A fundamental dilemma that faces both neurosurgery in general and the subspecialty field of spine surgery is the question of whether those who trained in the former and now work in the latter should maintain their links with their origins and remain under the broader umbrella of neurosurgery, or whether they should develop their own organizational structure and identity separate from organized neurosurgery. This challenge raises many questions with respect to future potential for growth and development, professional identity, and collegiality. This paper is an edited version of an invited speech to the 2007 Annual Meeting of the Joint Section on Disorders of the Spine and Peripheral Nerves. It uses the concept of synergy to review relevant history and explore possible future options for neurosurgery, neurospine, and neuroscience. An example from medical politics is used to illustrate the importance of perspective in approaching these questions, and examples of current therapeutic cutting-edge endeavors highlight the need for team-based behavior that takes a broad view. The premise of the paper is that while individual and specialty aspirations need to be acknowledged, considered, and managed, the results from truly working together will be greater than the sum of the individual efforts-synergy.