A systematic review examined the state of curriculum development based on entrusted professional activities (EPA) in orthopedic and neurosurgery of the spine. Of the 15,768 initial records, only 4 relevant studies were identified that developed EPA frameworks predominantly using expert consensus methods such as modified Delphi or nominal group techniques. Among the 10 professional societies surveyed, only the AO Foundation (AO Spine) and the Royal Academy of Physicians and Surgeons of Canada provided explicit EPA frameworks for spine surgery, which together defined 26 EPAs. The results show that EPA-based curricula in this area are still in the early stages of development and lack standardization. The implementation of these frameworks in structured residential programs is still limited. The review highlights the need for collaboration between professional societies to define, validate and implement specific EPAs for spine surgery to promote competency-based education and improve the quality of training.