29 May 2020
A collegial environment: AO Spine Knowledge Forum (KF) Tumor colleagues visit the National Center of Oncological Hadrontherapy (CNAO) in Padua, Italy. Pictured (left to right) are Stefano Boriani, Laurence Rhines, Cordula Netzer, Charles Fisher, Raphaële Charest-Morin, Michael Weber, Chetan Bettegowda, Jeremy Reynolds, Nicolas Dea, JJ Verlaan, John Shin, and Justin Bird.
Please tell us about your clinical work and what led you to this specialty.
For the past two years, I have practiced spine surgery at the Vancouver Spine Surgery Institute, a highly specialized organization within Vancouver (Canada) General Hospital. In this exclusively spine practice, we do everything. I’ve wanted to be a spine surgeon for as long as I can remember. My dad was a donor to Doctors Without Borders and from an early age I was fascinated by surgery. I wanted to help people.
Is it important to keep one foot in clinical practice and the other in research? Why?
I do think that’s important. Doing research forces you to always be up to date in your clinical practice so I think both of them are complementary. Being a researcher makes you a better clinician and being a clinician makes you a better researcher.
What are the biggest challenges faced by researchers in spinal oncology? Is research funding among these challenges?
Spinal oncology is a very small niche, and there are multiple pathologies. Spinal oncology—especially the primary tumor—is a rare disease and there is a lack of awareness. It can be difficult to get research funding under one umbrella, but I think as people know more about it, there will be more funding opportunities.
How did you become involved with AO Spine?
It started with my AO Spine Fellowship at Vancouver General Hospital in 2014–2015. One of my mentors was Dr Charles Fisher, who is chairperson of the AO Spine KF Tumor, and he integrated me into the KF. They were looking to publish a focus issue and for people to help with it. This KF has great discussions and is really a great opportunity to meet other people in spine.
Your research has earned some very prestigious honors, including the Canadian Orthopaedic Association’s Robert B. Salter award and recognizing excellence in basic science research and AO Spine North America’s Young Investigator Research Grant. Can you explain a bit about how researchers can leverage the AO Spine network to obtain extramural research funding?
One of the strengths of the KF Tumor is its members. We have the capacity to perform research because we have a broad group of researchers and centers. We have the necessary number of patients and a database that has been running for a couple of years. So, with this network as a strength and uniqueness, we are in a better position to appeal to grand funders. Every center wants to do its own research, but that can take many years, and we are stronger together. This network is unique to the AO.
In what other ways does your involvement with AO Spine benefit you professionally and—ultimately—advance scientific understanding in your field of practice and research?
AO Spine is a useful network in terms of all of the people I can reach out to with questions about complexities of cases. And because this is a global network, there are lots of opportunities for discovery. It’s a very collegial environment. It’s easy to reach out to people all over the world, and that’s really a strength of this KF.
What are you working on today in terms of research?
We’re working on the role of [human monoclonal antibody] denosumab in the treatment of giant cell tumors. We’re also looking at finding molecular predictors for response to that treatment. It’s very interesting and challenging, looking more at translating basic science into clinical practice. Additionally, the KF—with Lenny Verkooijen and principal investigator and Anne Versteeg and Charles Fisher as co-principal investigators—is working on the Patient Expectations and Perceptions in Spinal Oncology (PEPSO) study, which aims to develop an in-depth understanding of patient expectations of outcomes related to surgical treatment for spinal metastases. This is a collaboration between the Netherlands and Canada, and I am leading the project in Canada. We expect to publish within a year.
What do you think will be the next big breakthrough(s) in your area of research?
I’m interested in genome sequencing and finding targets for the treatments. Liquid biopsy, tumor markers and looking into the blood will one day replace imaging as a diagnostic tool. I think precision medicine and targeted treatments in the long term are the future of spinal oncology.