Supporting high-quality clinical and translational research in the spine field

KF Tumor: Effect of the intervertebral disc conditions on the risk of vertebral fracture in metastatic patients

Cancer patients with metastatic vertebrae are at an increased risk of fracture. When evaluating this risk, we frequently look only at the bone—the actual vertebrae—without looking at the role played by the intervertebral discs (IVD). In this research project, we aim to evaluate what the IVDs contribute to the reduction, or increase, of the risk of fracture.

Right now, assessing the risk of fracture in patients with metastatic vertebrae is quite difficult. It relies to a large extent on the clinicians’ expertise. I hope that we can provide fundamental knowledge in order to improve the treatment of debilitated oncological patients. Deciding on the best prophylactic treatment for a patient is an unsolved challenge. I zoomed out from just the vertebrae to the spine and I hypothesize that the IVDs might help us provide better predictions.

I am a mechanical engineer by training, and working on bones or with living tissues is far removed from the typical tasks of an engineer. On the other hand, it is really interesting to see how engineering know-how can be applied to approach medical problems. The AO Spine Knowledge Forum Tumor is the best place to share this kind of knowledge. As an engineer, I am something of an outsider in the group, as it is mostly made up of clinicians. But it is a great place to receive fresh input, to exchange new knowledge and challenges and to be inspired. I am really happy to be a part of this group.

If I was asked to give tips to younger colleagues, I would advise them to stop believing that there is only one way to solve a problem. Use different approaches, try out different strategies and find inspirations in other fields. You may sometimes head in the wrong direction, but in the long term, it works.

KF Spinal Cord Injury (SCI): The Degenerative Cervical Myelopathy—Subjective and Objective Score (DCM-SOS), a novel outcome measure

In this project, we seek to develop and validate a novel method to categorize the severity of degenerative cervical myelopathy (DCM) in patients. Our proposed DCM Subjective and Objective Score (DCM-SOS) will combine subjective questions with a brief objective scored neurological examination in a short assessment of up to ten minutes.

DCM is a common condition in which degenerative arthritic changes occur, causing compression and impairment of the spinal cord. Patients with moderate to severe neurological impairment can be treated surgically, as can patients with mild impairment that subsequently deteriorates. Currently however, categorization of DCM severity is based solely on the modified Japanese Orthopedic Association (mJOA) score. It is a simplistic and subjective tool that assesses four domains on ordinal scales using terms such as ‘mild’ or ‘severe’. We hope the DCM-SOS, which will be designed as an extension to the mJOA score, will allow us to assess DCM severity with more accuracy and detail.

I am passionate about making a difference in patient outcomes, and in spine surgery, DCM presents perhaps the greatest opportunity to do so. It is among the most common and treatable neurological disorders, but is grossly under-studied in comparison with traumatic spinal cord injury, stroke, multiple sclerosis, and central nervous system tumors. Furthermore, surgical treatment of DCM is safe and highly effective, not only to prevent further neurological deterioration, but to improve neurological status. However, DCM is infrequently covered in medical curricula and diagnosis is often delayed, even by some specialists. Furthermore, mild DCM is poorly understood, with a lack of diagnostic criteria and tools designed to measure mild impairment.

My involvement in the AO Spine Knowledge Forum SCI for the past two years has been a tremendously positive experience. It has linked me with global experts in SCI to produce meaningful research and allowed my own career to blossom. I have been involved in numerous systematic reviews, clinical practice guidelines, education projects, and incubators for the AO Spine RECODE-DCM project. I am very grateful to have received this award, and I believe it will allow the DCM-SOS project to succeed. I expect the KF will continue to produce impactful research over the coming years and I look forward to ongoing participation in it.

KF Degenerative: Pinpointing the specific macrophage phenotypes involved in intervertebral disc hernia regression

The goal of my research project is to identify specific macrophage phenotypes with a high potential to be used in a therapy to reverse intervertebral disc herniation in the lumbar region. Lumbar disc herniation (LDH) occurs when the outer, fibrous layer of an intervertebral disc tears, often as a result of trauma or degeneration. The soft substance in the center of the disc subsequently protrudes outward, often causing pain in the lower back or legs and severely affecting mobility and quality of life. It is an unmet clinical need, for which no physiological therapy is presently delivering consistent improvements.

Although we still have a long way to go regarding product development and clinical validation, what we propose in the long run is a therapy that will offer an alternative to invasive and costly surgery to remove the herniated tissue. Macrophages, a type of white blood cell, play a key role in hernia regression and we’re hoping to use them to provide a minimally invasive solution for patients under conservative treatment with highly uncertain prognoses. The ultimate goal is to improve patients’ quality of life.

The AO Spine KF Degenerative brings together spine experts from around the world and allows us to collectively discuss topics that are central to patient care. Since I am a researcher and a biologist by formation, the support from this network, which is composed mainly of clinicians, is extremely important to me: it better attunes my research towards clinical needs, and it will certainly be key in translating this line of research into the clinical world.