From interest to advancement: confronting structural inequities facing women in spine surgery

Women remain significantly underrepresented in spine surgery. Despite growing diversity among medical school matriculants, spine surgery continues to lag behind other specialties in recruiting, retaining, and promoting women across all stages of training and professional advancement. This perspective examines the structural inequities contributing to these disparities, including limited early exposure to the field, lack of mentorship, challenges related to family planning and pregnancy, occupational hazards, and pervasive gendered expectations surrounding work-life integration. We discuss how these issues intersect with systemic barriers such as the minority and woman tax, workplace hostility, and persistent financial inequities in compensation, research funding, and industry partnerships. Together, these factors contribute to lower representation and higher attrition among women in spine surgery, particularly among women from historically underrepresented backgrounds who experience compounded disadvantage. Drawing from national data and recent literature, we present actionable strategies to address these inequities, including early pipeline programs, protected and structured mentorship, standardized parental leave, institutional recognition of diversity-related service, equitable pay structures, and cultural reform across training and professional environments. We highlight initiatives that offer effective models for fostering interest and inclusion. Achieving gender equity in spine surgery requires more than individual resilience-it necessitates intentional, systemic change across institutions, training programs, and professional organizations. Representation is not merely a matter of fairness, but 1 that directly impacts the quality, innovation, and relevance of spine care in an increasingly diverse patient population.