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Michael Fehlings and Albert Yee

Michael Fehlings and Albert Yee

On June12, 2016 the University of Toronto (U of T) Department of Surgery Spine Program celebrated its 8th annual SpineFEST™ meeting at MaRS building. SpineFEST™ is the key annual academic meeting for the U of T Spine Program. Bringing together clinicians and scientists around the city’s university affiliated hospitals, this event aims to foster collaboration within the spine community locally and also serves as a venue to disseminate our activities to invited professors nationally and internationally.

Co-led by Dr. Michael Fehlings (University Health Network-Toronto Western Hospital/ UHN-TWH) and Dr. Albert Yee (Sunnybrook Health Sciences Centre/ SBHC), we held thematic sessions on cervical myelopathy and cervical deformity, also on controversies and complexities in cervical spine diagnosis including related management. We enjoyed research presentations by many of our city-wide spine trainees. Moderated by Dr. Fehlings, our keynote Tator-Hall Visiting Professorship Lecture was presented by Professor Daniel Riew, Professor of Orthopaedic Surgery, Co-Chief of Spine Division, and Director of Cervical Spine Surgery at Columbia Medical Center. Dr. Riew provided a dynamic talk titled “The Post-operative Patient with Persistent or Recurrent Symptoms”. He outlined some of the most common etiologies for failure of surgery including pseudarthrosis, inadequate decompression, poorly placed instrumentation, wrong-level surgery and non-cervical etiology. Dr. Riew reviewed accurate methods to avoid failure and outlined approaches to revision surgery. Our keynote speaker also led important discussions on how to communicate poor outcomes to patients after surgery.

Moderated by Dr. Eric Massicotte (UHN-TWH), the morning session on cervical myelopathy and cervical deformity presented the latest updates on the topic. Dr. Fehlings engaged us in an important dialogue about “what’s new & hot” in optimizing surgical outcomes for degenerative cervical myelopathy. Dr. Stephen Lewis (UHN-TWH & Hospital for Sick Children/HSC) provided an overview on the evaluation and management of cervical deformity, followed by a review of novel assessment techniques defining degenerative cervical myelopathy by Dr Sukhvinder Kalsi-Ryan’s (UHN-TWH).

The day continued with excellent presentations and discussions moderated by Dr. Howard Ginsberg (St. Michael’s Hospital/SMH) on controversies and complexities in cervical spine diagnosis and management. Dr. Henry Ahn (SMH) led off the session focusing on the role and timing of surgery for traumatic central cord syndrome. Dr Yee (SHSC) provided an evidence-based update on spine clearance in the trauma patient as well as process improvement initiatives from a Level I trauma centre perspective. Dr. Michael Angel shared his experience as a neurologist as he spoke about pearls and pitfalls of cervical myelopathy diagnosis. Lindsay Tetreault (PhD, Postdoc, UHN-Krembil Research Institute/KRI) concluded the session with an interesting talk reviewing the current state of the literature and outlining important knowledge gaps in degenerative cervical myelopathy.

In the academic session, our spine scientist surgeon trainees updated us on their work. Christopher Witiw (MD, PGY5 Neurosurgery) presented the rationale for surgical intervention and reviewed a health economic and patient-centered analysis on the value of surgery for degenerative cervical myelopathy. Robert Ravinsky (MD, PGY5 Orthopaedic Surgery) discussed spine surgery fellowship education and the competence-based training education syllabus in Canada and beyond.

This year, we received around 40 abstract submissions spanning clinical and pre-clinical spine research. Winners of 1st place abstract, 2nd place abstract, and 3rd place abstract provided oral presentations on their research findings. In first place clinical research abstract Alex Laliberte (PhD candidate -Institute of Medical Sciences/IMS) presented his work titled Hypoxia-Related MicroRNAs are Biomarkers of Degenerative Cervical Myelopathy Severity. In first place basic science research abstract Spyridon Karadimas (MD, PhD candidate, UHN-KRI) talked about the Riluzole blocks perioperative ischemia-reperfusion injury and enhances postdecompression outcomes in cervical spondylotic myelopathy.

group photo

Michael Fehlings, Pía Vidal, Daipayan Guha, and Albert Yee

In 2nd place clinical research abstract Daipayan Guha (MD, PGY4 Neurosurgery) presented his work titled Accuracy Validation in the Cervical Spine of a Novel, Rapid, Optical Intraoperative Spinal Navigation System: Initial Clinical Feasibility. In 2nd place basic science research abstract Pía Vidal (PhD, Postdoc, UHN-KRI) updated us about her work on early decompression attenuation of Ischemia-Reperfusion-Injury mediated inflammation for Cervical Degenerative Myelopathy (DCM). In 3rd place clinical research abstract Allan Martin (MD, BASc (EngSci), PGY4 Neurosurgery) presented his research titled Next-Generation MRI Identifies Tract- Specific Injury and Predicts Focal Neurological Deficits in Degenerative Cervical Myelopathy. Finally, in 3rd place basic science research abstract Stewart McLachlin (PhD, Postdoc, Sunnybrook Research Institute/ SRI) presented his work titled Virtual framework to evaluate osseous fixation pathways in the spine.

SpineFEST™ continued our green and ecofriendly session with 24 e-poster presentations. First Prize e-Poster Presentation was awarded to Laureen Hachem (MD Candidate, UHN-KRI) for her presentation entitled Glutamate increases in vitro survival and proliferation and attenuates oxidative stress-induced cell death in adult spinal cord-derived neural stem/progenitor cells via non-NMDA ionotropic glutamate receptors. The Second Prize went to Ayelet Atkins (Postdoc, SRI) and Mikhail Burke (PhD candidate SRI) for their work titled Characterization of microdamage accumulation in metastatically- involved vertebrae.

SpineFEST™ ended with an enjoyable evening with the U of T-GTA Spine Rounds chaired by Dr. Joel Finkelstein (SHSC) at the Park Hyatt Roof Salon. Dr. Daniel Riew provided a talk arguing whether we are overspecialized in spine care. The evening continued with celebration of our city-wide spine fellows graduation. Our Program Co-Directors Drs Fehlings and Yee congratulated our fellows on the completion of their 2015/16 fellowship year and presented their U of T Spine Program fellowship certificates and plaques.

The U of T Spine Program congratulated our citywide spine fellows (Drs Mohammad Zarrabian, So Kato, Safraz Mohammed, Markian Pahuta, Mark Kotter, Kevin Koo, Amit Keren, Kachinga Sichizya, Michael Dodds, and David Bellut) on a successful completion of their fellowship. On behalf of our citywide spine surgeons (Drs Michael Fehlings, Eric Massicotte, Raj Rampersaud, Stephen Lewis, Reinhard Zeller, Albert Yee, Joel Finkelstien, Michael Ford, Howard Ginsberg, and Henry Ahn) we extend best wishes to all fellows in their career and future endeavors.

The U of T Spine Program would like to thank our participants for contributing towards the ongoing success of SpineFEST. We extend our appreciation to Professor Charles Tator, Professor Hamilton Hall, Professor Andres Lozano, Professor Peter Ferguson, and Professor James Rutka for their strong support of SpineFEST™ and the U of T Department of Surgery Spine Program over many years. The Program also extends gratitude to our educational event sponsors Medtronic, DePuy Synthes & Ethicon, Zimmer Biomet, and Stryker.

Nadia Jaber with input from
Michael Fehlings and Albert Yee

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