Department of Surgery

About the Spine Program

Driven by the guidelines that have risen from the program’s 2010 Strategic Planning and 2007 External Review, the program continues boundless efforts in collaboration and integration within the internal and external spine communities maximizing their impact in education and teaching, clinical care and research, as well as in advocacy and global outreach.

Introduction

The Spine Program is co-governed by the Divisions of Neurosurgery and Orthopaedic Surgery at the U of T Department of Surgery and is Co-Directed by Dr Michael Fehlings (Professor, Neurosurgery) and Dr Albert Yee (Professor, Orthopaedic Surgery). The program brings together abroad interdisciplinary array of clinicians, researchers, and educators focused on disorders of the spine and spinal cord. The Program is unique and draws from about 30 interdisciplinary faculty with areas of interest spanning the continuum from bench to bedside to community to include: Neurosurgery, Orthopaedic Surgery, Physical and Occupational Therapy, Nursing, Health Policy Management and Evaluation, Laboratory Medicine and Pathobiology, Biomaterials and Biomedical Engineering, Psychiatry, Radiation Oncology, Radiology, Medical Biophysics, Medical Imaging, Medicine, Molecular Genetics, Pediatrics, Physiatry, Injury Prevention, Pain Management, and a broad variety of relevant research and disciplines.

Driven by guidelines that have risen from the program’s 2010 Strategic Planning and 2007 External Review, the program continues boundless efforts in collaboration and integration within the internal and external spine communities maximizing their impact in education and teaching, clinical care and research, as well as in advocacy and global outreach.

The U of T Spine Program has been recognized by external reviewers as  "the premier research and educational program for spine in the world”.

Message From the Co-Directors

Colleagues,

This year the University Of Toronto Department Of Surgery Spine Program celebrates its 11th Annual Spine Academic Day “SpineFEST”. It has been a productive academic year as our program continues to foster important city-wide collaborations within the University as well as participate and lead on several key regional and international initiatives.

SpineFEST is our city-wide annual academic spine event held in June of each year to celebrate the accomplishments of our clinical and research trainees, as well as learn from key academic thought leaders  from both the clinical as well as scientific perspective.  Because of your very strong support over the last decade, our program has grown a respected academic footprint locally, nationally, and globally.  Collaboration, inter-professional, inter-departmental, and inter-disciplinary knowledge exchange remains the key recipe to our success.

Recent activities have leveraged our education platform that has included the creation of a national spine surgery fellowship training curriculum for cognitive and procedural competencies.   Building on this, our program established enhanced Neurosurgery and Orthopaedic Surgery training opportunities between Toronto Academic Health Sciences Network (TAHSN) spine hospitals (Toronto Western Hospital (TWH-UHN); Sunnybrook Health Sciences Centre (SHSC); Saint Michael’s Hospital (SMH) and Hospital for Sick Children (HSC)). We have built top tier academic hub attracting and training between 12-15 national and international fellow surgeons each year.

At the beginning of each academic year, we launch our university academic calendar of events.  Dr. Stephen Lewis (TWH-UHN & HSC) chairs an introductory city-wide fellow surgical skills course, introducing advanced anatomy of spine with fellows performing anterior and posterior surgical approaches as well as spinal instrumentation.  This year on April 9th, Dr. Lewis extended this course to include advanced complex procedures (e.g. deformity osteotomy, minimally invasive surgery (MIS), and trauma techniques).  Over the past two years, our program has piloted and continues to offer a two-year fellowship program with a first general spine training year followed by a second year with more focused and advanced subspecialty city-wide experience.  Many thanks to Drs. Stephen Lewis, Eric Massicotte, Joel Finkelstein, Howard Ginsberg, Henry Ahn, and Reinhard Zeller for their valued help in shaping our city-wide fellowship training opportunities.  Building on our national fellowship curriculum our program also continues with the surgical case-log for our citywide spine fellows. We thank Dr. Jeremie Larouche, Dr. Tony Bateman, and Ms. Nadia Jaber for designing a successful case-log program for our fellows. On March 2nd this year, our Program organized an excellent national spine surgical skills course at the Canadian Spine Society Annual meeting which was held in Toronto.  The course utilized navigations system and focused on discussions of advanced cases in trauma, cervical myelopathy, deformity and metastatic tumor. We thank Drs. Massicotte, Jeff Wilson, and Larouche for their leadership in this course that was well received by trainee and staff surgeons in attendance.

