CLINICAL ORTHOPAEDICS AND RELATED RESEARCH
Number 449, pp. 244–248
Spine Fellowships
Kevin J. McGuire, MD
Future spine surgeons need fellowship training. Although
there is no formal demand for such education—and there
is no Certificate of Added Qualifications yet available for
spine surgery—the complexity of the cases as well as the
current marketplace make a spine fellowship a necessity,
especially for those surgeons who plan on taking care of
traumatic spine injuries. Even the best residency programs
will most likely not leave you with enough competence
and confidence to tackle the full gamut of spine condi-
tions. In particular, if you are interested in an academic
career in spine you will need to complete a fellowship.
Thus, the first things to consider are your own motivation
and career goals to ensure a spine fellowship is for you.
The most important factors to consider are the number
of operative cases, the case mix, and the role of the fellow.
The number of cases can be objectively measurable, and a
quick glance at the number and types of cases can give you
fairly good insight regarding the nature of the fellowship.
As a broad rule of thumb, the surgical volume should be at
least 250 cases for the year (per fellow). If it is less, you
probably won’t be operating enough. If the number is far
greater, you may find other aspects of the fellowship, such
as out-patient care, teaching, and research are deempha-
sized to the point your educational opportunities are com-
promised.
Although the number of cases per fellow is central,
perhaps more important is the variety of those cases. The
case mix can be broadly divided into adult and pediatric
spine. Among adult cases, a useful classification com-
prises “classic” degenerative cases (lumbar stenosis); de-
formity cases (scoliosis, kyphosis); cervical cases, and
trauma. Most fellowships provide a well-rounded experi-
ence in classic degenerative spine. Pay closer attention to
the opportunities offered regarding cervical and deformity
cases. Often a fellowship will have a weakness in one or
the other.
From the Department of Orthopaedic Surgery, Harvard Medical Faculty
Physicians, Beth Israel Deaconess Medical Center, Boston, MA.
Correspondence to: Kevin J. McGuire, MD, 330 Brookline Ave., East Cam-
pus, CC2, Boston, MA. Telephone: 617-667-3940; Fax: 617-667-2155;
E-mail: kjmcguiremd@yahoo.com.
DOI: 10.1097/01.blo.0000224070.08535.fe
244
© 2006 Lippincott Williams & Wilkins
Fellowships may vary quite a bit regarding exposure to
spine trauma. Some fellowships have no acute trauma: the
case mix is entirely elective. In other fellowships a large
part of the case mix is generated from the emergency
department. Even more variability is found among pro-
grams in the amount of pediatric and minimally invasive
procedures performed. My own feeling is pediatric spine
patients are often cared for by pediatric specialists, and
minimally invasive procedures can be learned after fellow-
ship (through coursework, for example) if the need arises.
Good, solid education in the principles of spine surgery
should prepare you to pick up additional skills even after
your formal education is completed.
The number of cases and the case mix, however, are
still not the end of the story. Find out who is indicating the
patients for surgery, who is actually performing the pro-
cedures, and who is taking care of the patients postopera-
tively. The first and third questions are just as important as
who is actually performing the surgery.
Another essential issue (and one that may be difficult to
define) is the division of responsibility. What is the rela-
tionship between the attending, fellow, and resident for
clinical and operative care of patients? Obviously, there
has to be some flexibility but, in general, I would give
extra points to those fellowship programs that have explic-
itly considered these questions and have an articulated
policy. Having a policy not only helps prevent conflict
between the fellow and the residents, it shows the fellow-
ship director has considered this important question and is
likely to have anticipated others.
Beyond case mix and the fellow’s role, the presence of
a “core curriculum” is crucial. The best programs will
have a schedule of conferences and other, perhaps infor-
mal, teaching sessions to ensure in a given year there is a
review of each of the major topics in the field. An example
would be weekly conferences reviewing the “simple” as
well the “complex” cases planned. In spine patients par-
ticularly, the indications for surgery and the type of pro-
cedure to be used once the necessity for surgery is estab-
lished are least clear cut. Some of the greatest geographic
variation in the rates of surgery is seen in the treatment of
spinal diseases. Because of this lack of consensus, a core
Number 449
August 2006
curriculum and informal teaching sessions are needed to
establish a foundation for your own decision making once
you are in practice.
In sum, all the best fellowships provide an adequate
numbers of cases, a good distribution of pathology, apt
participation by all members of the team and an explicit
curriculum.
Once you have determined a fellowship meets these
standards, there are still many factors to consider in de-
ciding if a given fellowship is right for you. If you are
interested in academics, you must consider the “tradition”
(or, more to the point, the reputation) of the fellowship.
There is no easy way of discerning the reputation of a
fellowship. I suggest you approach your chairman (assum-
ing he is not a spine surgeon) or some of the senior at-
tendings and ask their opinion regarding the top spine
programs. They may not know whether there are adequate
numbers of cases, good distribution of pathology, and so
forth, but they will have an overall sense of the program’s
reputation in the field.
For spine fellows, it is not the amount of on-call cov-
erage that matters; it is the quality of the call. What you are
required to do is far more important than how often you
are asked to do it. For example, answering patient calls for
more pain medication quickly ceases to be an educational
Spine Fellowships 245
experience. However, getting the chance to make medical
decisions with supervision is exceptionally educational. If
the on-call duty offers a quality experience, more frequent
on-call duty is preferable.
The final factor to consider after having defined the
best programs is what you can do to optimize your chances
of obtaining a position. You must recognize that, as im-
portant as it is for you to enter a good program, it is just
as important to the attendings they choose good appli-
cants. All of us look good on paper; you cannot be ad-
mitted to an orthopaedic residency without an excellent
record of performance. You must go beyond that, and
give the fellowship program a strong sense of your worth
not only on paper, but in person. The spine world is
small, and it is almost assured somebody at your pro-
gram knows someone at the program you would like to
attend. At the least, schedule an informational inter-
view with all attendings in your program who can recom-
mend you. If you cannot find any connections between
your home institution and the program(s) you want, it
may be necessary to rotate at the program as a visitor.
For better or worse, the reputation of your fellowship
will be a strong influence on your career, and the extra
effort you make while applying is highly likely to pay
dividends.
 Clinical Orthopaedics
246 McGuire and Related Research

