Dr. Michael Fehlings, Vice Chair Research for the Department of Surgery, University of Toronto and Co-Director of the University of Toronto Spine Program looks back on a conference in Toronto that changed neurosurgery.

Aerial view of University Ave & Queen's Park

In 1996, I brought the annual conference of the International Neurotrauma Society to Toronto for the first time. Back then, I was a young assistant professor of neuroscience and neurosurgery at the University of Toronto, just four years into my career. One of my areas of specialism is spinal cord injury, and, at the time, I was developing a new concept called “secondary injury”.

The idea behind this is that, when someone has a spinal cord injury, there is an initial trauma when the spinal cord is crushed. Then, another process evolves from that mechanical trauma, caused by changes at molecular and cellular level that amplify the extent of the injury. My hope was that, by defining this idea of secondary injury, we could improve the timing and the nature of surgical intervention.

The Toronto conference in 1996 became a crucial turning-point for the development of this notion. First, from a scientific perspective, I learned about a new genetic discovery called “cell death apoptosis”: there are gene programmes that cause cells to die, and these are activated when someone is suffering from disease or trauma. This was an epiphany to me. It supported my thesis about secondary injury, and I began to think about how I could apply it to my own research.

Second, in 1996 I was getting a lot of pushback from an earlier generation of specialists who had more conservative ideas about how spinal injury patients should be treated. They put a great deal of emphasis on non-surgical interventions and bed rest. And here I was, in my early thirties, proposing that we should perform early surgeries. The conference, however, was such a large gathering of international scientists and clinicians that I also saw that there was a younger cohort who were buying into my theory.

Together, we devised a clinical trial to prove the utility of early surgical interventions, without which we were never going to satisfy the naysayers. I could not have built this consensus without the conference.

Medical research test tubes being refilled

Twenty-two years later, in 2018, I brought the event back to Toronto. For me, the event marked how far the field had evolved. The scepticism I had faced in 1996 had been replaced by a widespread acceptance. As a consequence of the trial we carried out, secondary injury has been accepted: it is now part of the teaching about spinal cord injury, is included in every textbook and has been translated into clinical guidelines.

Progress in medicine relies on sharing knowledge, disseminating it among practitioners and translating it from the laboratory into clinical settings. In my field, there are few better places in the world to achieve those goals than Toronto. The department at the University of Toronto, where I work, is ranked in the top five academic departments of surgery in the world. Toronto Western Hospital, where I practice, is one of the top ten hospitals in the world, and the faculty of medicine at the University of Toronto is also in the top ten worldwide.

Added to that, Toronto has a well-deserved reputation for being an open, cosmopolitan city. More than 180 languages are spoken here, and it is easier for international visitors to come to Canada than to the United States. Interestingly, Toronto is the most popular conference destination outside the US for Americans – partly because it is such an active hub for international scientific research. This is one of the reasons the conferences I have brought to Toronto have been so successful in terms of attendance and impact.

Over the years, I have become heavily involved in teaching and in figuring out how best to transfer medical knowledge from centres of learning like Toronto to countries with fewer resources than we have in Canada. In 2019 the city hosted the Global Spine Congress. This was an international meeting of almost 2,000 people sponsored by the AO Foundation, a large Europe-based philanthropic organization. The foundation, which has an endowment of almost US$2bn, focuses its funds and energy on improving the dissemination of scientific research.

One of the big things that evolved from the Global Spine Congress was the idea of “knowledge forms”. These are study groups made up of international researchers covering specific topics, such as spinal oncology and spinal trauma. The event created an opportunity to reach out to our community to build these collaborations.

During my career, I have trained more than 200 doctors and scientists, who are now working all around the world. I am confident that the study groups we established through the AO Foundation in 2019 will vastly improve the reach of new research. Perhaps we will gather in 20 years’ time to see what impact they have had.

‘Progress in medicine relies on sharing knowledge, disseminating it among practitioners and translating it from the laboratory into clinical
settings'