For several years now, we have also complemented the resident’s surgical training with our Royal College Mock Oral on Spine course, co-moderated by Drs. Fehlings and Yee.  Our city-wide spine fellows took a key leadership role in teaching the residents and organizing a selection of representative case scenarios in examination format.  The fellows also provided valuable tips and updated literature reviews.  Our program continues to facilitate live platforms to disseminate knowledge and exchange advances in spinal surgery and research. We host City-wide Fellow Journal Club several times a year to discuss recent and controversial spine articles and a collection of relevant cases.  We also combined research updates with periodic journal clubs.  In our last Journal club – Research Update meeting on March 18th, our clinical fellows discussed current literature on trauma.  We thank our citywide fellows Drs. Chris Small and Frank Lyons from SHSC, Drs. Michel Schneider and Frank Jiang from TWH, and Dr. Alexander Romanaga from SMH for taking the lead in interesting case presentations which stimulated productive discussions. We also extend our thanks to Drs. Karl Zabjek and Carlo Ammendolia for organizing the research update meeting in which we discussed multiple clinical and observational studies being conducted in the city.  Given the increasing number of clinical trials in spine, the group discussed important issues regarding advancing team communications regarding patient eligibility and trial enrollment. We thank Drs. Jeff Wilson, Sukhvinder Kalsi-Ryan, Carlo Ammendolia and other city-wide trialists for their valued input and leadership promoting city-wide research. The international, multicenter RISCIS (Riluzole in Spinal Cord Injury Study) randomized controlled trial in patients with acute cervical spinal cord injury has now achieved an enrolment of 169 patients and remains a flagship trial led by Dr. Fehlings and the UofT Spine Program. Congratulations also to Dr. Jeff Wilson for his successful 7 year CIHR grant to examine the natural history of mild degenerative cervical myelopathy (DCM). It remains a desired opportunity to enhance awareness of promising research trials to both physicians as well as patients and their families.

Our Program continues to invite three to four world-renowned visiting professors each year to our hospital–based visiting professorship series in order to provide lectures on their area of interest in spine care and research. This year on February 11th, jointly with Dr. Carlo Ammendolia at MSH, we were very pleased to host Dr. Greg Kawchuck, Professor of Rehabilitation Medicine at the University of Alberta to share new insights into mechanisms underlying spinal manipulation therapy. Dr. Kawchuck also provided a memorable talk in the evening UofT- GTA Spine Rounds, chaired by Dr. Joel Finkelstein (SHSC), highlighting his initiatives towards mentorship of the future generation of scientists. On May 30th, our Program’s interdisciplinary collaboration continues as we, jointly with the Division of Orthopaedics at SHSC and TRI Lyndhurst Centre, hosted Dr. Allan Levi, from the University of Miami Miller School to feature Novel Treatment Strategies for Spinal Cord and Peripheral Nerve Injury. Special thanks to Drs. Sukhvinder Kalsi-Ryan and Albert Yee for organizing this visiting professorship. Last Fall on October 19th our Program, jointly with the Krembil Neuroscience Centre and the Collaborative Program in Neuroscience, hosted Dr. Mark Tuszynski (Professor of Neuroscience at University of California, San Diego) as the keynote speaker for our Tator-Turnbull SCI Symposium. Dr. Tuszynski highlighted opportunities using Neural Stem Cells for Spinal Cord Injury. Special thanks to Dr. Fehlings for organizing a successful symposium.

