AOSpine Knowledge Forum Tumor

The AOSpine KF Tumor is an international working group composed of 8 steering committee members who meet on a regular basis to discuss research, assess the best evidence for current practices, and formulate clinical studies in the domain of spinal oncology. It is charged with conducting clinical research, developing AOSpine classifications, guidelines, and outcome measures.




Steering Committee

Charles Fisher
University of British Columbia
Vancouver, BC, Canada

Stefano Boriani
IRCCS Istituto Ortopedico Galeazzi
Milano, Italy

Ziya Gokaslan
The Warren Alpert 
Medical School of Brown University
Providence, RI, USA

Peter Pal Varga
National Center for Spinal Disorders
Budapest, Hungary

Laurence Rhines
The University of Texas MD Anderson Cancer Center
Houston, TX, USA

Chetan Bettegowda
Johns Hopkins University School of Medicine
Baltimore, MD, USA

Norio Kawahara
Kanazawa Medical University
Kahoku-gun, Japan

Arjun Saghal
Sunnybrook Health Sciences Center
Toronto, ON, Canada

Project overview

Status: Planning
​Project Title ​Investigator(s) ​Aim Outcomes
​PEPSO ​Patient Expectations and Perceptions in Spinal Oncology ​To develop an in-depth understanding of patient expectations of outcomes related to surgical treatment for spinal metastases.
Status: Executing​ ​ ​
​Project Title ​Investigator(s) ​Aim Outcomes
​​MTRON ​Metastatic Tumor Research and Outcomes Network (MTRON): a multicenter prospective registry for the management of metastatic spine tumors ​PI: Charles Fisher
Co-PI: Arjun Sahgal
​​To prospectively investigate the prognostic variables (clinical, diagnostic, and therapeutic) in patients diagnosed with metastatic spine tumor(s) that are associated with patient reported outcomes, morbidity, local control, and survival.
​PTRON ​Primary Tumor Research and Outcomes Network (PTRON): a multicenter prospective registry for the management of primary tumors of the spine PI: Charles Fisher
Co-PIs: Ziya Gokaslan, Laurence Rhines

To prospectively investigate the prognostic variables (clinical, diagnostic, and therapeutic) within subgroups of patients diagnosed with primary spinal column tumors that are associated with survival, local recurrence, morbidity, and patient reported outcomes.  

Status: Publishing​
​Project Title ​Investigator(s) ​Aim Outcomes
​​TERT (an extension of Primary Tumor Retrospective) ​An analysis of the role of the TERT promoter mutations in retrospectively collected primary spinal column tumors ​​PI: Chetan Bettegowda
Co-PI: Ziya Gokaslan
​​To determine the rates of TERT promoter mutation (mutation of the promoter of the telomerase gene [23348506,23348503]) and its prognostic significance in primary spinal column tumors.

​The Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO)

​PI: Charles Fisher
Co-PI: Ziya Gokaslan

​To prospectively collect patient, diagnostic and treatment variables along with disease specific and generic health related quality of life (HRQOL) data on consecutively treated patients with metastatic spine tumors.
Remark: This project received co-funding from the Orthopaedic Research & Education Foundation (OREF) through a Spine Prospective Clinical Research Grant.

Publication Summary
Status: Completed ​ ​ ​ ​
​Project Title ​Investigator(s) ​Aim Outcomes
​​Systematic Reviews ​​Systematic reviews about the outcomes of surgical treatment of metastases to the spine and primary tumors of the spine ​​PI: Charles Fisher
Co-PI: Michelle Clarke, Daniel Sciubba, and Daryl Fourney
​​To perform a systematic review of the literature for prognostic factors specific to:
1) surgical treatment of prostate metastases to the spine
2) surgical treatment of breast metastases to the spine
3) surgical treatment of renal cell metastases to the spine
4) surgical treatment of lung metastases to the spine
5) symptomatic vertebral hemangioma
To perform a systematic review of the literature for the management of malignant primary tumors of the spine.

​​​Publication summary

​Primary Tumor Retrospective ​Predictors of mortality and morbidity in the surgical management of primary tumors of the spine: a multi-center retrospective cohort study with a cross-sectional survival check ​PI: Charles Fisher
Co-PI: Ziya Gokaslan
​To determine what variables (clinical, diagnostic, therapeutic, or demographic) are asso¬ciated with local recurrence and survival within defined groups of primary malignant and benign bone and soft tissue spine tumors.
1) Overall Analysis—analysis of the complete collection.
2) Histotype Analysis—analysis of each tumor histotype. Each histotype (13 identified) will undergo a separate analysis by assigned project members.

Publication summary

Spine Oncology Focus Issue Focus Issue II in Spine Oncology: Evidence-based Medicine Recommendations for Spine Oncology
PI: Charles Fisher

To produce a Spine Oncology Focus Issue which synthesizes the best available evidence and expert opinion in the management of primary spinal column tumors and metastatic spine disease.

Publication summary 

KF Tumor Focus Issue

​FFPE Chordoma (an extension of Primary Tumor Retrospective) ​An analysis of the role of the single nucleotide polymorphism rs2305089 in retrospectively collected chordomas ​PI: Chetan Bettegowda
Co-PI: Stephen Yip

​To determine the role that the SNP rs2305089 has in the prognosis of chordoma patients by evaluating whether or not there is a relationship between the status of the SNP and various clinical outcomes/measures (e.g., survival, local recurrence, response to radiation therapy, response to chemotherapy, link to metastasis, demographics).

Publication summary
​SINS (Spinal lnstability Neoplastic Score)

​Interdisciplinary validity and reliability of the SINS instability score in radiologists and radiation oncologists

​PI: Charles Fisher ​To assess the inter- and intra-observer reliability and validity of SINS in radiologists and radiation oncologists. Publication summary