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Dr. Michael Fehlings - University Health Network. Toronto, ON, CA

Dr. Michael Fehlings Dr. Michael Fehlings

Neurosurgeon, Krembil Neuroscience Centre | University Health Network

Toronto, ON, CANADA

Combining an expertise in complex spinal surgery with a innovative research program discovering new treatments for spinal cord injury

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Biography

Dr. Fehlings received his MD from the University of Toronto in 1983. Following a surgical internship at Queen’s University in 1983-84, Dr. Fehlings entered the University of Toronto Neurosurgical Training Program in 1984. During his residency, Dr. Fehlings worked towards and received his Ph.D. in 1989 in the Institute of Medical Sciences for his work on experimental spinal cord injury. Dr. Fehlings became a Fellow of the Royal College of Physicians and Surgeons of Canada in 1990 and a Fellow of the American College of Surgeons in 2006. In 1991, he undertook a post-doctoral research fellowship at NYU Medical Center under Dr. Wise Young. This was followed by a clinical spine fellowship under Dr. P. Cooper at NYU. Dr. Fehlings joined the Neurosurgical Staff at the Toronto Western Hospital (now The Krembil Research Institute) in 1992. He is currently Professor in the Department of Surgery, full member of the Institute of Medical Sciences School of Graduate Studies, a Scholar in the McLaughlin Centre of Molecular Medicine, a Scientist in the McEwen Centre for Regenerative Medicine, a Senior Scientist at the Krembil Research Institute, Director of the University of Toronto Neuroscience Program, Co-Director of the University of Toronto Spine Program, Director of the Spinal Program at the Krembil Research Institute, Medical Director of the Krembil Neuroscience Centre at the University Health Network and Krembil Chair in Neural Repair and Regeneration. His main clinical interests are in spinal neurosurgery, and his research focus is in molecular mechanisms underlying spinal cord injury.

Industry Expertise (7)

Advanced Medical Equipment Research Health Care - Services Health Care - Providers Health Care - Facilities Health and Wellness Training and Development

Areas of Expertise (12)

Neuroscience Clinical Research Molecular Biology Clinical Trials Biotechnology Confocal Microscopy Spine Stem Cells Cerebral Palsy Riluzole Decompression Surgery Neurosurgery

Accomplishments (13)

Olivecrona Award (professional)

2009-01-01

The top international honour for neurosurgeons and neuroscientists, awarded by the Nobel Institute at the Karolinska Institute in Stockholm

Leon Wiltse Award (professional)

2009-01-01

Awarded by the North American Spine Society for excellence in leadership and clinical research in spine care

Gold Medal in Surgery (professional)

1996-01-01

Awarded by the Royal College of Physicians and Surgeons

Lister Award in Surgical Research (professional)

2007-01-01

Awarded to an investigator who has shown outstanding and continuing productivity of international stature as evidenced by research publications, grants held, students trained and other evidence of stature of the work produced.

Reeve-Irvine Research Medal in Spinal Cord Injury (professional)

2012-01-01

The Reeve-Irvine Research Medal recognizes an individual, or individuals, who have made highly meritorious scientific contributions in the area of spinal cord repair, and whose research has stood the test of time and scrutiny.

Golden Axon Leadership Award (professional)

2012-01-01

The Golden Axon Award of the Foundation is meant to highlight world-class leadership in neuroscience. The award is presented to individuals who have reached out to their local communities and helped both the Brain Mapping Foundation and SBMT with their mission, which in short is advancing multidisciplinary neuroscience research.

Mac Keith Basic Science Lectureship Award (professional)

2012-01-01

For significant contributions to the basic science of cerebral palsy and childhood onset disabilities

Served as the 40th President of the Cervical Spine Research Society (CSRS) (professional)

2012-01-01

Only Canadian to do so.

CSRS Presidential Medallion (professional)

2013-01-01

For outstanding leadership and contributions to cervical spine research

Queen Elizabeth II Diamond Jubilee Medal (professional)

2013-01-01

Created in 2012 to mark the 60th anniversary of Her Majesty Queen Elizabeth II’s accession to the Throne as Queen of Canada, the Queen Elizabeth II Diamond Jubilee Medal was a tangible way for Canada to honour Her Majesty for her service to this country. At the same time, this commemorative medal served to honour significant contributions and achievements by Canadians. During the year of celebrations, 60 000 deserving Canadians were recognized.

H. Richard Winn Prize from the Society of Neurological Surgeons (professional)

2013-01-01

The purpose of this international award is to encourage research in the neurosciences and to recognize outstanding, continuous commitment to research in the neurosciences by a neurological surgeon.