In innovations and best practice efforts, our program has contributed towards numerous initiatives. We are proud to have the AOSpine Clinical Practice Guidelines for the Management of Patients with Acute Spinal Cord Injury and Guidelines for the Management of Patients with Degenerative Cervical Myelopathy (an effort led by Dr. Michael Fehlings) approved and published in the Global Spine Journal (https://journals.sagepub.com/toc/gsja/7/3_suppl). The guidelines now implemented into clinical practice.  Also, Dr. Raj Rampersaud (TWH-UHN) and colleagues continue to lead important efforts toward enhancing triage and care of many of our ‘elective’ patients with degenerative conditions of the spine.  Arising from the success of Inter-professional Spine Assessment and Education Clinic (ISAEC) pilot, the Ministry of Health and Long Term Care (MOH-LTC) the provincial expansion of the Low Back Pain (LBP) framework is progressing well and garnering interest by inter-professional health professionals. Leveraging the expertise of Advanced Practice Providers (APPs) link with primary care, Practice Leads (PL) are facilitating the triage of potential surgical patients through to our city-wide adult spinal centres.  Moreover, Dr. Michael Fehlings has also led efforts at the provincial level aimed towards enhancing access to patients with urgent and emergent spinal conditions. In “Time is Spine” Dr. Fehlings and his team, supported by analyses from the Institute for Clinical Evaluative Sciences (ICES) database, are advocating for timely surgical intervention within the first 24 hours after injury as critical for minimizing complications and maximizing recovery for patients with SCI.  Dr. Larouche, with U of T Surgeon Scientist Trainee (Dr. Matt Guttman) and senior author Dr. Avery Nathens have recently completed a study utilizing the TQIP (American College of Surgeon) database that further validates the opportunity for timely surgical fixation in spine trauma injured patients. Sunnybrook recently established a Division of Spine Surgery to enhance coordination of urgent spine care. Drs. Joel Finkelstein and Farhad Pirouzmand will co-lead activities as Division Head/service and Quality Leads respectively. Congratulations to Dr. Stephen Lewis for his appointment as the new chair of the AOSpine Knowledge Forum (KF) in Spinal Deformity. This KF is conducting a leading edge research in spine deformity management.

Towards the same goal, the Program is currently emerging as a translational research hub to foster collaborative efforts in multi-centre clinical trials and to improve data sharing between the respective research institutes.  There is a number of clinical trials in progress or recently completed across our city-wide clinical research units (RISCIS, Riluzole in Spinal Cord Injury Study; INSPIRE, the neuro-spinal scaffold in treatment of AIS A thoracic acute spinal cord Injury; EPOSO, surgery versus radiotherapy in metastatic disease of the spine; VERTEX, VX-210 in acute traumatic cervical spinal cord injury; and the successfully completed Lumbar Spinal Stenosis Study). In this respect, we are currently looking into implementing recommendations arising from our December 2017 strategic planning summit in support of creating a the U of T Spine Clinical Unit that will further synergetic efforts to induce better outcomes for better spine care.

Our Program continues in engaging and highlighting our local communities in multiple national and international society meetings held in Toronto. This year, on February 27 thru March 2nd, we were delighted to local host the national spinal community at the Canadian Spine Society 19th Annual Scientific Conference. Our CSS surgical skills course received excellent feedback. We thank our faculty Drs. Massicotte, Wilson, and Larouche as well as our national faculty Dr. Scott Paquette for making this educational activity a possibility.  We also acknowledge our industry partners who were instrumental in supporting this course and making available surgical and navigation equipment for the benefit of the attendees.  We congratulate Dr. Albert Yee on becoming the CSS president for 2019-2021 and we look forward to further synergetic initiatives at the national level. We were very excited about hosting The Global Spine Congress in Toronto this year on May 15th -18th. The congress is considered the world largest spinal scientific platform. We thank Dr. Michael Fehlings, the local host, for bringing in to the University and the City an important society and fostering collaboration with AO Spine knowledge forums and key opinion leaders. At the GSC we enjoyed hosting a reunion dinner event for a large number of our Fellow Alumni who attended the congress and enjoyed being re-acquainted, making new contacts as well as collaborative networks. Dr. Fehlings is also hosting and leading a Toronto AOSpine Course “AOPEER” this Fall to help guide research staff and trainees towards conducting successful clinical studies. We invite you to participate in this course being held at the UHN BMO Conference and Education Centre on November 9th -10th.

Enjoy SpineFEST 2019!  We had an excellent program last year with an enlightening keynote address from our visiting professor Dr. Sanford Emery (Professor and Chair of the Department of Orthopaedics and Director of Surgical Services at West Virginia University). Dr. Emery shared valued perspectives on Leadership Training for the Future Generation of Spine Surgeons.  This year we are delighted to welcome our keynote speaker Dr. Praveen Mummaneni (Professor of Neurosurgery at the University of California- San Francisco) as our keynote Tator-Hall Lecturer.  Dr. Mummaneni is the Director of the Cervical Spine Program and Minimally Invasive Spine Program, and Vice-Chair of the UCSF Department of Neurosurgery.  We very much look forward to his address on Advances in MIS Deformity Surgery.  In addition, we also welcome our guest speaker and the Canadian Orthopaedic Association Travelling fellow Dr. Guillaume Lonjon from Paris Descartes University and Paris European Hospital George Pompidou who will be featuring his views on Enhanced Recovery After spinal Surgery (ERAS).

