Michael Fehlings

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Michael Fehlings is a Canadian neurosurgeon based at Toronto Western Hospital in Toronto, Ontario, Canada. [1] Dr. Fehlings specializes in complex spine surgery with a special interest in traumatic and non-traumatic spinal cord injury and spine oncology. He mainly focuses on preclinical and clinical translational research related to enhancing repair and regeneration of the injured central nervous system. He holds many positions, including Professor of Neurosurgery at the University of Toronto, Vice Chair Research at the University of Toronto, Robert Campeau Foundation/Dr. C.H. Tator Chair in Brain and Spinal Cord Research at UHN, Scientist at the McEwen Centre for Regenerative Medicine, McLaughlin Scholar in Molecular Medicine, and Co-Director of the University of Toronto Spine Program. [2] He is the past inaugural Director of the University of Toronto Neuroscience Program, and was the previous Medical Director at Toronto Western Hospital. Dr. Fehlings is a Fellow of the American College of Surgeons and a Fellow of the Royal College of Surgeons of Canada.

Contents

Biography

He completed his MD at the University of Toronto, followed by his core training in general surgery at Queen’s University. He returned to the University of Toronto to complete his PhD, and was awarded his fellowship of the Royal College of Surgeons of Canada, followed by a post-doctoral fellowship in New York. [3] Dr. Fehlings specializes in spinal cord injury and has an active clinical practice as well as research at both the laboratory and clinical levels in the area. His research focuses preclinically on translationally relevant models of spinal cord and brain injury, and clinically on disorders of the spine/spinal cord. His peer-reviewed publications number over 1,100 spanning clinical and basic science. [4]

Work from his 1996 publication in the Journal of Neuroscience characterizing the secondary injury cascade following spinal cord injury (Agrawal and Fehlings, 1996 [5] ) resulted in receipt of the Gold Medal from the Royal College of Physicians and Surgeons. [6] This work has been translated into ongoing clinical trials examining riluzole for traumatic and nontraumatic spinal cord injury. In stem cell research, Dr. Fehlings' 2006 paper in the Journal of Neuroscience (Karimi-Abdolrezaee et al., 2006; [7] ) provides strong evidence of the functional impact of neural stem cells in repairing/regenerating injured spinal cords through remyelination of axons. This finding has been key in leading clinical translational efforts to use neural stem cells for spinal cord injury.

His research has impacted clinical practice as evidenced by the 2012 publication of results from the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS [8] ), which provided direct clinical trials evidence that early decompressive surgery improves neurological and functional outcomes after spinal cord injury. This trial is having an important impact on how spinal trauma is managed. In 2017 Dr. Fehlings was involved in an international effort to develop clinical practice guidelines for degenerative cervical myelopathy and traumatic spinal cord injury. [9] Dr. Fehlings’ work demonstrating that midcervical excitatory interneurons are essential for the maintenance of breathing in non-traumatic cervical SCI and critical for promoting respiratory recovery after traumatic SCI was published in Nature. [10]

Honours

Dr. Fehlings has been honoured with several awards and medals including the Reeve-Irvine Medal in Spinal Cord Injury (2012, jointly with Dr. Tator), [11] the Olivecrona Award by the Karolinska Institute (2009), the Henry Farfan award from the North American Spine Society (2013), [12] and the Richard H. Winn prize (2013), [13] presented by the Society of Neurological Surgeons. He received the Diamond Jubilee medal (2013) [14] for his ground-breaking work in childhood neurodevelopmental disorders and spinal cord injury and disease. This was presented by Canadian Prime Minister Stephen Harper. He has also been inducted into the Canadian Academy of Health Science [15] and as a Fellow of the Royal Society of Canada. [16] In 2016 he received the Mentor of the Year Award from the Royal College of Physicians and Surgeons. Dr. Fehlings is frequently invited to speak internationally and has spoken in over 35 countries. He was described, during the Henry Farfan Award ceremony, as the "single most influential active spinal cord injury researcher and clinician in the world". In 2019, the Right Honourable Jacinda Ardern, Prime Minister of New Zealand, presented him with the Ryman Prize for his work enhancing the quality of life for older people. [17]

Related Research Articles

<span class="mw-page-title-main">Neurosurgery</span> Medical specialty of disorders which affect any portion of the nervous system

Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peripheral nervous system.