Jonas Salk Award for Scientific Achievements from the March of Dimes Canada (professional)

2013-01-01

The Jonas Salk Award is presented annually to a Canadian scientist, physician or researcher who has made a new and outstanding contribution in science or medicine to prevent, alleviate or eliminate a physical disability.

Henry Farfan Award from the North American Spine Society (professional)

2013-01-01

To recognize outstanding contributions in spine related basic science research.

Education (2)

University of Toronto: Ph.D., Neuroscience 1988

University of Toronto: MD, Medicine 1983

Affiliations (9)

  • University of Toronto, Department of Surgery : Professor
  • Institute of Medical Sciences School of Graduate Studies : Full Member
  • McEwen Centre for Regenerative Medicine : Scientist
  • Toronto Western Research Institute : Senior Scientist
  • University of Toronto : Director, Neuroscience Program
  • University of Toronto : Co-Director, Spine Program
  • Toronto Western Hospital : Director, Spinal Program
  • Krembil Chair in Neural Repair and Regeneration
  • Vice Chair, Research, Department of Neurosurgery, University of Toronto

Media Appearances (9)

Michael G. Fehlings, MD, discusses the results of the Scoli-RISK-1 study

Healio  online

2014-04-29

At the American Association of Neurological Surgeons Annual Meeting, Michael G. Fehlings, MD, PhD, FAANS, FRCS, spoke of the results of the Scoli-RISK-1 study. In the prospective study of 276 patients who were treated at 15 sites in North America, Europe and Asia, researchers studied the neurologic complication rate following complex adult spinal deformity surgery. They identified neurologic deficit rates of about 23% at discharge, 17% at 6 weeks after surgery and 10% at 6 months after surgery for patients with complex adult spinal deformity...

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Surgery helps common arthritis-related spinal disease, prevents paralysis: study

CityNews Toronto  online

2013-09-18

Decompression surgery is a safe, effective means of treating a common but often misdiagnosed disease of the spine that can lead to paralysis, a Canadian-led international study concludes. The condition — known by the unwieldy name of cervical spondylotic myelopathy, or CSM — is estimated to affect about 20 per cent of Canadians, usually after age 50. About 10 per cent of those patients require surgery to alleviate progressively worsening symptoms...

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Oxygen deprivation could help improve mobility for patients with spinal injuries: study

CTV News  tv

2013-11-30

New research is showing that low-level oxygen deprivation may help people with spinal-cord injuries regain movement and strength.
The U.S. study, published earlier this week in the American Academy of Neurology medical journal, showed that exposing patients with limited movement to short periods of low oxygen helped them walk better and for longer periods.

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When the tumour in your spine is the size of a Tims cup

Toronto Star  online

2014-06-13

Less than three months after the honeymoon, Manji was diagnosed with chondrosarcoma, an extremely rare cartilage cancer. The tumour was the size of a medium Tim Hortons cup, and it was nestled against the right side of his spine.
Without the groundbreaking surgical approach her husband likely wouldn’t be here today, says Kaba.
“They’ve done this (surgery) now, and they know that they can do it,” she says. “Other people need to know this option exists.”
Toronto Western Hospital’s spine program is celebrating its 20th anniversary on June 16.
Dr. Michael Fehlings is medical director of the Krembil Neuroscience Centre, where the program is based. He says the spine centre’s programs are giving patients with limited options hope for treatment.

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Stem Cell Trial Gives Hope to Patients with Spinal Cord Injury

University Health Network  online

2014-03-06

When Zahra Chehimi was paralyzed from the chest down by a car accident in May 2013, the 40-year-old mother of two was told she had little hope of recovery.
But a clinical trial led by Dr. Michael Fehlings, Medical Director of the Krembil Neuroscience Centre, Head of the Spinal Program at Toronto Western Hospital and Senior Scientist, McEwen Centre for Regenerative Medicine, is giving the Chehimi family some hope that Zahra's prognosis might change in the future.

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Surgery for Spinal Cord Injury Within 24 Hours Improves Outcomes

University Health Network  online

2012-02-23

People who suffer a spinal cord injury should be getting surgery within the first 24 hours, according to a new multi-centre clinical trial, which shows the timing of surgery can reduce the likelihood of paralysis.

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'Surgery Helped Me Avoid Paralysis'

University Health Network  online

2013-09-18

Wang was finally diagnosed as having cervical spondylotic myelopathy (CSM). In his case, it was caused by a hardening of ligaments along the spine into bone (or, in medical terms, the ossification of the posterior longitudinal ligament (OPLL)).

Since Wang’s symptoms had worsened dramatically in such a short amount of time, it was recommended he have surgery.

