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Department of Surgery

Orthopaedic Surgery

Dr. Joel Finkelstein, MD, MSc, FRCS(C)

Associate scientist

Sunnybrook Health Sciences Centre
2075 Bayview Ave., Room MG 361
Toronto, ON
M4N 3M5

Phone: 416-480-6774
Fax: 416-480-4705

Clinical ProfileShow/hide details

Phone: 416-480-6774
Fax: 416-480-4705
Administrative Assistant:

Dr. Finkelstein has sub-specialty interest and expertise in spine surgery, particularly in trauma and oncologic reconstruction. His clinical practice involves traumatic and metastatic diseases of the spine, as well as degenerative disorders.

He is actively involved in post-graduate education in the University of Toronto's orthopaedic and spine program.

Research ProfileShow/hide details


  • B.Sc., 1984, University of Toronto, Canada
  • MD, 1988, University of Toronto
  • Fellowship training in spinal surgery, 1994-95, Sunnybrook Health Sciences Centre
  • Fellowship training in spinal surgery, 1995-96, Harborview Medical Center, Washington, USA
  • LMCC (licentiate), 1989, Medical Council of Canada, Canada
  • Medical license, 1989, Ontario Medical Association, Canada
  • FRCS(C), 1994, certification in orthopaedic surgery, Royal College of Physicians and Surgeons, Canada
  • American Board of Orthopaedic Surgery, July 16, 1999
  • M.Sc., 2010, U of T

Appointments and Affiliations:

  • Professor of Surgery University of Toronto, Evaluative Clinical Sciences, Holland Bone and Joint Research Program, Sunnybrook Research Institute
  • Associate professor, department of surgery, U of T
  • Staff surgeon, division of orthopaedic surgery, Sunnybrook
  • Associate staff, Odette Cancer Centre, Sunnybrook
  • Consulting medical staff, Baycrest Centre for Geriatric Care

Research Foci:

  • Clinical epidemiology related to metastatic disease of the spine: quality of life, survival and complications
  • Clinical epidemiology: outcome studies (spine), effect of response shift on outcomes
  • Biomechanics: metastatic spine, vertebroplasty
  • Trauma (spine): outcomes and evaluation of treatment protocols

Research Summary:

Dr. Finkelstein’s research has been involved with understanding the biomechanical effects of metastases on the spine and the outcome assessment and developing best practice guidelines for patient selection for patients with metastatic disease.

His research has more recently focused on patient reported outcomes for degenerative spinal conditions with an emphasis on Response Shift and Cognitive Appraisal which as well as the physical, encorporates the psychosocial factors which can affect how a patient interprets and evaluates changes in quality of life over time.

Machine Learning is the next horizon and his current research now uses artificial intelligence for predicting outcomes enabling clinicians to determine who best to operate on, what the best procedure may be and why are some patients doing better than others.

Selected Recent Grants, Publications and Chapters:


2022/9 -2025/12 Co –Investigator: Intelligent image segmentation, registration and 3-dimensional visualization in a unified virtual reality workflow for image guided therapy Funding Source: INOVAIT Focus Fund. Total Funding Wesolowski, M, (PI), Hardisty, M, Beg, Mirza Faisal; Finkelstein, Joel; Popuri, Karteek; $1,099,521 CDN

2022 January Co- Investigator. Funding Source CIHR: Quantifying Osteosarcopenia Progression with Imaging Biomarkers in Prostate Cancer. PI: M. Hardisty . Co- Investigators: M. Akens R. Charest-Morin U. Emmenegger, J. Finkelstein, F. Lyons, A. Martel, J. Street, C. Whyne $636,180 CDN (5 years)

2021/1 Co-Investigator. Funding Source INOVAIT’s Strategic Innovation Fund, Sunnybrook Research Institute. “Artificial intelligence applied to planning, clinical diagnostics and stability assessment in spine stereotactic body radiation therapy (SBRT)” PI: Michael Hardisty. Collaborators: Felix Baldauf-Lenschen, Noel Camille, Cari Whyne, Arjun Sahgal, Anne Martel Joel Finkelstein, Jay Detsky, 125000 CDN

2013/12 – 2016/12 Co-Investigator. Funding Source: Qatar National Research Fund (QNRF).Multi-physics modeling and validation of the couple dynamic response of whiplash trauma and head restraint. Principle Investigator:. Shaker Meguid. Co-Investigators: Joel Finkelstein, Cari Whyne 800,000 USD.