<span class="mw-page-title-main">Syringomyelia</span> Disorder in which a cyst forms in the spinal cord

Syringomyelia is a generic term referring to a disorder in which a cyst or cavity forms within the spinal cord. Often, syringomyelia is used as a generic term before an etiology is determined. This cyst, called a syrinx, can expand and elongate over time, destroying the spinal cord. The damage may result in loss of feeling, paralysis, weakness, and stiffness in the back, shoulders, and extremities. Syringomyelia may also cause a loss of the ability to feel extremes of hot or cold, especially in the hands. It may also lead to a cape-like bilateral loss of pain and temperature sensation along the upper chest and arms. The combination of symptoms varies from one patient to another depending on the location of the syrinx within the spinal cord, as well as its extent.

<span class="mw-page-title-main">Tetraplegia</span> Paralysis of all four limbs and torso

Tetraplegia, also known as quadriplegia, is defined as the dysfunction or loss of motor and/or sensory function in the cervical area of the spinal cord. A loss of motor function can present as either weakness or paralysis leading to partial or total loss of function in the arms, legs, trunk, and pelvis; paraplegia is similar but affects the thoracic, lumbar, and sacral segments of the spinal cord and arm function is spared. The paralysis may be flaccid or spastic. A loss of sensory function can present as an impairment or complete inability to sense light touch, pressure, heat, pinprick/pain, and proprioception. In these types of spinal cord injury, it is common to have a loss of both sensation and motor control.

<span class="mw-page-title-main">Spinal cord injury</span> Injury to the main nerve bundle in the back of humans

A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury. Injury can occur at any level of the spinal cord and can be complete, with a total loss of sensation and muscle function at lower sacral segments, or incomplete, meaning some nervous signals are able to travel past the injured area of the cord up to the Sacral S4-5 spinal cord segments. Depending on the location and severity of damage, the symptoms vary, from numbness to paralysis, including bowel or bladder incontinence. Long term outcomes also range widely, from full recovery to permanent tetraplegia or paraplegia. Complications can include muscle atrophy, loss of voluntary motor control, spasticity, pressure sores, infections, and breathing problems.

Myelopathy describes any neurologic deficit related to the spinal cord. The most common form of myelopathy in humans, cervical spondylotic myelopathy (CSM), also called degenerative cervical myelopathy, results from narrowing of the spinal canal ultimately causing compression of the spinal cord. When due to trauma, myelopathy is known as (acute) spinal cord injury. When inflammatory, it is known as myelitis. Disease that is vascular in nature is known as vascular myelopathy.

<span class="mw-page-title-main">Cervical fracture</span> Medical condition

A cervical fracture, commonly called a broken neck, is a fracture of any of the seven cervical vertebrae in the neck. Examples of common causes in humans are traffic collisions and diving into shallow water. Abnormal movement of neck bones or pieces of bone can cause a spinal cord injury, resulting in loss of sensation, paralysis, or usually death soon thereafter, primarily via compromising neurological supply to the respiratory muscles as well as innervation to the heart.

<span class="mw-page-title-main">Spinal fusion</span> Immobilization or ankylosis of two or more vertebrae by fusion of the vertebral bodies

Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine and prevents any movement between the fused vertebrae. There are many types of spinal fusion and each technique involves using bone grafting—either from the patient (autograft), donor (allograft), or artificial bone substitutes—to help the bones heal together. Additional hardware is often used to hold the bones in place while the graft fuses the two vertebrae together. The placement of hardware can be guided by fluoroscopy, navigation systems, or robotics.

<span class="mw-page-title-main">Central cord syndrome</span> Human spinal cord disorder

Central cord syndrome (CCS) is the most common form of cervical spinal cord injury. It is characterized by loss of power and sensation in arms and hands. It usually results from trauma which causes damage to the neck, leading to major injury to the central corticospinal tract of the spinal cord. CCS most frequently occurs among older persons with cervical spondylosis, however, it also may occur in younger individuals.