SpineCare Medical Group/San Francisco Los Angeles Spine Surgery Institute UCLA Medical Center
Spine Institute 2200 West 3rd Street, #120 Fellowship Program/Department of
1850 Sullivan Avenue, Suite 200 Los Angeles, CA 90057 Orthopaedic Surgery
Daly City, CA 94015 (213) 207-5635 10833 Le Conte Avenue
(650) 985-7500 katherinewilliams@dochs.org Los Angeles, CA 90095-6902
jfaier@spinecare.com Website: spinecare.com (310) 825-6557
csams@mednet.ucla.edu
Website: www.ortho.medsch.ucla.edu

University of California, Davis
Department of Orthopaedics
4860 Y Street, Suite 3800
Sacramento, CA 95817
(916) 734-2937
daniel.benson@ucdmc.ucdavis.edu
University of California, San Francisco
Department of Orthopaedic Surgery
500 Parnassus Avenue, Room MU320 W
San Francisco, CA 94143-0728
(415) 514-1519
bervens@orthosurg.ucsf.edu
Website: http://orthosurg.ucsf
.edu/mededu/spine.html
St. Mary’s Spine Center
One Shrader Street, Suite 450
San Francisco, CA 94117
(415) 750-5835
yaquai@aol.com

Southern California Orthopaedic Institute Rocky Mountain Spine Clinic, P.C. Florida Spine Institute
6815 Noble Avenue 10103 Ridge Gate Parkway, Suite 306 2250 Drew Street
Van Nuys, CA 91405 Lone Tree, CO 80124 Clearwater, FL 33765
(818) 901-6600, ext 1512 (303) 225-8120 (727) 797-7463
eleanor@scoi.com Website: www.spineclinic.com contactus@floridaspineinstitute.com
Website: www.floridaspineinstitute.com