In closing, we would like to thank all our program faculty members and industry partners for their support over many years. We are privileged to benefit from the diverse and specialized expertise of our program membership. Special thanks to Ms. Nadia Jaber, our Program Coordinator, for her outstanding expertise and valued help in moving forward our collaborative agenda.

 

Sincerely,

 

Michael & Albert

 

Overview 2015/16

Dear Spine Community,

This year the University of Toronto Department of Surgery Spine Program celebrates its 8th annual SpineFEST meeting. It has been a productive academic year as our program continues to foster important city-wide collaborations within the university as well as participate and/or lead on several key regional, national, and international initiatives.  Earlier this spring, we inaugurated the first edition of our program newsletter that provides the opportunity for us to highlight and recognize the ongoing accomplishments of our city-wide faculty and trainees. 

As a program, we benefit from the ongoing strong support of our University Department of Surgery, and Divisions of Neurosurgery and Orthopaedics.  We value the clinical, research and education expertise of our city-wide faculty and trainees in support of our important Program Council, Research and Education Committee activities.  Key spine community and industry collaborators have helped nurture growth in our academic program.
  
It has been an enjoyable and collaborative 2015/16 Visiting Professorship Series:

  • Division of Neurosurgery Botterel Symposium, Toronto Western Hospital-University Health Network (TWH-UHN) hosting, with Dr. Shekar Kurpad from the Medical College of Wisconsin.
  • Neurosciences Collaborative Program Distinguished Lectureship, TWH-UHN hosting, with Professor Jack Feldman from UCLA featuring neural networks involved in respiration.
  • Sunnybrook Health Sciences Centre, Odette Cancer Centre, Radiation Oncology invited professor, hosted Dr. Mark Bilsky from Memorial Sloan Kettering Cancer Center who discussed the importance of separation surgery in Stereotactic Radiosurgery for the treatment of Metastatic Spine Disease.
  • Professor Yu Liang from Jiao Tong University, hosted by Dr Henry Ahn, St. Michael’s Hospital (SMH).  Dr Liang provided key perspectives of surgical techniques and research in minimally invasive MIS-TLIF for the treatment of spondylolisthesis.
  • Professor Stefan Parent from the University of Montreal, hosted by Dr. Reinhard Zeller, Hospital for Sick Children (HSC), engaged us with discussions about predictive models of progression in adolescent idiopathic scoliosis considering 3D spine parameters.
  • Dr. John Kostuik from John Hopkins-Baltimore, hosted by Dr Michael Fehlings (TWH).  Dr. Kostuik captivated our attention with a fascinating talk about the history of spine deformity from ancient India to today. 
  • Tator –Turnbull Spinal Cord Injury Symposium, TWH-UHN hosting, was highlighted with a tremendous turnout to the keynote address about Spinal Cord Injury-induced Immune Deficiency Syndrome provided by our distinguished invited speaker Professor Jan Schwab from Ohio State University, Columbus.  It was a memorable celebration of Barbara Turnbull’s legacy in advancing spine research and care.

In education and teaching, we have had an active year which continues to focus on excellence in fellowship and resident education.  We held our second joint city-wide Orthopaedics & Neurosurgery Royal College of Physician and Surgeon’s of Canada (RCPSC) Mock Oral Prep Course for senior university resident trainees.  In particular, we acknowledge the significant contributions to the success of this meeting by our city-wide spine fellows, led by Dr. Mark Pahuta, whose time in preparation of the cases as well as valuable practical tips were well received by the residents.  At the fellowship level, selective rotation/observership opportunities have been offered to incoming fellows over the last couple of years, with some fellows choosing to pursue this added educational offering.  Our fellowship education working group is now planning a pilot fellowship project that leverages work conducted by members of our program (through the Canadian Spine Society) with a recent publication on competence objectives for fellowship training in Canada.  This opportunity builds upon competencies that may be acquired during a general first fellowship year, followed by a second year catered to advanced/focused competencies.  Our city-wide program has an established fellows surgical case-log program that is based upon our national training competencies.  Our city-wide clinical fellows have also taken on important leadership roles in organizing and hosting journal clubs throughout the year (the aging spine, metastatic spine disease).  Special thanks to Dr. Stephen Lewis for organizing an exceptional fellows surgical skills course, complemented by our semi-annual research update meetings organized by Drs. Carlo Ammendolia and Karl Zabjek.

