Mark Hadley, M.D., professor and Charles A. and Patsy W. Collat Endowed Chair of Neurosurgery at the University of Alabama at Birmingham Department of Neurosurgery, reflected on the history and evolution of spinal neurosurgery at the Society of Neurological Surgeons 2026 Annual Meeting.
During his presentation, “Foundations: Neurosurgery and Spine,” outlined the major milestones that shaped modern spine surgery, tracing the field from its beginnings. He covered early external stabilization techniques used by ancient civilizations to the development of advanced spinal instrumentation, navigation, robotics and minimally invasive surgical technologies seen today.
He highlighted several historical figures and innovations that contributed to the advancement of spinal surgery, including early laminectomy procedures, the development of spinal fusion techniques and the introduction of the pedicle screw.
Hadley also discussed the changing role of neurosurgeons within spine surgery. He noted that before the 1970s and 1980s, orthopedic surgeons largely dominated complex spine procedures, while neurosurgeons primarily performed less complex spinal operations.
To move the specialty forward, neurosurgical leaders organized efforts to expand spinal neurosurgery education, training and advocacy. Hadley described the formation of the Joint Section on Disorders of the Spine and Peripheral Nerves, the development of formal spine fellowships and the expansion of residency training requirements that established neurosurgeons as leaders in complex spinal surgery.
The presentation also described how neurosurgeons and orthopedic surgeons collaborated on large-scale historical cohort studies to generate evidence supporting pedicle screw safety and effectiveness. According to Hadley, this collaborative effort ultimately led to FDA reclassification of pedicle screws and permanently changed relationships between the specialties.
The lecture also emphasized the emergence and importance of spinal cord injury research. Hadley reviewed multicenter trials and research efforts that helped establish modern evidence-based treatment protocols and guidelines for spinal cord injury care.
Throughout the lecture, Hadley connected national developments in spine surgery with his own professional experiences and training, illustrating the rapid pace of change within the specialty over the past several decades. He described advancements in navigation, minimally invasive techniques, robotics, and other modern developments as transformative innovations that reshaped spinal neurosurgery between 1990 and 2010.
Hadley concluded the presentation by reflecting on the current state of spinal neurosurgery and the specialty’s future trajectory, noting that neurosurgeons now perform a majority of complex adult spine procedures and a substantial portion of complex pediatric spine surgeries nationwide.