Current Projects

Clinical Research

Elucidating the effects of a prehabilitation program on spinal surgery candidates with cardiac comorbidities: A randomized controlled trial
• A randomized, controlled clinical trial to determine the effects of a physical activity and education based program pre-operatively on spinal surgery candidates with 3, or more cardiac risk factors.
• Collaboration with Dr. Robert Stevenson (Cardiology, Saint John Regional Hospital)
Please note this project is on hold due to COVID-19.

Effects of Intra-Operative Ropivaciane® Epidural Injection on Post-Operative Outcomes Following Elective Lumbar Fusion: A double blinded randomized controlled trial
• A double blinded, randomized controlled trial to test the efficacy of an intra-operative injection of Ropivaciane® on post-operative pain management.

National Registries in Which Canada East Spine Centre Participates

Canadian Spine Outcomes and. Research Network (CSORN)
• The objective of the CSORN registry study is to track specific outcome measures of different surgical techniques
used to treat spinal conditions. This multicentre Canadian study prospectively enrols patients with spinal
pathology primarily requiring surgical treatment. Registry data collection is comprised primarily of
participant and physician reported outcomes.

Praxis Spinal Cord Injury Institute
• Praxis is a Canadian-based not-for-profit organization that leads global collaboration in spinal cord injury research, innovation and care. The objective of Praxis is to provide translation of discoveries and best practices into improved treatments for people with traumatic and non-traumatic spinal cord injuries.

National Collaboration Prospective Registry Projects

Canadian Spine Outcomes and. Research Network (CSORN) substudy: Surgical Treatment of Adult Spinal Deformity
• To identify if significant regional variation occurs in the referral pattern and surgical treatment of adult spinal deformity patients in Canada.
• To determine if specific variables independently predict the clinical outcome of surgical intervention for adult spinal deformity.
• To determine if specific variables independently predict adverse events associated with adult spinal deformity surgery.
• To determine if specific variables independently predict the radiographic outcome of surgical intervention for adult spinal deformity.

Canadian Spine Outcomes and. Research Network (CSORN) substudy: Cervical Spondylotic Myelopathy
• To determine the natural history of CSM patients selected for conservative management based on mild non progressive symptoms or patients preference not to undergo surgery
• To determine the outcomes of patients decompressed anteriorly, posteriorly and with a combined anterior/posterior approach.
• To determine differences in outcome for patients undergoing laminectomy and fusion (LF) versus laminoplasty (LP) for multi-level CSM based on a Standardized Clinical Assessment and Management Plan (SCAMP)
• To perform cost-utility analysis for different surgical and non-surgical management strategies for CSM

Canadian Spine Outcomes and. Research Network (CSORN) substudy: Prediction of Neuropathic Pain Post Cervical Compressive Myelopathy Decompressive Surgery
• The objective is to determine if the occurrence of Neuropathic Pain Post Cervical Compressive Myelopathy
Decompressive Surgery be predicted preoperatively.
• To determine the prevalence rate and effects of Neuropathic pain on patients undergoing Cervical
Compressive Myelopathy Decompressive Surgery.

Canadian Spine Outcomes and. Research Network (CSORN) substudy: Surgical Treatment of Degenerative Spondylolisthesis: A Standardized Clinical Assessment and Management Plan (SCAMPS) Canadian Spine Society (CSS) Multicentre Prospective Cohort Study
• A prospective observational study aiming to classify surgical techniques for the management of degenerative spondylolisthesis based on the stability of the pathology.

Pediatric Spine Sub Study: PERFORM
•This multicentre Canadian study will prospectively enrol pediatric patients with spinal pathology requiring surgical treatment. The Canadian Pediatric Spine Society Sub-Study PERFORM (Pediatric Registry For Spine Outcomes and Research Metrics). The objective of the PERFORM sub-study is to track specific outcome measures of different surgical techniques. Data collection will be comprised primarily of pediatric participant and physician reported outcomes.

