A longitudinal survey of adult spine and peripheral nerve case entries during neurosurgery residency training

Presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

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Currently, there is a lack of research assessing residents’ operative experience and caseload variability. The current study utilizes data from the Accreditation Council for Graduate Medical Education (ACGME) case log system to analyze national trends in neurosurgical residents’ exposure to adult spinal procedures.


Prospectively populated ACGME resident case logs from 2013 to 2017 were retrospectively reviewed. The reported number of spinal procedures was compared to the ACGME minimum requirements for each surgical category pertaining to adult spine surgery. A linear regression analysis was conducted to identify changes in operative caseload by residents graduating during the study period, as well as a one-sample t-test using IBM SPSS software to compare the mean number of procedures in each surgical category to the ACGME required minimums.


A mean of 427.42 total spinal procedures were performed throughout residency training for each of the 877 residents graduating between 2013 and 2017. The mean number of procedures completed by graduating residents increased by 19.96 (r2 = 0.95) cases per year. The number of cases in every procedural subspecialty, besides peripheral nerve operations, significantly increased during this time. The two procedural categories with the largest changes were anterior and posterior cervical approaches for decompression/stabilization, which increased by 8.78% per year (r2 = 0.95) and 9.04% per year (r2 = 0.95), respectively. There was also a trend of increasing cases logged for lead resident surgeons and a decline in cases logged for senior resident surgeons. Residents’ mean caseloads during residency were found to be vastly greater than the ACGME required minimums: residents performed at least twice as many procedures as the required minimums in every surgical category.


Graduating neurosurgical residents reported increasing case volumes for adult spinal cases during this 5-year interval. An increase in logged cases for lead resident surgeons as opposed to senior resident surgeons indicates that residents were logging more cases in which they had a more critical role in the procedure. Moreover, the average resident was noted to perform more than twice the number of procedures required by the ACGME in every surgical category, indicating that neurosurgical residents are getting greater exposure to spine surgery than expected. Given the known correlation between case volume and improved surgical outcomes, this data demonstrates each graduating neurosurgical residency class experiences an augmented training in spine surgery.

ABBREVIATIONS ACDF = anterior cervical approach for decompression/stabilization and fusion; ACGME = Accreditation Council for Graduate Medical Education; PCDF = posterior cervical approach for decompression/stabilization and fusion.

Article Information

Correspondence Nitin Agarwal: University of Pittsburgh Medical Center, Pittsburgh, PA. agarwaln@upmc.edu.

INCLUDE WHEN CITING Published online July 20, 2018; DOI: 10.3171/2018.3.SPINE171370.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



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    National means for the total number of spinal procedures for graduating residents. Figure is available in color online only.

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    Mean number of procedures logged by each level of resident plotted from 2013 to 2017. Senior resident surgeon, y = -36.7x + 344.30 (r2 = 0.9476); lead resident surgeon, y = 56.71x + 20.81 (r2 = 0.9780); and assistant resident surgeon, y = 1.71× − 1.11 (r2 = 0.8758). Figure is available in color online only.

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    Mean number of procedures performed nationally by graduating residents, plotted with the standard error of the mean, compared to the required minimum for each surgical category. Thoracolumbar fusion procedures had a mean of 145.95 ± 3.07 and a required minimum of 20. Lumbar discectomy procedures had a mean of 125.70 ± 2.89 and a required minimum of 25. Anterior cervical approach for decompression/stabilization and fusion (ACDF) procedures had a mean of 72.66 ± 4.62 and a required minimum of 25. Posterior cervical approach for decompression/stabilization and fusion (PCDF) procedures had a mean of 56.98 ± 3.73 and a required minimum of 15. Total peripheral nerve procedures had mean of 26.20 ± 0.79 and a required minimum of 10. One-sample t-test: *p < 0.001 and **p < 0.0001. Figure is available in color online only.



Accreditation Council for Graduate Medical Education: Case Log Guidelines. Chicago: ACGME Review Committee for Neurological Surgery2017 (https://www.acgme.org/Portals/0/PFAssets/ProgramResources/Case_Log_Guidelines.pdf?ver=2016-04-19-140246-217) [Accessed April 10 2018]


Accreditation Council for Graduate Medical Education: Neurological Surgery Case Log Defined Case Categories and Required Minimum Numbers. Chicago: ACGME Review Committee for Neurological Surgery2017 (https://www.acgme.org/Portals/0/PFAssets/ProgramResources/160_Neurological_Surgery_Defined_Case_Categories_and_Required_Minimum_Numbers.pdf) [Accessed April 10 2018]


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