<span class="mw-page-title-main">Spinal stenosis</span> Disease of the bony spine that results in narrowing of the spinal canal

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

<span class="mw-page-title-main">Nicholas Theodore</span> American neurosurgeon

Nicholas Theodore is an American neurosurgeon and researcher at Johns Hopkins University School of Medicine. He is known for his work in spinal trauma, minimally invasive surgery, robotics, and personalized medicine. He is Director of the Neurosurgical Spine Program at Johns Hopkins and Co-Director of the Carnegie Center for Surgical Innovation at Johns Hopkins.

Arthur L. Jenkins III is an American fellowship-trained neurosurgeon, co-director of the Neurosurgical Spine Program, and Director of Spinal Oncology and Minimally Invasive Spinal Surgery (MIS) Program at the Mount Sinai Hospital, New York. Additionally, he is an associate professor of Neurosurgery and of Orthopedic Surgery at the Mount Sinai School of Medicine. Dr. Jenkins has multiple patents and patent applications for spine-related implants and support systems, and is developing new minimally invasive treatments for patients with cancer that has spread to the spine. He is an innovator in the treatment of acute spinal cord injury as well as degenerative and congenital anomalies of the spine, taking a minimally invasive or minimal-impact approach where possible. He is board certified in Neurological Surgery and is licensed in New York and Connecticut.

<span class="mw-page-title-main">Spinal precautions</span> Efforts to prevent movement of the spine in those with a risk of a spine injury

Spinal precautions, also known as spinal immobilization and spinal motion restriction, are efforts to prevent movement of the spine in those with a risk of a spine injury. This is done as an effort to prevent injury to the spinal cord. It is estimated that 2% of people with blunt trauma will have a spine injury.

Spinal cord injury without radiographic abnormality (SCIWORA) is symptoms of a spinal cord injury (SCI) with no evidence of injury to the spinal column on X-rays or CT scan. Symptoms may include numbness, weakness, abnormal reflexes, or loss of bladder or bowel control. Neck or back pain is also common. Symptoms may be brief or persistent. Some do not develop symptoms until a few days after the injury.

<span class="mw-page-title-main">Krembil Research Institute</span>

The Krembil Research Institute, formerly known as the Toronto Western Research Institute, is an academic medical research institute in Toronto. It is one of the largest research institutes in Canada focusing on human neurological disease.

Branko Kopjar is a physician and epidemiologist at the University of Washington. He is best known for his contributions in the 1990s to the field of injury prevention and his later work on spine, orthopedic and spinal cord injury research. In addition, he has been published in several top journals in the fields of cardiology, oncology, public health and neurosurgery resulting in a total of more than 500 articles, reports, reviews and abstracts.

<span class="mw-page-title-main">Cervicocranial syndrome</span> Medical condition

Cervicocranial syndrome or is a neurological illness. It is a combination of symptoms that are caused by an abnormality in the neck. The bones of the neck that are affected are cervical vertebrae. This syndrome can be identified by confirming cervical bone shifts, collapsed cervical bones or misalignment of the cervical bone leading to improper functioning of cervical spinal nerves. Cervicocranial syndrome is either congenital or acquired. Some examples of diseases that could result in cervicocranial syndrome are Chiari disease, Klippel-Feil malformation osteoarthritis, and trauma. Treatment options include neck braces, pain medication and surgery. The quality of life for individuals suffering from CCJ syndrome can improve through surgery.

<span class="mw-page-title-main">Odette Harris</span> American neurosurgeon

Odette Harris is a professor of neurosurgery at Stanford University and the Director of the Brain Injury Program for the Stanford University School of Medicine. She is the Deputy Chief of Staff, Rehabilitation at the VA Palo Alto Health Care System.

Sarah Dunlop is an Australian researcher working in neuroplasticity, neuroscience and community programs for people with spinal cord injury.

<span class="mw-page-title-main">Bizhan Aarabi</span> Iranian-American neurosurgeon

Bizhan Aarabi is an Iranian-American neurosurgeon, researcher, author, and academic. He is a Professor of Neurosurgery at University of Maryland and the Director of Neurotrauma at the R Adams Cowley Shock Trauma Center.

Marjorie Wang is an American neurosurgeon, researcher, and academic. She is a professor of Neurosurgery and Director of the Complex Spine Fellowship Program at the Medical College of Wisconsin.