National Collaboration Retrospective Registry Projects

Conus medullaris recovery in motor strength, bowel and bladder function.
•Examine factors association with neurological improvements and the recovery of the bowel and bladder sphincters in patients with Conus Medullaris Injury using the Canadian Rick Hansen Spinal Cord Injury Registry (RHSCIR) from Praxis Spine Institute.
•Determine incidence and causes of conus medullaris injuries in a Canadian population

Multi-Level Decompression/Fusions are as Effective as Single Level Lumbar Spinal Stenosis Operations
• To determine if an increase in the number of segments fused in thoracolumbar spinal fusion surgeries effects intraoperative and long-term patient outcomes.
• Collaboration with St. Michael’s Hospital’s Dr. Ahn and CSORN registry

Minimally Invasive vs Open Thoracolumbar Decompression for Lumbar Spinal Stenosis in a diabetic Population
• Compare outcomes of patients with diabetes undergoing MIS vs. OPEN surgery for lumbar spinal stenosis (LSS).
• Collaboration with the CSORN registry

Postoperative Recovery Patterns Following Discectomy Surgery for Lumbar Radiculopathy
• To identify the trajectories of pain and disability in patients who underwent lumbar discectomy surgery, and to investigate the construct validity of the trajectory subgroups based on clinically meaningful changes.
• Collaboration with the CSORN registry

Exploring the Impact of the Covid-19 Lockdown on Spine Surgery Patients in Canada Introduction
• Determine if the emergence of a global pandemic affected the biopsychosocial profile of patients waiting for spine surgery across Canada.
• Determine if the emergence of a global pandemic affected the biopsychosocial profile of patients in early recovery from spine surgery across Canada.
• Collaboration with the CSORN registry

Are There Gender Based Differences in Outcomes for Elective Lumbar Spine Surgery in Canada?
• The purpose of this study was to determine gender differences in the outcome for lumbar decompression, microdiscectomy, and lumbar decompression and fusion, utilizing the national CSORN registry.
• Collaboration with St. Michaels Hospital Dr. Ahn and the CSORN registry.

Preoperative depression risk is associated with unfavorable trajectories of neck and arm pain following anterior cervical discectomy and fusion
• Identify postoperative trajectories of neck and arm pain in patients undergoing ACDF.
• Investigate the associations between preoperative depression and trajectory subgroup membership.
• Collaboration with the CSORN registry.

An Examination of Life Satisfaction(LS) Following Traumatic Spinal Cord Injury induced Quadriplegia (QP) and Paraplegia (PP): Comparing Society’s Expectations to Patient reported Life Satisfaction
• To see though the general population and individuals living with QP or PP will report average or above average LS, the no paralysis group will report higher levels of LS than individuals living with paralysis.
• To determine if unaffected individuals will report lower levels of LS when asked to imagine that they are living with paralysis, as compared to their actual levels of LS.
• To determine if individuals who imagine that they are living with paralysis will report lower LS than the LS reported by individuals actually living with paralysis.
• To determine if LS associated with living with QP will be lower than LS associated with living with PP in both the real paralysis and imagined paralysis groups.
• Collaboration with the Praxis Spinal Cord Institute and the University of New Brunswick Saint John

Opioid Prescribing Patterns of Spine Surgeons in Canada: Preliminary Investigation
• To investigate the opioid and nonsteroidal anti-inflammatory drug prescribing patterns of spine surgeons in Canada
• Collaboration with the Canadian Spine Society membership and CSORN registry.

Prospective Canada East Spine Centre Projects

Wait Time for Knee Arthroscopy: What are the Potential Impacts on Patients’ Quality of Life
• The objective is to determine if wait time for knee arthroscopy surgery is affecting physical health, mental health, and ability to work or study for patients over the age of 14.
• Collaboration with Dr. Brendan Sheehan (Saint John Orthopaedics) and McMaster University

Predictors of Post-Operative Urinary Retention in a Spinal Surgery Patient Population
• A prospective observational study to determine if post-operative urinary retention (POUR) in a spinal surgery population can be predicted by pre-operative administration of a self-report urinary tract symptoms measure (I-PSS questionnaire).
• Collaboration with Dr. Thomas Whelan (Urology, Saint John Regional Hospital).

Psychological Risk Factors for Poor Spine Surgery Outcomes
• A prospective, observational study to test the hypothesis that a combination of psychological risk factors can affect the recovery of a spine surgery patient.
• Collaboration with Dr. Dean Tripp (Pain Psychology, Queens University)

Cannabis and Spine
• Prevalence of Cannabis Usage throughout Canada pain, disability, and opioid use
• Collaboration with Sherbrooke Hospital in Sherbrooke, Quebec.