University of Florida University of Miami School of Medicine
Department of Neurosurgery, Box 100265 Department of Orthopaedics
1600 SW Archer Road and Rehabilitation
Gainesville, FL 32610 PO Box 016960 (D-27)
(352) 392-4331 Miami, FL 33101
jacob@neurosurgery.ufl.edu (305) 585-7138
dreconco@med.miami.edu
Emory University School of Medicine
The Emory Spine Center
59 Executive Park South, Suite 3000
Atlanta, GA 30329
(404) 778-7112
john_heller@emoryhealthcare.org

Rush University Medical Center, Southern Illinois University School Spine Surgery PSC
Department of Orthopaedic of Medicine 210 East Gray Street, Suite 601
Surgery #1471 Jelke Division of Orthopaedics and Louisville, KY 40202
Beverly J. Kendall-Morgan, Rehabilitation (502) 585-2300
Fellowship Coordinator PO Box 19679 holt@spine-surgery.com
1653 W. Congress Parkway Springfield, IL 62794-9679
Chicago, IL 60612 (217) 545-8865
(312) 942-5850 aweinhoeft@siumed.edu
Beverly_Kendall-Morgan@rush.edu

Spine Institute LSU Health Sciences Center New England Baptist Hospital,
210 East Gray Street, Suite 900 Department of Orthopaedics Orthopaedic Surgery
Louisville, KY 40202 1542 Tulane Avenue, T6-7 #609 c/o Carolyn Mullane
(502) 584-7525 New Orleans, LA 70112 125 Parker Hill Avenue
tallgeyer@spinemds.com (504) 568-4680 Boston, MA 02120
jarsen@lsuhsc.edu (617) 754-5413
cmullane@caregroup.harvard.edu

Department of Orthopaedic Surgery-JHOC 5231 St. Joseph’s Hospital William Beaumont Hospital
The Johns Hopkins Outpatient Center 7505 Osler Drive, Suite 104 Department of Orthopaedic Surgery
601 North Caroline Street Towson, MD 21204 3535 W. 13 Mile Road, Suite 744
Baltimore, MD 21287-0882 (410) 337-8888 Royal Oak, MI 48073
(410) 955-6930 spinefellows@aol.com (248) 551-0426
nochrzc@jhmi.edu cmusich@beaumont.edu

Twin Cities Spine Center Mayo Clinic Washington University School of Medicine
913 E. 26th Street, Suite 600 200 First Street SW Department of Orthopaedic Surgery
Minneapolis, MN 55404-4515 Rochester, MN 55905 660 S. Euclid, Campus Box 8233
(612) 775-6200 (507) 284-3316 St. Louis, MO 63110
education@tcspine.com mgsm.roch.mn.orthopedics@mayo.edu (314) 747-2536
iffrigt@wustl.edu (fellowship coordinator)
Number 449
August 2006 Spine Fellowships 247

Charlotte Spine Center Duke University Medical Center Albany Medical College
2001 Randolph Road Division of Orthopaedic Surgery AMC Academic Office
Charlotte, NC 28207 Box 3077 1367 Washington Avenue, Suite 202
(704) 339-1386 Durham, NC 27710 Albany, NY 12206
bruce.darden@orthocarolina.com (919) 684-5711 (518) 453-3074
wilke005@mc.duke.edu alcsar@nycap.rr.com

Hospital for Special Surgery New York University Hospital for Joint Diseases Case Western Reserve University
Attention: Graduate Medical 301 East 17th Street, 1402 School of Medicine
Education Coordinator New York, NY 10003 11100 Euclid Avenue
535 East 70th Street (212) 598-6509 Cleveland, OH 44106
New York, NY 10021 Randie.Godette@nyumc.org (216) 844-1050
(212) 606-1466 Julie.Bunkelman@uhhs.com
academictraining@hss.edu

