As the new Head of the Spine Program in the Division of Neurosurgery at UHN, Dr. Carlo Santaguida has come full circle. The Toronto spine surgeon trained at Toronto Western Hospital, and he has returned at a pivotal moment. This year, UHN launches its endoscopic spine surgery program, set to perform Toronto’s first spinal endoscopy.
We spoke with our complex spine surgery specialist about his mandate, the program’s greatest strengths, and how AI will reshape the patient journey. He also reflected on the nurse who first inspired him to pursue a career in health care — his mother.
What excites you most about your new role as Head of the Spine Program at UHN?
On a personal level, everything. I trained here, my mentors are here, and coming back to work with some of the best scientists and surgeons I’ve ever known is a real honour.
What excites me even more is my mandate for the future. Construction for the new surgical tower began in 2024 with an expected opening in 2028 and I’m here at the perfect time to make sure it’s built for the next generation of spine surgery.
The building blocks are already here: an incredible international reputation, great surgeons and great researchers. My job is to build a launching pad that takes us to the next level.
What does that next level look like?
We’re starting our endoscopy program now, with robotics to follow shortly. At the same time, we’re building a centralized, patient-centred intake system. Together, these will propel our program forward.
Why does endoscopic spine surgery matter for patients?
It’s the leading edge of minimally invasive surgery. Instead of making a large incision, we operate through an opening often less than a centimetre wide, using a thin tube with a tiny camera and light at its tip. This means less disruption to the muscles and tissue around the spine, so there is often less pain, faster recovery, and in many cases, patients go home the same day. Obviously, this really resonates with patients. Other Canadian centres offer it, but we intend to help make it mainstream here.
How will AI change the way patients experience spine care?
AI is already part of how we deliver care, and we’ll integrate it – along with other digital tools – at every step from referral to recovery.
From the moment a patient is referred, it can show them how long they’ll wait, match them with the right surgeon and give a sense of their likely outcome.
At their first visit, it helps us decide whether surgery is the right path and spot risks early.
In the OR, it helps us work with greater precision. During recovery, it lets us follow patients closely and step in if something isn’t going as expected.
Now that you have arrived at UHN, what aspect of the the Spine Program stands out?
The institutional alignment and groundswell of support for innovation in spine surgery is incredibly impressive. From personal support workers, nurses and technologists to surgeons and administration, everyone is excited.
With this kind of enthusiasm, I can’t imagine we won’t succeed.
What drew you to health care?
It was my mom. She found nursing later in life, after her kids were older, and I watched her go through nursing school. I remember her excitement when she brought home her first stethoscope and blood pressure cuff, and I wanted to be part of that.
It was seeing her become a nurse that inspired me. She went on to teach nursing, and we even crossed paths once on a rotation. She was essential to my entering health care, and everything followed from there.
Mentorship shaped the rest. As a medical student, I cold-emailed a surgeon in Montreal I’d read about, expecting no reply.
He invited me to join him the following Monday at 6:30 a.m. Stepping into the operating room, I found myself scrubbing into surgery for the very first time — and on a brain tumor removal, no less.
From that moment I knew I would be a neurosurgeon.
You’re known for your collaborative approach. What does that look like in practice?
Collaboration has long meant the multidisciplinary clinic, where several disciplines come together to treat a complex condition. That remains essential.
But I see it more broadly: giving everyone who touches the patient journey – including the patient – the tools to work together toward the best possible outcome.
As surgery becomes more technical, demands on staff will grow. We need to coordinate with imaging, sterilization, recovery and inpatient teams to plan our cases -so we make the most of our resources without straining the system. That takes full collaboration, from patient to environmental services.
Why is central intake such a priority for you?
Today, referrals often go to an individual surgeon who may not be the right fit for that condition. Some surgeons focus on the cervical spine and spinal cord, others on deformity or the lumbar spine. We can’t expect patients or community doctors to know those distinctions.
Once on a wait list, patients often have no idea when they’ll be seen, and we know long waits can hurt outcomes. Some referrals lack the information needed to triage them properly, so someone who urgently needs care may be ranked lower.
Central intake gives patients a role: sharing information, seeing expected wait times and learning whether another surgeon could see them sooner.
It can also identify people better served by a non-surgical path. I hope this becomes a model for all of Toronto. Its impact on the community may be greater than any technology we bring into the OR.
How will you prepare the next generation of spine surgeons?
At heart, I’m an educator. Helping patients is rewarding, but training others to help them has even greater impact. With so much innovation coming so quickly, I don’t want to leave anyone behind.
The apprenticeship model in the OR still holds, but we’ll also need to train people outside it. I envision a simulation-heavy environment where surgeons learn each new technology, like robotics and endoscopy, before using it in the OR.
What role does philanthropy play?
The Ministry of Health funds standards of care well and is an important partner. But before something new becomes a standard of care, we need another way to fund it.
These initiatives depend on research and like-minded donors who want to support this and see spine care delivered more efficiently, more safely and with better outcomes. Without philanthropic support, we would simply be maintaining what we have.
Without philanthropic support of research, we would simply be maintaining what we have.”
– Dr. Carlo Santaguida
What impact do you hope your work will have?
Spine surgery is one of the few reversible causes of neurological dysfunction we have. As procedures become routine and volumes grow, it’s important not to forget what we’re giving people: the ability to walk again, work again and enjoy life again. That impact is enormous.
Where do you see the spine program in five years?
I don’t think we’ll recognize today’s program. Centralized intake, personalized care and greater transparency will put patients at the centre of their care.
Endoscopy and robotics will transform the operating room. And after surgery, we’ll have many more ways to help patients get the full benefit of their treatment.