References

  1. ↑ "UHN Doctor Profile Page, Michael G Fehlings". www.uhn.ca. 2017. Retrieved 19 January 2017.
  2. ↑ "University of Toronto Department of Surgery Faculty Listing for Michael Fehlings". www.utoronto.ca. University of Toronto. Retrieved 19 January 2017.
  3. ↑ "University Health Network Doctor Details for Michael Fehlings". www.uhn.ca. University Health Network. 2017. Retrieved 19 January 2017.
  4. ↑ Search Results for author Fehlings M on PubMed .
  5. ↑ Agrawal, SK; Fehlings, MG (1996). "Mechanisms of secondary injury to spinal cord axons in vitro: role of Na+, Na(+)-K(+)-ATPase, the Na(+)-H+ exchanger, and the Na(+)-Ca2+ exchanger". The Journal of Neuroscience. 16 (2): 545–52. doi:10.1523/JNEUROSCI.16-02-00545.1996. PMC   6578655 . PMID   8551338.
  6. ↑ "Royal College :: Past Recipients in Surgery". Archived from the original on 2014-09-07. Retrieved 2014-08-25.
  7. ↑ Karimi-Abdolrezaee, S; Eftekharpour, E; Wang, J; Morshead, CM; Fehlings, MG (2006). "Delayed transplantation of adult neural precursor cells promotes remyelination and functional neurological recovery after spinal cord injury". The Journal of Neuroscience. 26 (13): 3377–89. doi:10.1523/JNEUROSCI.4184-05.2006. PMC   6673854 . PMID   16571744.
  8. ↑ Di Giovanni, Simone; Fehlings, Michael G.; Vaccaro, Alexander; Wilson, Jefferson R.; Singh, Anoushka; W. Cadotte, David; Harrop, James S.; Aarabi, Bizhan; Shaffrey, Christopher; Dvorak, Marcel; Fisher, Charles; Arnold, Paul; Massicotte, Eric M.; Lewis, Stephen; Rampersaud, Raja (2012). "Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS)". PLOS ONE. 7 (2): e32037. Bibcode:2012PLoSO...732037F. doi: 10.1371/journal.pone.0032037 . PMC   3285644 . PMID   22384132.
  9. ↑ "Global Spine Journal - Volume 7, Number 3_suppl, Sep 01, 2017". Sage Journals.
  10. ↑ Satkunendrarajah, Kajana; Karadimas, Spyridon K.; Laliberte, Alex M.; Montandon, Gaspard; Fehlings, Michael G. (October 2018). "Cervical excitatory neurons sustain breathing after spinal cord injury". Nature. 562 (7727): 419–422. Bibcode:2018Natur.562..419S. doi:10.1038/s41586-018-0595-z. ISSN   1476-4687. PMID   30305735. S2CID   52956151.
  11. ↑ "Dr. Charles Tator and Dr. Michael Fehlings Receive Award". www.tgwhfonline.ca/. Toronto General and Western Hospital Foundation. 2012. Retrieved 19 January 2017.
  12. ↑ Vaidya, A (30 July 2013). "Becker's Spine Review Dr. Michael Fehlings Receives Henry Farfan Award from NASS". www.beckerspine.com. ASC Communications. Retrieved 19 January 2017.
  13. ↑ "Winn Prize Past Recipients". www.societyns.org. The Society of Neurological Surgeons. 2013. Retrieved 19 January 2017.
  14. ↑ "Dr Michael Fehlings receives Diamond Jubilee medal in the Prime Minister's Parliament Hill Office". www.tgwhfonline.ca. Toronto General & Western Hospital Foundation. 2013. Retrieved 19 January 2017.
  15. ↑ "CAHS Fellows Directory". www.cahs-acss.ca/. Canadian Academy of Health Sciences (CAHS). 2017. Archived from the original on 23 May 2017. Retrieved 19 January 2017.
  16. ↑ "Class of 2014. New Fellows" (PDF). www. rsc-src.ca. The Royal Society of Canada. 2014. Archived from the original (PDF) on 7 July 2015. Retrieved 19 January 2017.
  17. ↑ Foundation, Ryman Prize. "Canadian neurosurgeon wins the 2019 Ryman Prize". www.rymanhealthcare.co.nz. Retrieved 2019-10-17.
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