Thomas Jefferson University Hospital Shriners Hospitals for Children University of Pittsburgh Medical Center
Department of Orthopaedic Surgery 3551 North Broad Street 3471 5th Avenue
1015 Chestnut Street, Suite 719 Philadelphia, PA 19140 Pittsburgh, PA 15213
Philadelphia, PA 19107 (215) 430-4026 (412) 605-3218
(215) 955-1500 rbetz@shrinenet.org donaldsonwf@upmc.edu
susan.randolph@jefferson.edu

Vanderbilt University Medical Center Baylor College of Medicine Texas Back Institute
Vanderbilt Orthopaedic Institute Department of Orthopaedic Surgery 6020 W. Parker Road, Suite 200
Medical Center East, South Tower, 1709 Dryden Road, 12th Floor Plano, TX 75093
Room 4200 Houston, TX 77030 (972) 608-5148
Nashville, TN 37232-8774 (713) 986-7390 plane@texasback.com
(615) 343-6364 judyo@bcm.tmc.edu
dan.m.spengler@mcmail.vanderbilt.edu

UTHSCSA and South Texas Orthopaedic
and Spinal Surgery Associates
9150 Huebner Road, Suite 350
San Antonio, TX 78240
(210) 561-7234
info@spinetex.com
University of Virginia Health System University of Wisconsin
Division of Spine Surgery, Attention: Amanda Cranney
Department of Orthopaedics 600 Highland Avenue, K4/739
Box 800159 Madison, WI 53792-7375
Charlottesville, VA 22908 (608) 263-3178
(434) 243-0266 cranney@orthorehab.wisc.edu
va3e@virginia.edu

MCW Clinics at Froedtert East, Vancouver Hospital and Health Sciences Center Foothills Medical Centre
PO Box 26099 D6, Heather Pavilion, 2733 Heather Street 1403 29th Street N.W., Room G33
9200 West Wisconsin Avenue Vancouver, B.C. V5Z 3J5 Calgary, Alberta T2N 2T9
Milwaukee, WI 53226 Canada Canada
(414) 805-7433 (604) 875-5859 (403) 944-8157
akinowsk@mcw.edu charles.fisher@vch.ca roger.cho@calgaryhealthregion.ca

International Spine and Orthopaedic Institute University of Rochester Medical Center OrthoIndy
12770 Cimarron Path, Suite 132 Department of Orthopaedic Surgery 8450 Northwest Blvd.
San Antonio, TX 78249 601 Elmwood Avenue, Box 665 Indianapolis, IN 46278
(210) 614-3900 Rochester, NY 14642 (317) 802-2862
docsim@aol.com (585) 275-2787 jharmless@orthoindy.com
Kim_Foote@urmc.rochester.edu

University of Tennessee-Campbell Clinic Panorama Orthopedics and Spine Center Pennsylvania Hospital
Department of Orthopaedic Surgery 660 Goldenridge Road, Suite 250 800 Spruce Street
1211 Union Avenue, Suite 510 Golden, CO 80401 Philadelphia, PA 19107
Memphis, TN 38104 (303) 233-1223 (215) 829-2205
(901) 759-3274 dwong@panoramaortho.com Byrner@pahosp.com
rgraham5@utmem.edu bmuff@panoramaortho.com

Phillips Ambulatory Care Center
Spine Institute, Beth Israel Medical Center
10 Union Square East, Suite 5P
New York, NY 10003
(212) 844-8692
gfallowe@chpnet.org
Website: www.BISpine.com
The Cleveland Clinic Spine Institute San Diego Center for Spinal Disorders
9500 Euclid Avenue, Desk A41 4130 La Jolla Village Drive, Suite 300
Cleveland, OH 44195 La Jolla, CA 92037-1481
(216) 444-2744 (858) 678-0610
mclainr@ccf.org bcisneros@sandiego-spine.com
 Clinical Orthopaedics
248 McGuire and Related Research

University of California, San Diego, University of Texas Medical Branch, University of Utah Orthopaedic Center
Dept. of Orthopaedic Surgery Galveston Department of Orthopaedics
Betsy Macias, Spine Fellowship Coordinator Room 2.316, Attention: Rebecca Sealy 590 South Wakara Way
4150 Regents Park Row, Suite 300 301 University Boulevard Salt Lake City, UT 84108
La Jolla, CA 92037 Galveston, TX 77555-0165 (801) 587-5450
(858) 657-8248 (409) 747-1300 darrel.brodke@hsc.utah.edu
sgarfin@ucsd.edu vmzimmer@utmb.edu