2011/6- 2013/6 Co-Investigator. Funding Source: Center for Spinal Trauma, Sunnybrook Health Sciences Centre. Therapeutics and imaging for the injured spinal cord: MRI guided focused ultrasound and viral delivery across the blood spinal cord barrier Principal Investigator: Whyne Cari: Co-Investigators: Aubert I, Chopra R, Finkelstein J, Hynynen K, Staniscz G, Yee A. 40000 CDN

2009/7- 2011/6 Principal Investigator. Funding Source: Physicians Services Incorporated Foundation (The) (PSI).Grant# 08-52. Enhancing the application of health-related quality of life evaluations for guiding clinical care: An Examination of changes in appraisal in lumbar degenerative disease patients before and after surgical intervention. Principle Investigator: Joel Finkelstein 59,000 CAD

2008/7 – 2012/6 Collaborator. Funding source:Canadian Institutes of Health Research (CIHR). Bone stability and tumour burden in the metastatic spine: Implications of variable disease patterns. PI: Whyne, Cari, PhD. Collaborator(s): Joel Finkelstein MD, Albert Yee MD. 94,966 CAD.

Selected Publications:

  1. Carolyn E. Schwartz, Roland B. Stark, Phumeena Balasuberamaniam, Mopina Shrikumar, Abeer Wasim, Joel A. Finkelstein. Moving toward better health: Exercise practice is associated with improved outcomes after spine surgery in individuals with degenerative lumbar conditions. Canadian Journal of Surgery 2021 Jul 29;64(4):E419-E427. doi: 10.1503/cjs.010620.
  2. Joel A. Finkelstein, Roland B. Stark, James Lee, Carolyn E. Schwartz. Patient factors that matter in predicting spine surgery outcomes: a machine-learning approach. Journal of Neurosurgery Spine .2021 May 21;1-10. doi: 10.3171/2020.10.SPINE201354.
  3. Carolyn E. Schwartz ScD, Roland B. Stark MEd, Phumeena Balasuberamaniam, Mopina Shrikumar, Abeer Wasim and Joel A. Finkelstein MD, MSc, FRCS(C) Responsiveness of standard spine outcome tools: do they measure up? Journal of Neurosurgery: Spine. Vol. 32 DOI: SRA
  4. Robarts S, Razmjou H, Yee A, Palinkas V, Finkelstein J. Psychometric properties of the Optimal Screening for Prediction of Referral and Outcome Yellow Flags (OSPRO-YF) in patients with lumbar spine pain, European Journal of Physiotherapy 2019 Dec DOI: 10.1080/21679169.2019.1706633 SRA
  5. Joel A. Finkelstein, Carolyn E. Schwartz, Invited review for 75th Anniversary Edition – Patient reported outcomes in spine surgery: Past, current and future directions”. Journal of Neurosurgery: Spine. Vol. 31. Pages155-164:2019. DOI: 10.3171/2019 PA
  6. Schwartz CE, Zhang J, Rapkin BD, Finkelstein JA. Reconsidering the minimally important difference: evidence of instability over time and across groups. Spine J. 2019 Apr: 19(4): 726-34.doi: 10.1016/j.spine.2018.09.010 SRA
  7. Mohammad Obeidat, Zachary Tan, Joel A. Finkelstein. Cortical bone trajectory screws for fixation across the cervicothoracic junction: Surgical technique and outcomes. Global Spine Journal. Vol. 9 Page 859-65, 2019. (Trainee publication, Mohammad Obeidat, spine fellow) SRA
  8. Tan Zachary, MD, McLachlin Stewart PhD, Whyne Cari, PhD, and Finkelstein Joel, MD, MSc, FRCSC. Validation of a freehand technique for cortical bone trajectory screws in the lumbar spine. Journal of Neurosurgery Spine. Volume 31. Pages 201-208. April 19, 2019;DOI: 10.3171/2019.1.SPINE181402. (Trainee publication, spine fellow Zachary Tan) SRA
  9. Nater A, Tetreault LA, Kopjar B, Arnold PM, Dekutoski MB, Finkelstein JA, Fisher CG, France JC, Gokaslan ZL, Rhines LD, Rose PS, Sahgal A, Schuster JM, Vaccaro AR, Fehlings MG. Predictive factors of survival in a surgical series of metastatic epidural spinal cord compression and complete external validation of 8 multivariate models of survival in a prospective North American multi centre study. Cancer, 2018 Jul 5. Doi: 10.1002/cncr.31585. PMID: 29975401. CA
  10. Schwartz CE, Stucky B, Rivers CS, Noonan VK, Finkelstein JA, RHSCIR Network. Quality of life and adaptation in people with spinal cord injury: Response shift effects from 1 to 5 years postinjury. Arch Phys Med Rehabil. 2018 Mar 2. Doi: 10.1016/j.apmr.2018.01.028 (Epub ahead of print). SRA
