Advancing Metastatic Spine Tumor Research: A Review of AO Spine Knowledge Forum Tumor's Scientific Contributions Derived From the EPOSO Network, 2014-2024

Joost P H J Rutges¹, Scott L Zuckerman^{2

3}, Paul M Arnold⁴, Chetan Bettegowda⁵, Stefano Boriani⁶, Michelle J Clarke⁷, Michael G Fehlings⁸, Ziya L Gokaslan⁹, Aron Lazary¹⁰, Laurence D Rhines¹¹, Arjun Sahgal¹², Daniel M Sciubba¹³, James M Schuster¹⁴, Michael H Weber¹⁵, Ilya Laufer¹⁶, Charles G Fisher¹⁷; on the behalf of the AO Spine Knowledge Forum Tumor

Affiliations

¹ Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
² Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
³ Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
⁴ Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA.
⁵ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.
⁷ Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
⁸ Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, University Health Network, Toronto, ON, Canada.
⁹ Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
¹⁰ National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary.
¹¹ Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Centre, Houston, TX, USA.
¹² Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
¹³ Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA.
¹⁴ Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
¹⁵ Spine Surgery Program, Department of Surgery, McGill University, Montreal, QC, Canada.
¹⁶ Department of Neurosurgery, New York University Langone Health, New York, NY, USA.
¹⁷ Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, BC, Canada.

PMID: 40074676
PMCID: PMC11907629
DOI: 10.1177/21925682251326515

Review

Advancing Metastatic Spine Tumor Research: A Review of AO Spine Knowledge Forum Tumor's Scientific Contributions Derived From the EPOSO Network, 2014-2024

Joost P H J Rutges et al. Global Spine J. 2025 Jul.

. 2025 Jul;15(6):2999-3006.

doi: 10.1177/21925682251326515. Epub 2025 Mar 12.

Authors

Affiliations

¹ Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
² Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
³ Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
⁴ Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, USA.
⁵ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.
⁷ Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
⁸ Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, University Health Network, Toronto, ON, Canada.
⁹ Department of Neurosurgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
¹⁰ National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary.
¹¹ Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Centre, Houston, TX, USA.
¹² Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
¹³ Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA.
¹⁴ Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
¹⁵ Spine Surgery Program, Department of Surgery, McGill University, Montreal, QC, Canada.
¹⁶ Department of Neurosurgery, New York University Langone Health, New York, NY, USA.
¹⁷ Combined Neurosurgical and Orthopaedic Spine Program, University of British Columbia, Vancouver, BC, Canada.

PMID: 40074676
PMCID: PMC11907629
DOI: 10.1177/21925682251326515

Abstract

Study DesignNarrative Review.ObjectivesTo summarize the work of the AO Spine Knowledge Forum Tumor, specifically studies from the Epidemiology, Process and Outcomes in Spine Oncology (EPOSO) study.MethodsA narrative review of all published manuscripts from the EPOSO study was undertaken. EPOSO represents a multicenter, prospective registry effort across 10 North American and European sites to enroll patients with metastatic disease of the spine.ResultsThe current review summarized all studies from the EPOSO network, divided into the following five sections: (1) quality of life and satisfaction, (2) overall survival, (3) spinal instability, (4) neurologic outcome in patients with metastatic epidural spinal cord compression or radicular pain, and (5) patient and tumor-specific factors. Several important findings were elucidated. Patient evaluation should include SINS, nutritional status, severity and duration of neurologic deficit, extent of metastatic tumor burden, and differentiation of axial from radicular pain. Moreover, SOSGOQ2.0 serves as a useful and validated instrument for patient-reported outcome instrument. Despite the palliative nature of metastatic spine surgery, clear improvement in quality-of-life is seen. Even in patients with short-survival, the remaining weeks and months of life result in improved quality-of-life. Metastatic spine surgery often improves neurologic function, potentially enhancing survival through increased performance status.ConclusionsSeveral noteworthy results have come from the EPOSO network, highlighting important trends in metastatic spine care. The AO Spine Knowledge Forum Tumor has helped advancing metastatic spine tumor research as well as ensure these new findings reach and benefit clinicians and their patients.

Keywords: metastases; oncology; spine; tumor.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

**Figure 1.**
Key messages in the five areas of EPOSO research of quality-of-life, overall survival, stability/biomechanics, neurologic recovery, and patient/tumor factors.

See this image and copyright information in PMC

References

1. Versteeg AL, Verlaan JJ, Sahgal A, et al. The spinal instability neoplastic score: impact on oncologic decision-making. Spine. 2016;41 Suppl 20(20):S231-S237. doi: 10.1097/brs.0000000000001822 - DOI - PubMed
1. Fisher C. The Epidemiology, Process and Outcomes of Spine Oncology (EPOSO). Hong Kong: AO Foundation, AO Spine. https://clinicaltrials.gov/study/NCT01825161
1. Fisher C. Metastatic Tumor Research and Outcomes Network (MTRON). AO Innovation Translation Center. https://clinicaltrials.gov/study/NCT02830451
1. Barzilai O, Sahgal A, Rhines LD, et al. Patient-reported and clinical outcomes of surgically treated patients with symptomatic spinal metastases: results from Epidemiology, process, and outcomes of spine oncology (EPOSO), a prospective, multi-institutional and international study. Neurosurgery. 2024;95:1148-1157. doi: 10.1227/neu.0000000000002989 - DOI - PMC - PubMed
1. Versteeg AL, Sahgal A, Kawahara N, et al. Patient satisfaction with treatment outcomes after surgery and/or radiotherapy for spinal metastases. Cancer. 2019;125(23):4269-4277. doi: 10.1002/cncr.32465 - DOI - PMC - PubMed

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Advancing Metastatic Spine Tumor Research: A Review of AO Spine Knowledge Forum Tumor's Scientific Contributions Derived From the EPOSO Network, 2014-2024

Affiliations

Advancing Metastatic Spine Tumor Research: A Review of AO Spine Knowledge Forum Tumor's Scientific Contributions Derived From the EPOSO Network, 2014-2024

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

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