Florida Orthopaedic Institute The Spine Institute Sinai Hospital of Baltimore

13020 Telecom Parkway North 1301 20th Street, Suite 400 2401 W. Belvedere Avenue
Tampa, FL 33637 Santa Monica, CA 90404 Baltimore, MD 20215
(813) 978-9700 (310) 828-7757 (410) 601-4600
dclabeaux@floridaortho.com spineinfo@espineinstitute.com alevine@lifebridgehealth.org

Indiana Spine Group Foundation for Orthopaedic, Athletic University of Kentucky

8402 Harcourt Road, Suite 400 & Reconstructive Research Kentucky Clinic, 740 S Limestone St.,
Indianapolis, IN 46260 6410 Fannin Street, Suite 1535 Suite K-401
(317) 715-4887 Houston, TX 77030 Lexington, KY 40536-0284
rsasso@indianaspinegroup.com (713) 799-2429 (859) 323-5533
michele@foarr.com shafferw@uky.edu

St. George Hospital Beth Israel Deaconess Medical Center/ Spine Education & Research Institute
Department of Orthopaedic Surgery Harvard Medical School 9005 Grant Street, Suite 100
4-10 South Street, Level 2 330 Brookline Avenue, CC2 Denver, CO 80229
Kogarah, Sydney NSW 2217 Boston, MA 02115 (720) 540-7374
Australia (617) 667-2225 lamc@spine-education.org
61 2 9350-2827 paulglazer@comcast.net
admin@ori.org.au

Yale University Oregon Health and Science University Southeastern Spine Center
800 Howard Avenue, PO Box 208071 Department of Orthopaedics & Research Institute
New Haven, CT 06520 and Rehabilitation 5922 Cattlemen Lane, Suite 201
(203) 737-5662 3181 SW Sam Jackson Park Road, Sarasota, FL 34232-6217
james.yue@yale.edu Mail Code OP31 (941) 371-9773
Portland, OR 97239 ALPHASPINEDOCTOR@yahoo.com
(503) 494-6406
hartro@ohsu.edu

Spine Surgery Associates Trillium Health Center SUNY Upstate Medical University
3800 J Street, Suite, #210 101 Queensway West, Suite 410 550 Harrison Center, Suite 130
Sacramento, CA 95816 Mississauga, Ontario L5B 2P7 Syracuse, NY 13202
(916) 771-2355 Canada (315) 464-8263
Ulises@spinedocs.com (905) 276-5829 fredricb@upstate.edu
robmcbroom@rogers.com

South Texas Spinal Clinic Sunnybrook and Women’s College Cedars-Sinai Institute for Spinal Disorders
18626 Hardy Oaks Boulevard, Health Sciences Centre 444 South San Vicente Boulevard, Suite 800
Suite 300 2075 Bayview Avenue, MG 301 Los Angeles, CA 90048
San Antonio, TX 78258 Toronto, Ontario M4N 3M5 (310) 423-9900
(210) 293-2922 Canada anandn@cshs.org
dgutierrez@spinaldoc.com (416) 480-5500 Website: www.csmc.edu/spine
carolyn.gimera@sw.ca

Harborview Medical Center State University of New York at Buffalo Woodridge Spine Center, PC
University of Washington 100 College Parkway, Suite 100 3550 Lutheran Parkway West, Suite 201
325 9th Avenue, Box 359798 Williamsville, NY 14221 Wheat Ridge, CO 80033
Seattle, WA 98104 (716) 204-0487 (303) 403-7000
(260) 731-3267 clhamill@acsu.buffalo.edu WoodridgeSpine@aol.com
sjordan@u.washington.edu

Copyright © American Academy of Orthopaedic Surgeons 2006. Reproduced here courtesy of Stryker, the exclusive licensee.