AHN Spine Surgery Fellowship Curriculum & Rotations
The AHN Spine Surgery Fellowship is a twelve-month program structured around a single fellow and a small, integrated faculty group. Approximately 70% of the fellow’s time is operative and 30% is non-operative, with structured clinic, research, and didactic time.
Year structure
Rotation Structure
Anatomic and diagnostic case mix
Graduated autonomy
Outpatient clinic
Case volume and surgical experience
Conferences and education
Year structure
- Length: 12 months, August 1 – July 31
- Positions: 1 fellow per year
- Operative time: ~70% — Approximately three to four operative days per week across the faculty
- Non-operative time: ~30% — Clinic, didactics, cadaver lab, research, conferences
- Call: The fellow is not required to take primary call. They serve in a supervisory role on the resident call service, which preserves operative learning as the year’s primary focus.
- Research: Two publishable-quality research projects required during the fellowship year, supported by a dedicated research team led by Boyle Cheng, PhD.
Rotation structure
Rather than rigid month-long blocks, the fellow rotates with each faculty member on a continuous basis throughout the year, mirroring the way the team operates in practice. The blended rotation structure is designed to give the fellow:
- Continuous exposure to minimally invasive and endoscopic spine surgery, with a deliberate emphasis on building lumbar endoscopic disc surgery competency
- A core experience in open degenerative spine surgery (decompression, fusion, instrumentation) across cervical, thoracic, and lumbar regions
- Adult and pediatric spinal deformity exposure
- Spinal trauma, oncology, and infection at a Level 1 trauma center
- Robotic-assisted instrumentation experience using the Medtronic Mazor platform, now upgraded to the new Stealth Autopilot system
- Anterior lumbar surgery exposure, including anterior lumbar interbody fusion and anterior lumbar disc replacement
- Cervical disc replacement experience
Graduated autonomy
Operative autonomy is graduated through the year with the goal that, by the second half of the fellowship, the fellow is performing the critical portions of routine cases as the primary surgeon under direct faculty supervision. This is the explicit philosophy of the program and is shared by every faculty member.
Outpatient clinic
The fellow participates in faculty outpatient clinics to develop expertise in preoperative work-up, indications, non-operative management, and post-operative follow-up. The fellow is expected to evaluate new patients, develop and discuss treatment plans, and contribute to long-term follow-up across the full continuum of spine care.
Case volume & surgical experience
The AHN Spine Surgery Fellowship is built around an exceptional breadth and complexity of cases. The fellow is intentionally exposed to the full modern spectrum of spine surgery — from same-day endoscopic disc surgery to complex spine surgery, including adult and pediatric deformity, spinal trauma, and oncology — and is supported in building competency across every category below. Allegheny General Hospital is one of the earliest recipients of the Joint Commission’s Advanced Certification in Spine Surgery (ACSS).
Minimally invasive & endoscopic spine surgery
Minimally invasive and endoscopic techniques are a programmatic priority. AHN is one of a small number of U.S. fellowships training to competency in lumbar endoscopic disc surgery.
- Uniportal endoscopic spine surgery: Lumbar endoscopic discectomy, foraminoplasty, and decompression. Transforaminal and interlaminar approaches.
- Biportal endoscopic spine surgery (UBE): Lumbar decompression, discectomy, and fusion using biportal endoscopic technique.
- Tubular minimally invasive decompression: Tubular retractor microdiscectomy and laminectomy across lumbar levels.
- Minimally invasive spinal fusion: MIS TLIF, percutaneous pedicle screw instrumentation, and lateral / oblique interbody fusion as appropriate.
Anterior lumbar surgery
- Anterior lumbar interbody fusion (ALIF): Single- and multi-level ALIF, including stand-alone constructs.
- Anterior lumbar disc replacement: Motion-preserving lumbar disc arthroplasty in indicated patients.
Cervical surgery
- Cervical disc replacement: Single- and multi-level cervical disc arthroplasty.
- Anterior cervical discectomy and fusion (ACDF): Single- and multi-level ACDF.
- Posterior cervical surgery: Laminectomy with instrumented fusion, laminoplasty, and posterior cervical foraminotomy.
Complex spine surgery: deformity
- Adult spinal deformity: Long-construct thoracolumbar reconstruction, pedicle subtraction and Smith-Petersen osteotomies, sagittal balance correction.
- Pediatric spinal deformity: Adolescent idiopathic and neuromuscular scoliosis correction in collaboration with the AHN pediatric spine team.
Complex spine surgery: trauma & oncology at a Level 1 trauma center
Complex spine care is a defining strength of the program. Allegheny General Hospital is a regional Level 1 trauma center, and the fellow takes a supervisory role on the resident call service — providing extensive exposure to high-acuity spinal trauma, oncology, and infection without the burden of primary call.
- Vertebral column trauma: Acute thoracolumbar fractures, cervical trauma, and robotic-assisted percutaneous instrumentation of unstable fractures using the Mazor / Stealth Autopilot platform.
- Spinal oncology: En-bloc spinal tumor resection, metastatic disease, and complex reconstruction.
- Spinal infection: Operative management of epidural abscess, discitis, and vertebral osteomyelitis.
- Emergent decompression: Cauda equina, central cord, and other emergent presentations.
Technology & instrumentation
- Robotic-assisted spine surgery: Medtronic Mazor robotic platform — now upgraded to the new Stealth Autopilot system — for pedicle screw placement and complex instrumentation, with active program experience reported in the peer-reviewed literature
- Intraoperative navigation and imaging: Intraoperative CT-based navigation as appropriate to the case.
- Advanced visualization: Endoscopic and exoscopic systems.
Conferences & education
The fellow’s academic year is anchored by a structured weekly didactic schedule, regular hands-on cadaver lab sessions, and protected time to attend national and regional spine meetings.
Weekly didactic schedule
- Spine indications conference: Weekly faculty-led case conference. The fellow presents cases for the upcoming operative week, faculty discuss indications and surgical planning, and the literature is reviewed against each case.
- Spine journal club: Monthly review of high-impact spine literature led by faculty and the fellow.
- Orthopaedic Grand Rounds: Weekly department grand rounds at Allegheny General Hospital.
- Morbidity & Mortality conference: Monthly M&M case review with a focus on systems-level quality improvement.
Cadaver lab
The fellow has frequent access to cadaveric dissection sessions throughout the year. Sessions are organized around specific procedural skills (uniportal endoscopy, biportal endoscopy, anterior lumbar approach, cervical disc arthroplasty, deformity osteotomies, robotic instrumentation) and are scheduled in coordination with the AHN Department of Orthopaedic Surgery skills lab and industry-partnered courses where appropriate.
Spine research curriculum
In addition to the operative and clinical experience, the fellow participates in a structured research curriculum led by Boyle Cheng, PhD, and the AHN spine research team. This is described in detail on the Research page.
Meetings and structured industry programs
The fellow is supported in attending major national and regional spine meetings during the fellowship year, including:
- North American Spine Society (NASS) Annual Meeting
- AAOS Annual Meeting
- AO Spine North America courses and the Global Spine Congress
- Regional spine meetings and the Pittsburgh Spine Summit
- In addition, the fellow participates in a structured, year-long industry-partnered training program:
- Arthrex UltraMIS Fellowship Program: A year-long, hands-on minimally invasive and endoscopic spine surgery training program, integrated across the fellowship year to reinforce uniportal and biportal endoscopic and tubular MIS techniques.
Travel funding is provided through the fellowship education budget, with meeting selection coordinated with the Program Director.