'I feel very honoured by this': Canadian neurosurgeon wins Ryman Prize for spinal cord research

Transcript

Dr. Michael Fehlings didn't even know he was nominated for the award.

But on Friday, New Zealand Prime Minister Jacinda Ardern presented the Canadian researcher with the 2019 Ryman Prize. The international award comes with a $250,000 prize ($210,170 Cdn) and is given to someone who directly impacts and enhances the quality of life for the elderly.

Fehlings is a neurosurgeon at Toronto Western Hospital and a professor at the University of Toronto.

Working with his colleagues and students at University of Toronto and Toronto Western Hospital, Fehlings has made significant advancements in improving the diagnosis and treatment of spinal conditions.

The award-winning research was also supported by the Swiss-based non-profit AO Foundation.

As It Happens guest host Nil Köksal spoke to Fehlings about his research and what it means to win the prestigious award. Here is part of their conversation.

First of all, Dr. Fehlings, congratulations. How did you find out you'd won?

It was a complete shock to me.

I was traveling to the United States, and when I got off the plane, I saw I had a missed call from New Zealand — turned out it was David King from the Ryman Foundation. 

He first let me know that I'd been nominated and then he said, "Oh, by the way, you've won the award."

It was just a total surprise, very humbling, and I feel very honoured by this.

You won this award for your work on degenerative cervical myelopathy. What exactly is that?

Imagine that your mind is totally clear. But your thoughts, your wishes, your commands cannot be translated into proper actions by your hands. Your legs don't work and you may have significant numbness and pain. You can't walk properly. Your handwriting is off and you're losing your independence.

That's what happens when your spinal cord doesn't work properly. The spinal cord conveys the signals from your brain to your body.

And the most common cause of spinal cord impairment in the world is a condition called degenerative cervical myelopathy, which results from progressive compression of the nerves in the spinal cord, in the neck area, the cervical area.

And this causes progressive dysfunction and problems with the nerve cells in the spinal cord. And, if left untreated, this will result in very profound impairment.

It really resets conventional thinking that I think a lot of lay people might have when they hear about spinal conditions. They think that there has to be an accident. But what you're saying is that's not the case in so many of these cases.

Yeah, that's correct. So people are generally aware of traumatic spinal cord injury, when we think of Christopher Reeve, Rick Hansen, and so on. And it's a devastating injury that results in the sudden loss of function.

But there's another type of spinal cord injury that we refer to as non-traumatic spinal cord injury, and it's far more common. The onset is more gradual and more progressive, and it can often occur in such a way that it's not recognized, or it's misdiagnosed.

And this occurs as a result of aging, with degeneration of the spinal ligaments and the soft tissues in the bones around the spinal cord. But it doesn't necessarily only affect older individuals. And, in fact, the average age of a person who gets this condition is in their mid-50s. But I've operated on people who are in their 20s who develop this condition.

It's estimated that perhaps as many as 10 per cent of individuals in our society will get this condition. So it's something that the public and general physicians need to be increasingly aware of.

Most individuals will describe the surgery as a game changer in their lives.- Dr. Michael Fehlings, neurosurgeon

What should people be looking for so they can prevent a misdiagnosis?

The typical symptoms involve problems with walking where you may trip. You may need to use a handrail on the stairs whereas previously you did not. And then, numbness, tingling and problems with dexterity in the hands.

The condition is often misdiagnosed as carpal tunnel syndrome.

And then the third issue that arises, but only in about half of patients, is significant pain in the neck. And the pain may be referred down one or both arms. When that occurs, usually the diagnosis is made more readily.

Can you give us a sense of how your work has helped one of your patients?

A typical scenario is typified by a patient I just operated on a couple of weeks ago. And this is an individual who was in my clinic and had significant problems with his walking and his hands weren't working properly anymore.

He had significant numbness in the hands and pain. He had degenerative arthritis. It had taken some time to make the diagnosis. He had significant pressure on the spinal cord.

We operated on this man. We released the pressure on the spinal cord, and then we reconstructed the spine because it was very arthritic and there was deformity.

And as soon as he woke up, he noticed that his hands felt differently. And then, within a day or two, he was starting to walk more steadily. Most individuals will describe the surgery as a game changer in their lives.

Can you understand why this is so often misdiagnosed? We talk a lot about the treatment of older people and how much attention is or isn't being paid to that segment of society.

There is a certain stigma that people have related to neurological conditions. We see this in the setting of Alzheimer's disease, Parkinson's and other neurodegenerative conditions.

It's frightening to individuals when they start losing function, and there's a sense of denial. And then it tends to get written off as, "Oh, it's just old age," unless the person is much younger.

This is not unlike the situation we faced with heart attacks in the 1960s and 70s and then stroke, where there needed to be major public awareness campaigns to enable individuals to self diagnose their symptoms.

And I think now the opportunity is there just to be aware of the potential.

Written by Morgan Passi and John McGill. Interview produced by Morgan Passi. ​​Q&A has been edited for length and clarity.