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.
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
What an unprecedented time we are currently living in! The COVID-19 has imposed challenges for our spinal community at multiple levels. This has impacted training, surgical practice, research, clinical care and certainly has adversely affected personal stress and well-being. However, given the resilience and team-work of our community we are confident that we will successfully navigate these challenges and transition to a brighter future.
Around this time of the year, we gather at SpineFEST Day to highlight the accomplishments of our spinal community, as well as to disseminate recent clinical and scientific advances. This year is no exception! We decided to hold our SpineFEST virtually using Zoom Webinar technology. In order to present the conference in a more accessible format, we decided to split the usual all-day event into two evening webinars. On Monday June 15th at 5pm Professor Marcus Stoodley, (Sydney-Australia) will present the Tator-Hall Lecture on the management of syringomyelia. This will be followed by a session on the Craniovertebral Junction with a focus on Ehlers-Danlos Syndrome. On Tuesday June 16th, the second webinar will focus on the research accomplishments of our trainees which will be presented through oral talks and an online e-poster session using VoiceThread technology.
We are very grateful to Dr. Stoodley for agreeing to presenting his lectures virtually and for graciously accommodating our SpineFEST schedule. Dr. Stoodley is the Head of Neurosciences and leads the neurosurgical research team at Macquarie University Hospital in Sydney, Australia – it is one of the largest neurosurgery research groups in Australasia with focused expertise in syringomyelia, CSF physiology, and brain AVMs. In addition to his neurovascular expertise, Professor Stoodley is recognised internationally for the clinical management of disorders of the craniovertebral junction and syringomyelia. Please join us in welcoming Professor Stoodley to our SpineFEST 2020!
This year the University of Toronto Department of Surgery Spine Program celebrates its 12th 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. 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 element 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, over many years, has established and enhanced Neurosurgery and Orthopaedic Surgery spinal training opportunities between Toronto Academic Health Sciences Network (TAHSN) teaching 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 a top tier academic hub which attracts 12-15 national and international clinical fellows and many visiting surgeons each year.
Over the past years, our program continues to offer both a one-year core fellowship training experience and a two-year fellowship program with first year comprehensive spine training experience followed by second year with more focused and advanced subspecialty exposure. While the fellowships are largely focused at one of the TAHSN hospitals, great options exist for a 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.
Each year we launch our University academic calendar of events with a welcome dinner for our incoming fellows which is combined with an update of our city-wide research opportunities. Thanks to Dr. Carlo Ammendolia and Karl Zabjek for organizing the research meeting. We also organize a mini bootcamp course for our fellows and senior residents on Traumatic Spinal Cord Injury which covers management, clinical trials, case controversies and the detailed ASIA neurological assessment. Thanks to Dr. Sukhvinder Kalsi-Ryan for coordinating the course with Drs. Fehlings, Yee, Jeremie Larouche and Jeff Wilson. Each year, Dr. Stephen Lewis (TWH-UHN & HSC) chairs a 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 June 9th, Dr. Lewis extended this course to include advanced complex procedures (e.g. deformity osteotomy, minimally invasive surgery (MIS), and trauma techniques). In compliance with Covid-19 preventive measures our Program managed to facilitate and lead the way for an outstanding surgical skills course with a combination of wet lab, simulation, and virtual faculty lectures/case discussions throughout the day.
For several years now, we continue to complement the resident’s surgical training with our Royal College Mock Oral on Spine course Co-Chaired by Drs. Fehlings and Yee. On Feb 12th 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. We also host City-Wide Fellow Journal Club several times a year to discuss recent and controversial spine articles and a collection of relevant cases. We thank Dr. Lewis and Dr. Finkelstein for hosting two of our journal clubs on deformity and trauma at their residences. Dr. Fehlings and Dr. Yee also hosted an online Journal Club webinar on COVID-19 and its impact on spine surgery. The program featured Dr. Yongchao Wu, a former U of T fellow, and his first-hand experiences from Wuhan China which included valuable strategies for us towards managing health care services during the pandemic. The webinar was timely, well attended and received quite positive responses.
Our Program continues to invite several 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. On November 4th we held the Tator-Turnbull SCI symposium which we host jointly each year with TWH to pay tribute to the enormous contribution of Dr. Charles Tator and Barbara Turnbull in driving SCI research and related advocacy. We thank Dr. Brian Kwon from the University of British Columbia who provided an excellent keynote presentation on translational research in acute spinal cord injury. The event also featured a special talk from Dr. Hideyuki Okano from Keio University-Japan who shared perspective on the challenges of stem cells clinical trials for SCI. On February 4th we also hosted a special lecture featuring our guest speaker Dr. Simon Archibald from Dublin who presented application of regenerative medicine with focus on peripheral nerve and spinal cord injury. Given the current situation, it was unfortunate that we had to postpone a planned May 6th hospital based visiting professorship at SickKids with Professor Dror Ovadia from Israel; we look forward to his postponed visit next year on January 25th.
We would like to take this moment and welcome new faculty to our spinal community. Dr. Christopher Witiw, a spine neurosurgeon at St. Michael’s Hospital and Dr. Michael Hardisty, a scientist at Sunnybrook Research Institute joined our program this past academic year. There have also been numerous awards that we would like to recognize. We congratulate Dr. Fehlings on winning the 2019 Ryman Prize in recognition of his contributions to understanding degenerative cervical myelopathy. Also, congratulations to Drs. Yee and Cari Whyne on receiving the distinction of being named Fellows of International Orthopaedic Research (FIOR) from the International Combined Orthopaedic Research Society (ICORS). Congratulations to Dr. Lewis on his appointment as the Chairman AO Spine Knowledge Forum Deformity and to Dr. Arjun Sahgal on his appointment as the Co-Chair of AO Spine Knowledge Forum Tumor. Dr. Michael Fehlings established and is Past Chair of the AOSpine Spinal Cord injury Knowledge Forum. It is remarkable that three U of T Spine Program surgeons have been recognized by the AO Foundation in this way. We also congratulate Dr. Meaghan O’Reilly on receiving the ISTU Frederic Lizzi Early Career Award and Dr. Jeff Wilson on receiving the Government of Ontario Early Researcher Award and for receiving the Peters Prize from the Department of Surgery.
We also wish to celebrate the graduation of our 2019/2020 city-wide spine fellows (Drs. Allan Martin, Anna Reinmuller, Thorsten Jentzch, Colby Oitment, Hananel Yashuv, Brett Rocos, Kaoru Eguchi, Isaac Carreno, Kunal Bhanot, Eric Crawford, Carolyn Lai, Tan Chen, and Dora Pelletier). We congratulate all our fellows on successful completion of their fellowship and we wish them great success in their professional and personal life.
We would like to thank all our program faculty members and industry partners for their support over many years, and particularly during this unprecedented time. We also wish to recognize the support from the U of T Department of Surgery and Divisions of Neurosurgery and Orthopedic Surgery. 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 technological skills which have become of great value in moving forward our collaborative agenda and virtual academic activities during this evolving time.
Michael & Albert
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.
Michael & Albert