?

The historical origins

In 1934 two American surgeons, Mixter & Barr, published a landmark paper about the treatment of sciatica. Discectomy proved successful in treating sciatica, relieving the pain and discomfort of a spinal condition that afflicted countless thousands of people.

Over the ensuing decades laminectomies were all the rage as neurosurgeons held sway in the treatment of spinal conditions.

Claims about the success of laminectomies extended to include the treatment of trauma and tumour-related spinal complaints.

Except that laminectomies were not always successful.

French revolution led by (quelle horreur) orthopaedic surgeons

In the late 1960s two French orthopaedic surgeons started treating scoliosis using a hooks and rod system. Attached to the spinal cord, this proved successful in correcting the debilitating deformity.

This led to the next breakthrough: pedicle screws. Placed on individual vertebrae, they stabilised the spine and provided space for the discs, relieving nervous pain symptoms.

The turf war began.

Bigger, deeper truths

Professional sniping is typically based in fear and ego. Neither of which are helpful in treating patients in pain.

The spine is a whole series of interconnected bones around the major nervous system in the body – the spinal column. Therefore, a legitimate focal point for both schools of surgery.

Truth #1:

It is about patient care, not which surgical school you studied at.

Spinal surgeons should avail themselves of all technologies and learnings in treating their patients. History is just that and advances in treatments are more important, irrespective of the background of the researchers.

Truth #2:

It is about the vocational drive of the surgeon, not which school you studied at.

The drive, interest and enthusiasm of the surgeons will determine the field in which they specialise. As such their initial medical training is just the starting block.

The healing has begun

Recognising this, a group of Australian neuro and orthopaedic surgeons came together to create a united voice and approach to training surgeons with a vocation to treat spinal conditions.

And so the Spinal Post Fellowship Education and Training (Spinal PFET), a committee sponsored by both the Neurological Society Australia and the Australian Orthopaedic Association, was created.

Ratified by the Royal Australian College of Surgeons, its fundamental goal is to unite both camps and bring spinal surgery together with unified guidelines and accreditation.

So that, in future, surgeons will focus on the deeper truths. So that they can bring an open and curious mind to the discoveries of fellow surgeons.

After all, it is all about patient care; not the college you studied at.


Dr Ralph Stanford is a spinal surgeon with over 20 years’ experience. He is adept in all surgical approaches to successfully treat his patients.

Dedicated to lifelong learning, Ralph attends spinal conferences worldwide and regularly consults with colleagues about successful treatments.

He is also a current member of Spinal PFET and an active researcher in spine disorders.

The fact that he studied as an orthopaedic surgeon is an historical quirk. Irrelevant in successfully treating your patients.


Posted 18 August 2019