From a clinical research perspective, The Program continues to serve as an academic hub to foster collaborative efforts in facilitating clinical trials and data sharing agreement between the hospitals (UHN-TWH, SHSC, and SMH). Among of which, the Riluzole in Spinal Cord Injury Study (RISICS) which is principally sponsored by AOSpine North America. RISCIS is a worldwide multi-centre trial launched to evaluate efficacy and safety of Riluzole in improving neurological motor outcomes of patients with acute spinal cord injury. The Primary Spine Tumor Study, which has been initiated under the leadership of Dr. Arjun Sahgal, has also been brought under the umbrella of the Program as a randomized multi-centre trial and to be launched in Montreal and Toronto at SHSC and Princess Margaret Hospital.  This will be a pivotal trial directly comparing conventional versus stereotactic radiation therapy in spine oncology.  The Lumbar Spinal Stenosis Study, led by Dr. Carlo Ammendolia at MSH has been successful in completing recruitment and progression towards outcomes. This research is complemented by efforts to translate knowledge in developing clinical practice guidelines for spinal cord injury and cervical myelopathy.

In patient care advocacy and global efforts, the Program has made an impact on several levels. Drs. Fehlings and Raj Rampersaud have been actively involved with provincial initiatives to enhance access to care and service delivery for patients with acute and chronic spine conditions. Drs. Yee and Fehlings are working with AO Spine North America to more broadly disseminate knowledge gained from our national competence based training education efforts.  In similar perspective, the Program co-hosted an international meeting with AO Spine North America, AO Spine International, Rick Hansen Institute, and Cervical Spine Research Society to identify and develop guidelines for Acute Spinal Cord Injury (ASCI) and Cervical Spondylotic Myelopathy (CSM). This comes as an initiative to enhance quality of care by establishing clinical protocols for management of patients with ASCI, and aid clinicians in evidence-based decision making based on recommendations for important and controversial areas of ASCI management. Interestingly, our “Time is Spine” concept, in which Dr Fehlings stresses early surgical decompression improves outcomes from spinal cord injuries, has been highlighted by the Spine Summit and Spine Universe, supported as AOSpine guidelines, and is being considered for teaching as AO principle. We partnered with the Rick Hansen Institute (RHI) in their strategic planning meeting on Oct 24, 2015 to explore area of collaboration on registries and SCI research. The Program, in collaboration with the UHN-TWH, was rated top-host site for last year’s Cervical Spine Research Society travelling fellows for the hospitality, and the excellent academic, research, and clinical program. We have also been selected as a host site for the Scoliosis Research Society (SRS) Traveling Fellows 2016 visiting Toronto end of this month. With Dr Fehlings’ lead, we are excited about taking part in hosting the Cervical Spine Research Society (CSRS) Annual Meeting and the instructional course on Nov 30th , and Dec 1st -3rd this year. The CSRS has collected over 500 abstracts this year the largest collection has been for this event. We have also been successful in our bidding to bringing in AOGlobal Spine Congress to Toronto in 2019. This event enables opportunities to leverage our global advocacy and outreach.

In closing, thank you for all your support over the years. We are privileged to benefit from the diverse and specialized expertise of our program members. We are excited about updating our Strategic Plan later this year and look forward to continuing to work together to shape the landscape of spine academia at the University and beyond.  Many thanks to Ms. Nadia Jaber, our program coordinator that has been instrumental in moving forward our collaborative agenda.
Join us in welcoming our SpineFEST Keynote Speaker Professor Daniel Riew MD from New York. Dr Riew is a Professor of Orthopaedic Surgery, Co-Chief of Spine Division, and Director of Cervical Spine Surgery at Columbia Medical Center. His practice is exclusively limited to the operative treatment of the cervical spine, a rarity among spine surgeons.  He is an engaging speaker and we all look forward to his wealth of expertise in the management of patients with complex cervical disorders.

Sincerely,

Michael & Albert 

Contact Us

Contact:

Nadia Jaber. Program Coordinator: email:uoft.spine@utoronto.ca

University of Toronto Spine Program│Department of Surgery

Room 503│5th Floor│Stewart Building│149 College Street│Toronto ON  M5T 1P5

T: (416) 978-8468│F: (416) 978-0844│

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