A spinal surgery specialization allows the opportunity to cultivate definitive knowledge regarding a specific and challenging area. This rapidly changing field burgeons with new information and procedures due to prolific spinal research. The spine surgeon can train in the subspecialties of scoliosis and spinal deformity surgery. A wide variety of spine problems such as cervical or lumbar, congenital, and acquired or degenerative disorders offers unique and difficult treatment decisions, spinal instrumentation, and fusion for this patient group. Insurance companies fail to recognize this specialization or tend to make compensation problematic. Surgery is expensive and many managed care organizations do not promote spinal surgery as a viable option. As the number of good candidates for this specialization diminish, maintaining a practice that includes general orthopaedic patients appears expedient.