Department of Surgery


Mar 25, 2018


This is a landmark year for the University Of Toronto Department Of Surgery Spine Program!  A Decade Celebration of SpineFEST

As many know, SpineFEST has become our key city-wide annual academic spine event held in June of each year.  We 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.

As Co-Directors of this program, we would like to take this opportunity to thank our Program Council and Research and Education Committee members for their years of dedicated service and valued contributions.

Recent activities have leveraged education activities 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 12-15 fellow surgeons annually who have come to Toronto from across the world. 

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 fellows surgical skills course, introducing the anatomy of spine with fellows performing anterior and posterior surgical approaches and spinal instrumentation.  This year, Dr Lewis plans to extend this course to include advanced complexed 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. Eric Massicotte, Stephen Lewis, 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, in 2015 our program also launched a surgical case-log program designed by recent fellows (Drs. Jeremie Larouche and Tony Bateman) for future fellows.  Finally, we thank Dr Massicotte for his longstanding contributions to spine residency training and appreciate his assisting as Drs. Jeff Wilson and Jeremie Larouche now take key leadership roles in organizing the training education course for the upcoming academic year.

Over the past four years, we have also complemented the resident’s surgical training with our Royal College Mock Oral spine prep course co-moderated by Drs. Fehlings and Yee.  Our city-wide spine fellows have assumed a key leadership role in the organization of this course with the selection of case senarios as well as related examination of the residents along with providing valuable ‘tips’ and an updated literature review.  Our program continues to facilitate live platforms to disseminate knowledge and exchange advances in spine 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. At our last Journal club, our fellows discussed the newly established guidelines of Spinal Cord Injury (SCI) and guidelines of the Degenerative Cervical Myelopathy (DCM). Furthermore, we invite three to four world-renowned visiting professors each year to our hospital–based visiting professorship to provide lectures on their area of interest in spine care and research.

This year on February 26th, we were very pleased to host Dr Marcel Dvorak (Professor of Orthopedics at the University of British Colombia) who shared his thoughts on what improves care for patients with acute SCI. On May 7th, we also enjoyed a visit by Dr Ashwini Sharan (Professor of Neurological Surgery and Neurology at Jefferson University) who updated us on modern advances in spine neuromodulation.  Chaired by Dr Joel Finkelstein (SHSC), The U of T- GTA Spine rounds are also held three to four times a year. At these rounds, we hear interesting personal perspectives from our visiting professors reflecting on their own career and life as spine surgeons. We also bring together expertise and leading clinicians and scientists of spine and musculoskeletal care in the U of T & China Symposium held biennially in conjunction with the Division of Orthopedic Surgery and SHSC.  Here we host a delegation of academic musculoskeletal and spine surgical oncology leaders from throughout China.  In the fall of 2017 and jointly with the Krembil Neuroscience Centre, Toronto Western Hospital, and the Collaborative Program in Neuroscience we held our annual Tator-Turnbull Spinal Cord Injury Symposium. In this 16th annual meeting Dr Dalton Dietrich, the Scientific Director of Miami Project to Cure Paralysis in Florida, provided an interesting keynote address highlighting the current and future challenges of the translational studies for spinal cord injury.

In innovations and best practice efforts, our program has contributed in numerous initiatives. We are proud to have our Clinical Practice Guidelines for the Management of Patients with Acute Spinal Cord Injury and Guidelines for the Management of Patients with Degenerative Cervical Myelopathy approved by the AOSpine and published in the Global Spine Journal.  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) is now expanding this triage and assessment Low Back Pain (LBP) framework province wide.  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.

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 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.

In communications and outreach, the Program has successfully leveraged a multi-media strategy with flyers, posters, and brochures. We launched a Program Newsletter several years ago and maintain an on-line presence through our newly updated website at the Department of Surgery and our social media activity such as LinkedIn and Twitter.

We held the biennial Ontario Spinal Cord Injury Research Network (OSCIRN) meeting in May last year as a combined meeting with Canadian Spinal Cord (CSC).  We invite you all to attend the 19th Annual Scientific Conference of the Canadian Spine Society Toronto is hosting next year from February 27th thru March 2nd, 2019.  Additionally, our Program acts as local hosts for several key international meetings held and planned: the 44th Annual Meeting of the Cervical Spine Research Society (CSRS) in December 2016; The 18th Annual conference of the International Society for the Advancement of Spine Surgery (ISASS) held in April 11-13, 2018; the NeuroTrauma 3rd Joint Symposium August 11-16, 2018; and the Global Spine Con-gress in May 15-18, 2019.

In advancing our Spine Program academic calendar, we continue to pursue alternative sources of sustainable funding. Our program is grateful for the longstanding support of the University of Toronto Department Of Surgery, and the university Divisions of Orthopedic Surgery and Neurosurgery. We also value the support of Medtronic, Zimmer Biomet, DePuy Synthes, Ethicon, and Stryker.

Enjoy SpineFEST.  We had an excellent program last year with an enlightening keynote address from our visiting professor Dr Zoher Ghogawala from Tufts University School of Medicine who spoke of searching for truth in spinal surgery.  This year we are delighted to welcome Professor Sanford Emery as our key Tator-Hall Lecturer.  Dr Emery is the Chair of Department of Orthopedics and Director of Surgical Services at West Virginia University.  We very much look forward to his address on opportunities in leadership training for surgeons. In addition, we are excited to have our Deputy Minister of Health and Long-Term Care, Dr Robert Bell join us to share his journey of leadership in health care. We thank our city-wide Surgeon-in-Chiefs for sitting on a Leadership Panel Discussion (Dr Shaf Keshavjee at UHN; Dr Avery Nathens at SHSC; Dr Christopher Caldarone at HSC; along with Dr Najma Ahmed, Vice-Chair Education at the U of T Department of Surgery and our visiting professor Dr Emery.

Special thanks to Ms. Nadia Jaber for all her expertise and valued help as our Program’s Coordinator.


Michael & Albert