He began doing research about this option and soon came across the name of Dr. Michael Fehlings, a neurosurgeon at the Krembil Neuroscience Centre at Toronto Western Hospital – a leader in the treatment of spinal cord injuries.

Wang knew he wanted Dr. Fehlings to take him on as a patient.

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New Treatment for ‘Arthritis of the Spine’ Prevents Paralysis

University health Network  online

2013-09-18

In a world-first, decompression surgery has been shown to be an effective procedure to treat cervical spondylotic myelopathy (CSM) – a common progressive, degenerative disease of the spine that can lead to paralysis – according to the results of a multi-centre clinical trial published today.

The study, with its use of multiple outcome measures to determine patient improvement, is the first research of its kind to show that decompression surgery has a significant improvement in both the symptoms and quality of life of CSM patients at all levels of severity.

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The Reason Behind the Research

University Health Network  online

2013-10-17

This year, Fehlings received the top research award given to a neurosurgeon in North America, the H, Richard Winn, M.D. Prize, an annual award presented by the Society of Neurological Surgeons (SNS).

The award recipient receives an engraved gold medal and a leather-bound volume of peer-reviewed research published throughout their career. The SNS presented Fehlings with two volumes to accommodate all of the research papers he's published – approximately 450 studies which have been cited by other researchers at least 11,000 times.

"It's humbling and gratifying because I want to help people who have serious injuries of the brain and spinal cord in a meaningful way," said Fehlings.

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Event Appearances (2)

Current surgical practice for traumatic spinal cord injury in Canada

2014 Combined Spine Conference  Hamilton, ON.

2014-01-03

Neuroprotection of the Injured Spinal Cord: Novel Translational Strategies

5th National Spinal Cord Injury Conference  Toronto, ON.

2012-10-18

Articles (10)

Delayed transplantation of adult neural precursor cells promotes remyelination and functional neurological recovery after spinal cord injury The Journal of Neuroscience

2006-01-01

Spinal cord injury (SCI) results in loss of oligodendrocytes demyelination of surviving axons and severe functional impairment. Spontaneous remyelination is limited. Thus, cell replacement therapy is an attractive approach for myelin repair. In this study, we ...

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A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status Spine

2005-01-01

A new proposed classification system for thoracolumbar (TL) spine injuries, including injury severity assessment, designed to assist in clinical management. Objective. To devise a practical, yet comprehensive, classification system for TL injuries that assists ...

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Epidemiology, demographics, and pathophysiology of acute spinal cord injury Spine

2001-01-01

Spinal cord injury occurs through various countries throughout the world with an annual incidence of 15 to 40 cases per million, with the causes of these injuries ranging from motor vehicle accidents and community violence to recreational activities and workplace- ...

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Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up Results of the third National Acute Spinal Cord Injury Randomized Controlled Trial Journal of Neurosurgery

1998-01-01

A randomized double-blind clinical trial was conducted to compare neurological and functional recovery and morbidity and mortality rates 1 year after acute spinal cord injury in patients who had received a standard 24-hour methylprednisolone regimen (24MP) with ...

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Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms Journal of Neurosurgery

1991-01-01

In patients with spinal cord injury, the primary or mechanical trauma seldom causes total transection, even though the functional loss may be complete. In addition, biochemical and pathological changes in the cord may worsen after injury. To explain these phenomena, ...

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Incidence, Impact and Risk Factors of Adverse Events in Thoracic and Lumbar Spine Fractures. An Ambispective Cohort Analysis of 390 patients The Spine Journal - North American Spine Society

2014-11-28

BACKGROUND CONTEXT:
Adverse events (AEs) in thoracic and lumbar spine fractures are common but little is known about the type of AEs that are specific to this population. Further, very little is known about the incidence and clinical impact of these AEs on patients in the presence of traumatic spinal cord injury (TSCI) and whether they are treated operatively or non-operatively.
PURPOSE:
To determine the incidence of AEs in patients with thoracic or lumbar spine fractures treated both operatively and non-operatively and determine their impact on length of stay (LOS). Secondarily, determine the difference in incidence of AEs in both neurologically intact and compromised patients. Study design/setting: Ambispective cohort study at a quaternary referral center.

