MESSAGE FROM THE CO-DIRECTORS

Jun 10, 2019

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