The impact of 3 or more cardiac comorbidities on spine surgical outcomes
• To determine if patients with stenosis with neuroclaudication who underwent fusion surgery with 3 or more cardiac comorbidities have worse adverse events, disability, death after spine surgery.

Diabetes, Gender and Spine Surgery
•To investigate the role of diabetes on gender undergoing with thoracolumbar spine surgery

MIS vs open spine surgery for patients who have lumbar spine stenosis and an ASA score of greater than 2
• Stenotic Patients with ASA scores of greater than 2 will have better operative outcomes when undergoing minimally invasive surgical (MIS) compared to open surgical (OPEN) thoraco-lumbar (TL) decompression with or without fusion for lumbar spinal stenosis (LSS).
• Stenotic Patients with ASA scores of greater than 2 will have better long-term surgical outcomes when undergoing MIS compared to OPEN TL decompression with or without fusion for LSS.

Upcoming Prospective Projects

National Occupational Classification National CSORN Registry Study
• This study will be proposed nationally to the CSORN Steering Committee through the Canadian Spine Society looking at the National Occupation Classification (NOC) codes and what jobs/industries affect those with spine surgery. This is a continuation of the Canada East Spine Centre’s initial project looking at how the NOC affects return-to-work tune, post-operative opioid use, chronic pain and disability in thoracolumbar surgery patients.

Retrospective Canada East Spine Centre Projects

The Importance of Resuscitation (DNAR) Orders with Patients Undergoing Spine Surgery
• This study would review elective spine surgery patients’ charts who are enrolled in the Canadian Spine Outcomes and Research Network (CSORN) registry to see if they had a DNAR form completed before their surgery from 2015 to 2020 at the Saint John site. To see the percentage of these patients who had this form completed and had intraoperative and in hospital AEs to those who did not have the form completed and experienced AEs.
• Collaboration with Nicole Miller RN (Horizon Health Network)

Paediatric Health-Related Quality of Life Outcomes Following Surgery for Adolescent Idiopathic Scoliosis
• To identify patient trajectories of recovery defined by change in health-related quality of life (HRQOL) following surgery for adolescent idiopathic scoliosis (AIS).
• Collaboration with the IWK in Halifax, Nova Scotia

Exploring the ability of radiographic parameters of stenosis severity to predict patient recovery patterns
• To explain if specific pathological features or severity of features in patients with lumbar spinal stenosis prior to surgery significantly adds to predictive models in the accuracy of surgical failure
• To identify if surgical failure in terms of improvements in pain and disability are independent of surgical correction.

Impact of undergoing thoracolumbar spine surgery on patient mental health
• To investigate the impact of thoracolumbar spine surgery on patients’ psychological profiles

Tissue Plasminogen Activator in Addition to Twist Drill Drainage as a Treatment for Chronic Subdural Hematomas – A Descriptive Analysis
• Compare volume of hematoma drainage when tPA is used in combination with either the BHD or TDD procedure for the drainage of cSDH.
• Describe haematoma recurrence rates following the use of tPA in combination with either the BHD or TDD procedure.
• Assess how often surgeons at this site are using tPA, and the parameters under which it is being used.

New Brunswick Inter-Professional Spine Assessment and Education Clinic (NB-ISAEC)
• Initially designed as a pilot project at Horizon's Saint John Regional Hospital and The Moncton Hospital to fill a gap in the current standard of care for low back pain patients, the program was created to better serve patients, and to help them return to good health through rapid assessment, and excellent individualized care. Canada East Spine Centre played a role in validating the program's success. They have shown success in reducing unnecessary imaging, improving overall patient outcomes, and reducing wait times.

Undifferentiated Presentation of Unilateral Hypoplasia of Cervical Pedicle and Contiguous Vertebral Hemangioma Case Report
• This case report demonstrates a rare presentation of cervical hemangioma with associated unilateral pedicle aplasia with features of both osseous erosion from the hemangioma, as well as morphologic abnormalities typically seen with absence of a pedicle. This study will also review the literature with regard to developmental pedicle abnormalities and vertebral hemangioma.

Photodynamic therapy and Spine
• PDT as part of a pre-operative decolonization strategy to decrease incidence of SSI in Orthopedic & Spine patient population