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A conversation with Michael G. Fehlings, MD, PhD, FRCSC, FACS, FRSC

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In this issue, Spine Surgery Today poses five questions to Michael G. Fehlings, MD, PhD, FRCSC, FACS, FRSC. Dr. Fehlings holds several academic positions at the University of Toronto (UT). He is a Professor in the Department of Surgery, Division of Neurosurgery, Vice Chair of the Department of Surgery and Co-Chair of the UT Spine Program.

Michael G. Fehlings

Dr. Fehlings also holds an academic chair — the Halbert Chair in Neural Repair and Regeneration — at the University Health Network (UHN), where he also holds the positions of Director of the Spinal Cord Clinic, Director of the Spinal Program and Staff Neurosurgeon. Dr. Fehlings works at the UHN Toronto Western Hospital campus.

Dr. Fehlings received his medical degree from the University of Toronto in 1983. Following general surgical training at Queen’s University, he entered the University of Toronto Neurosurgical Training Program. During his residency, Dr. Fehlings worked towards his doctorate, which he received at the Institute of Medical Sciences for his work on experimental spinal cord injury. In 1990, Dr. Fehlings became a Fellow of the Royal College of Physicians and Surgeons of Canada (Royal College) and became a Fellow of the American College of Surgeons in 2006. In 1991, he undertook a post-doctoral research fellowship at NYU Medical Center under Wise Young, MD, PhD, followed by a clinical spine fellowship under Paul R. Cooper, MD, at NYU. Dr. Fehlings joined the Neurosurgical Staff at the Toronto Western Hospital in 1992.

Dr. Fehlings is a member of the Editorial Board of Spine Surgery Today. He has received numerous awards, which include the Royal College Gold Medal in Surgery (1996), the Lister Award in Surgical Research (2006), the Leon Wiltse Award from the North American Spine Society (2009), the Olivecrona Award (2009), the top international award for neurosurgeons and neuroscientists awarded by theKarolinska Institute, for his contributions to spinal cord injury. Dr. Fehlings was named a Fellow of the Royal Society of Canada in 2014 in honor of his internationally acclaimed scientific contributions to neurosurgery and neuroscience.

Spine Surgery Today: What are your hobbies outside of practicing medicine and what do you enjoy doing to relax?

Michael G. Fehlings, MD, PhD, FRCSC, FACS, FRSC: I enjoy spending time with my family and have recently had the thrill of becoming a grandfather to a beautiful baby girl named Abigail Lily. This certainly marks a very happy transition in my life and does also serve to reorder one’s priorities.

Outside of family, I enjoy walks in the woods, bicycling and, in the winter, skiing (both cross-country and Nordic) and snow-shoeing. We recently built a beautiful vacation property in the Muskoka Lakes district of Northern Ontario. I try to spend as much time as possible at the lake house as it combines many of the things I enjoy most outside of medicine including nature, serenity and the opportunity to enjoy sporting activities.

Spine Surgery Today: Who has had the greatest influence on your career?

Fehlings: As a junior neurosurgery resident, I had the great fortune to meet Charles H. Tator, MD, PhD, FRCSC, FACS — one of the most important clinician-scientists in the field of spinal cord injury. Dr. Tator served as a role model, as an excellent neurosurgeon and an outstanding scientist who has focused on a very important question, namely, enhancing neural recovery after severe central nervous system injury. Because of my good fortune to become linked with Dr. Tator, I decided to focus my career in spinal neurosurgery and to undertake PhD research training in neuroscience with the focus on defining the key pathobiological events following spinal cord injury. The greatest areas of interest in terms of research continue to be the quest to enhance neural repair and regeneration after various forms of central nervous system injury. My initial focus was on traumatic spinal cord injury, which continues to be my great passion. However, I have now extended my research focus to include areas of non-traumatic brain and spinal cord injury arising from ischemia and progressive cord compression secondary to degenerative disease or cancer. I have had the great fortune to be able to translate a number of research discoveries from the laboratory into the clinic. These translational efforts have been greatly enhanced by my work in research networks including AOSpine, the North American Clinical Trials Network (NACTN), the Rick Hansen national research program in Canada and through my affiliation with the Wings for Life Foundation.

Spine Surgery Today: What advice would you offer a medical student today?

Fehlings: I would advise medical students that being a physician allows one the great privilege to be able to take care of patients who are in great need. As such, it is incumbent upon the medical student to train themselves to the best of their ability and to combine a passion for medicine with a quest for learning while at the same time maintaining humility and compassion. I would also encourage medical students to consider the option of combining an academic career in research with their clinical activities. While this combination is not for everyone, I feel some training in research is essential for the complete education of a physician.

Spine Surgery Today: Have you ever been fortunate enough to witness or to have been part of medical history in the making? If so, please explain.

Fehlings: I have had the great fortune to play a significant role in defining the pathophysiologic events after traumatic spinal cord injury which have now been referred to as the secondary injury cascade. Through my affiliation with Dr. Tator, we defined the critical role of post-traumatic ischemia in initiating the secondary injury events following traumatic spinal cord injury. This discovery has been translated into an important principle of caring for patients with spinal cord injury, namely maintaining spinal cord blood flow through hypertensive maneuvers. As a further effort to translate the concept of influencing secondary injury into the clinic, I embarked on a major prospective, multicenter effort to define the role in timing of surgical decompression after traumatic cervical spinal cord injury. This work culminated in the publication of the STASCIS trial which demonstrated that early surgical intervention for traumatic cervical spinal cord injury (within 24 hours after injury) resulted in significantly improved neurologic recovery for these patients. This work has now led to changes in clinical practice wherein early intervention for cervical spinal cord injury, and indeed most forms of spinal injury, has become the norm. It has been a great privilege for me to be involved with these translational research efforts.

Spine Surgery Today: What is up next for you?

Fehlings: I will continue to focus on translational efforts in neural repair and regeneration of the injured central nervous system. In particular, I hope to be able to translate a promising neuroprotective therapy (the sodium glutamate antagonist Riluzole) into clinical application for the treatment of acute spinal cord injury and the enhancement of neurologic outcomes in patients undergoing surgery for cervical spondylotic myelopathy and high-risk spinal deformity. I also hope to be able to translate regenerative therapeutics into the clinic. I am currently focusing on two main strategies: 1) using neural stem cells, and 2) using methods to block key inhibitory molecules in the central nervous system which prevent central nervous system regeneration. From a personal perspective, I plan to balance these research goals with a continued focus on mentoring my students and junior colleagues and spending more time with family and friends.