  11. Carolyn E. Schwartz, Joel A. Finkelstein, Bruce D. Rapkin. Appraisal assessment in patient-reported outcome research: Methods for uncovering the personal context and meaning of quality of life. Quality of Life Research. 2017 26:545.doi;10.1007/s11136-016-1476-2. CA
  12. Schwartz, Carolyn E; Ayandeh, Armon; Finkelstein, Joel A. When patients and surgeons disagree about surgical outcome: Investigating patient factors and chart note communication. Health and Quality of Life Outcomes. 2015 Sep 29;13(1):161. SRA
  13. R. Rampersaud, C. Fisher, A. Yee, J. Finkelstein, D. Alexander. Health related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: A Canadian multicenter study. Canadian Journal of Surgery. 2014 Aug 3;57(4):E126-33. doi: 10.1503/cjs.032213. CA
  14. Carolyn E. Schwartz, Tolulope T. Sajobi, Lisa M. Lix, Brian R. Quaranto & Joel A. Finkelstein. Changing values, changing outcomes: The influence of reprioritization response shift on outcome assessment after spine surgery. Quality of Life Research. 2013 Nov 22;22(9):2255-64. DOI 10.1007/s11136-013-0377-x. ISSN 0962-9343.SRA
  15. Joel A. Finkelstein, Brian R. Quaranto & Carolyn E. Schwartz. Threats to the internal validity of spinal surgery outcome assessment: Recalibration response shift or implicit theories of change? Applied Research in Quality of Life. 2014. Volume 9, Issue 2, pp 215-232. DOI 10.1007/s11482-013-9221-2, ISSN 1871-25874. PA
  16. Carolyn Schwartz, Joel Finkelstein, Mirjam Sprangers, Rita Bode, Brian Quaranto, Paul Glazer. Doing good, feeling good, and having more: Resources mediate the health benefits of altruism differently for males and females with lumbar spine disorders. Applied Research in Quality of Life. 7(3).September 2012. DOI 10.1007/s 11482-012-9165-y. CA
  17. Phumeena Balasuberamaniam, Abeer Wasim, Mopina Shrikumar, Tan Chen, Tracey Anthony, Andrea Phillips, Avery Nathens, Martin Chapman, Eric Crawford, Carolyn E. Schwartz, Joel Finkelstein. Predictors of hospital-acquired pressure injuries in patients with complete spinal cord injury: a retrospective case-control study. BMC Musculoskeletal Disorders. (2023) 24:329
  18. Finkelstein, S., Oliogu, E., Yee, A. Milton L, Rivlin L, Henry P, Behroozian T, Chow E, Finkelstein J. Literature review on the use of methoxyflurane in the management of pain in cancer-related procedures. Support Care Cancer 31, 232 (2023).
  19. Ayling O, Rampersaud YR, Candurand C, Yuan P, Ailon T, Dea N, McIntosh G, Christie S, Abraham E, Bailey C, Johnson M, Bouchard J, Weber M, Pquet J, Finkelstein J, Stratton A, Hall H, Manson N, Thomas K, Fischer C. Surgical outcomes of patients who fail to reach minimal clinically important differences: comparison of minimally invasive versus open transforaminal lumbar interbody fusion. J Neurosurgery Spine 37;376-383; 2022.
  20. Carolyn E. Schwartz, Bruce D. Rapkin, Katrina Borowiec and Joel A. Finkelstein. Cognitive processes during recovery: Moving toward personalized spine surgery outcomes. J. Pers. Med., 12(10), 1545; September 20, 2022. SRI.
  21. Kunal Bhanot, Jessica Widdifield, Anjie Huang, J Michael Paterson, David Shultz, Joel Finkelstein. Survival after surgery for spinal metastases: A population based study. Can J Surg. 65 (4). Published Aug 4. 2022. Doi: 10.1503/cjs.000921

Book Chapters:

  1. Michael Hardisty, Joel Finkelstein, Jay Detsky, Isabelle Thibault, Arjun Sahgal. Vertebral compression fracture post-spine SBRT. In "Image-Guided Hypofractionated Stereotactic Radiosurgery" Chapter 20. 2021 (In press) Co Author
  2. Edward Chow, Joel A. Finkelstein, Arjun Sahgal, and Robert E. Coleman. Metastatic cancer to the bone. In: Wolters Kluwer Health/Lippincott Williams & Wilkins, editor(s). Devita, Lawrence, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th Edition. (United States): Lippincott Philadelphia; Chapter 119 page 1970-1982; 2018. Co PA

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