Spinal neurosurgery Spinal neurosurgery is the diagnosis and treatment of the spinal cord and its supporting structures, is an important branch of neurosurgery, its scope of treatment mainly includes: 1, degenerative diseases of the spine, such as cervical spondylosis, lumbar disc herniation, etc., these most common diseases account for more than 80% of all kinds of spinal surgery; 2, spine, spinal cord trauma; 3, spinal canal tumors; 4, spinal deformities. In the early days, due to the backwardness of imaging technology, surgical instruments, lighting equipment and the lack of awareness of spinal stability among neurosurgeons, the accuracy of clinical work in diagnosing spinal cord diseases was poor, and surgical treatment was ineffective, and complications such as spinal cord injury and medical deformity of the spine often occurred after surgery. 1973 Hounsfield invented CT, which was the first major leap in the history of spinal neurosurgery. In 1977, the application of MRI in the field of neurology became the second leap in spinal neurosurgery. In 1983, Denis proposed the “three-column theory of the spine,” which became the mechanical basis of chiropractic surgery. Based on this theory, with the development and integration of engineering and materials science, and the innovation of surgical instruments, new materials, techniques and methods have emerged and been applied clinically, and spinal neurosurgery has developed rapidly, especially in the last decade or so. The definition of spinal neurosurgery comes from the American Association of Neurological Surgeons’ definition of neurosurgery, which reads: medicine for the diagnosis and treatment of the central, peripheral and autonomic nervous system and its supporting structures. The Chinese Society of Neurosurgery also clearly states that the diagnosis and treatment of spinal cord disorders falls within the profession of neurosurgery. This has laid the foundation for neurosurgeons to perform spinal surgery. As we all know, the spine and spinal cord are inseparable and interdependent, just like the relationship between the skull and the brain. The brain and spinal cord are both part of the central nervous system, and the skull is the support structure for the brain, which is the scope of neurosurgery. The spine, as the supporting structure of the spinal cord, should also belong to an important branch of neurosurgery. And based on the fact that neurosurgeons are more familiar with neuroanatomy and neurophysiology, they pay more attention to the protection of neural tissue. Especially with the widespread use of microscopic techniques in neurosurgery, neurosurgeons operate more delicately and with higher surgical safety. Therefore, most of the spine and spinal cord surgeries in Europe and the United States are performed by neurosurgeons. The concept of spinal cord disease has always been that the epidural lesions belong to orthopedic treatment and the intradural lesions belong to neurosurgery. In fact, spinal neurosurgery is a typical cross-discipline that includes both the bony structures of the spine and the central nerve and spinal nerve structures of the spinal cord. Because of the late start of neurosurgery in China, the treatment of spinal neurosurgery diseases was basically undertaken by orthopedic surgeons in the past. Although there were neurosurgical predecessors who started spinal surgery at the beginning of the country, the proportion of them was very small and the surgery was mainly focused on the removal of tumors in the spinal canal. One of the main reasons is that neurosurgeons focus more on the protection of the spinal cord and nerves and give less consideration to the stability aspects of the spine, or have little understanding of the biomechanical structure of the spine and internal fixation techniques. In the past, it was mostly simple to bite off the vertebral plate, or even bite off multiple segments of the vertebral plate, and many of these patients were found to have spinal deformities years later. So neglecting spinal stability became the biggest problem for neurosurgeons in the past with this type of surgery. Neurosurgeons began to reflect on this and began to understand spinal cord disease from a comprehensive, holistic perspective and began to learn new techniques and theories about spinal fixation. Some major hospitals in China have now established spinal neurosurgery treatment centers, combining neuro-microsurgery techniques and internal fixation techniques, and have achieved excellent results in the surgical treatment of spinal and spinal cord diseases. In Europe and the United States, spinal diseases are mostly attributed to neurosurgery, and neurosurgeons are dedicated to this field of spinal neurosurgery. The volume of surgery for spinal and spinal cord diseases accounts for more than 40-60% of the total number of surgeries in many large neurosurgery centers, and there is no shortage of neurosurgeons in the history of spinal neurosurgery. Cushing, Cloward, Goel, Bryan Laheri and other neurosurgeons have made great contributions to the development of spinal fixation materials. In 2000, J Neurosurgery, the journal of the American Association of Neurological Surgeons, officially published the spine subsection J Neurosurgery: Spine, thus making spinal neurosurgery another important branch following functional neurosurgery, interventional neurosurgery, etc. Spinal neurosurgery can be summarized in two areas, namely decompression and fixation. It has been reported that incomplete decompression is the main reason for the poor outcome of cervical spine surgery, and that serious complications and even death caused by high cervical segment surgery are also mostly related to the surgical operation, and it is in this aspect that neurosurgeons can give full play to their specialties through microscopic operation techniques. Neurosurgeons and orthopedic surgeons each have their own strengths in spinal surgery, with neurosurgeons specializing in spinal cord and nerve protection and orthopedic surgeons specializing in spinal stabilization. Chiropractic neurosurgery must be a perfect combination of both, analyzing and treating from a holistic perspective. You must have formal specialized training to practice spinal neurosurgery, and the difficulty of transitioning a neurosurgeon from intramedullary microsurgery to intervertebral disc surgery is obviously different from the difficulty of transitioning an orthopedic surgeon from intervertebral disc surgery to spinal microsurgery. With microsurgical skills and a different training background, neurosurgeons have a deeper understanding of the anatomy and physiology of the spinal nerves and are uniquely positioned to handle spinal cord and nerve decompression. In fact, neurosurgeons can not only maintain and restore spinal stability through internal fixation devices, but can also minimize the impact on spinal stability by reducing the extent of spinal canal openings and surgical trauma to the spine through microsurgical techniques. It can be argued that while neurosurgeons also require training in internal spinal fixation, this is not a difficult task compared to microsurgery, whereas the transition from orthopedics to spinal neurosurgery requires special training. It is important to note that spinal neurosurgery is a cross-discipline, and neurosurgery and orthopedics each have their own strengths. The two disciplines should not be isolated, competitive or even antagonistic, but should learn from each other, complement each other’s strengths, promote each other, and develop harmoniously. For neurosurgeons, a positive attitude should be taken to carry out spinal neurosurgery work, but to carry out spinal neurosurgery work must be open-minded to orthopedic surgeons to learn spinal fixation techniques, be sure to undergo strict training in spinal fixation techniques, do not blind arrogance, rapid success. At present, the scale of spinal neurosurgery in China is still far behind that of developed countries in Europe and the United States. Our neurosurgeons should learn from each other and orthopedic surgeons with the idea of “everything for the patient”, implement the scientific concept of minimally invasive, give full play to the advantages of neurosurgical microscopy, and actively promote the development of spinal neurosurgery in China, ultimately bringing more help to patients. We will bring more help to the patients.