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International Spinal Cord Injury: Spinal Interventions and Surgical Procedures Basic Data Set Spinal Cord

2014-11-25

Study design:Survey of expert opinion, feedback and final consensus.Objective:To describe the development and the variables included in the International Spinal Cord Injury (SCI) Spinal Interventions and Surgical Procedures Basic Data set.Setting:International working group.Methods:A committee of experts was established to select and define data elements. The data set was then disseminated to the appropriate committees and organizations for comments. All suggested revisions were considered and both the International Spinal Cord Society and the American Spinal Injury Association endorsed the final version.Results:The data set consists of nine variables: (1) Intervention/Procedure Date and start time (2) Non-surgical bed rest and external immobilization, (3) Spinal intervention-closed manipulation and/or reduction of spinal elements, (4) Surgical procedure-approach, (5) Date and time of the completion of the intervention or surgical closure; (6) Surgical procedure-open reduction, (7) Surgical procedure-direct decompression of neural elements, and (8 and 9) Surgical procedure-stabilization and fusion (spinal segment number and level). All variables are coded using numbers or characters. Each spinal intervention and procedure is coded (variables 1 through 7) and the spinal segment level is described (variables 8 and 9). Sample clinical cases were developed to illustrate how to complete it.Conclusion:The International SCI Spinal Interventions and Surgical Procedures Basic Data Set was developed to facilitate comparisons of spinal interventions and surgical procedures among studies, centers and countries.

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Examination of the Combined Effects of Chondroitinase ABC, Growth Factors and Locomotor Training following Compressive Spinal Cord Injury on Neuroanatomical Plasticity and Kinematics PLoS One

2014-10-28

While several cellular and pharmacological treatments have been evaluated following spinal cord injury (SCI) in animal models, it is increasingly recognized that approaches to address the glial scar, including the use of chondroitinase ABC (ChABC), can facilitate neuroanatomical plasticity. Moreover, increasing evidence suggests that combinatorial strategies are key to unlocking the plasticity that is enabled by ChABC. Given this, we evaluated the anatomical and functional consequences of ChABC in a combinatorial approach that also included growth factor (EGF, FGF2 and PDGF-AA) treatments and daily treadmill training on the recovery of hindlimb locomotion in rats with mid thoracic clip compression SCI. Using quantitative neuroanatomical and kinematic assessments, we demonstrate that the combined therapy significantly enhanced the neuroanatomical plasticity of major descending spinal tracts such as corticospinal and serotonergic-spinal pathways. Additionally, the pharmacological treatment attenuated chronic astrogliosis and inflammation at and adjacent to the lesion with the modest synergistic effects of treadmill training.

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Psychometric Properties of the Modified Japanese Orthopaedic Association Scale in Patients with Cervical Spondylotic Myelopathy Spine

2014-10-22

Study Design. Prospective studyObjective. This study aims to determine the psychometric properties of the modified Japanese Orthopaedic Association (mJOA) scale.Summary of Background Data. Several outcome measures assess functional impairment and quality of life in patients with cervical myelopathy. However, a gold standard has not been established. One of the most widely accepted tools for assessing functional status is the modified Japanese Orthopaedic Association (mJOA) scale.Methods. Two hundred and seventy-seven surgical CSM patients were enrolled in the prospective CSM-North America study. Functional status was evaluated at baseline and at 6, 12 and 24 months postoperatively. The internal consistency of the mJOA was assessed by computing a Cronbach's alpha for the total score and after removing one item at a time. Convergent and divergent validity were measured by correlating the mJOA with other assessment tools. The scale's responsiveness was determined by comparing mJOA scores at baseline and 12 months post-surgically and computing a Cohen's effect size.Results. The scale's internal consistency was moderate with a Cronbach's alpha of 0.63. Sphincter dysfunction measured a different dimension than the other three scale components. The mJOA was correlated with the Nurick score (r = [FIGURE DASH]0.625) but was not associated with subscales of the SF-36 that measure different constructs. These findings suggests convergent and divergent validity. The mJOA was responsive to change as reflected by a Cohen's effect size of 1.Conclusions. The mJOA is a useful tool in the assessment of CSM and should be adopted as the standard for evaluating functional status in this population.

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Views of people with traumatic spinal cord injury about the components of self-management programs and program delivery: a Canadian pilot study BMC Neurology

2014-10-21

BACKGROUND:
Given the increasing emphasis on the community management of spinal cord injury (SCI), strategies that could be developed and implemented in order to empower and engage individuals with SCI in promoting their health and minimizing the risk of health conditions are required. A self-management program could be one approach to address these complex needs, including secondary complications. Thus, the objective of this study was to determine the importance attributed to the components of a self-management program by individuals with traumatic SCI and explore their views/opinions about the delivery of such a program.
METHODS:
Individuals with SCI were recruited by email via the Rick Hansen Institute (Vancouver, British Columbia, Canada) as well as an outpatient hospital spinal clinic. Data were collected by self-report using an on-line survey.

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