Recognize a patient with spinal metastases faster and on time. This prevents unnecessary suffering and complicated (and expensive) emergency surgeries. This is what Jorrit-Jan Verlaan, Professor of ‘Mobility with spinal metastases’ at UMC Utrecht, is striving for.
Emergency room, Friday afternoon…
Mrs. de Jonge, a lively woman in her early sixties with a history of breast cancer, is brought into hospital. She can no longer walk and has lost control of her bladder. Her story – full of persistent back pain and uncertain diagnoses – ends in emergency surgery. Technically, it is successful, but she leaves the hospital in a wheelchair and will never walk again.
Mrs. de Jonge (a fictitious name) was the central figure in Jorrit-Jan Verlaan’s inaugural lecture on 25 April 2025. In his passionate and crystal-clear speech, titled Zorgeloos het weekend in (‘Entering a carefree weekend’), Jorrit-Jan shared his goals for the coming years, as professor of ‘Mobility in spinal metastases’ at UMC Utrecht.
“Half of the patients we operate on for spinal metastases arrive as emergencies,” Jorrit-Jan says. ”By then, their symptoms are often well advanced. And the outcome of emergency surgery is significantly worse than if we could have intervened earlier. Let’s make sure that patients like Mrs. de Jonge won’t come in on Friday afternoon anymore.”
Silent killer among metastases
Spinal metastases (cancer spread to the spine) are not rare. In the Netherlands, an estimated 25,000 people are annually diagnosed with this condition. These metastases often cause no symptoms at first. However, in some patients, the growing tumor will affect the stability of the vertebrae, making them unstable and putting pressure on the spinal cord.
“This process often progresses insidiously,” explains Jorrit-Jan. ”First, people will experience nagging back pain, and then they will become increasingly limited in their movement. It’s only when they will no longer be able to stand or walk – or when they become incontinent – that the realization sets in that something serious is going on. But by then, it’s often too late.”
Risk patients go unnoticed
The challenge? Recognizing high-risk patients in time. And this proves to be difficult in practice. General practitioners, who see patients first, rarely encounter these severe spinal metastases – on average, less than one patient every two years.
“They have to find the high-risk patient among more than 100 people a year with back pain,” says Jorrit-Jan. ”It’s like searching for a needle in a haystack.”
But even in hospital, it’s not guaranteed that such metastases will be spotted early on. ”Spinal metastases develop from various types of cancer, which means that multiple specialties are involved. But not every doctor immediately recognizes the warning signs, let alone the right urgency.”
Why always on Fridays?
A striking phenomenon: notably many patients with acute spinal complaints arrive on Fridays. Jorrit-Jan discusses research from the Netherlands and France confirming what health professionals in hospitals already suspected: Friday afternoon is the peak time for referrals with severe symptoms.
Why does this happen? According to Jorrit-Jan, the ‘weekend feeling’ plays an important role: ”Doctors, patients, and families don’t want serious problems lingering until the weekend. The consequence: everything will converge at the end of Friday. But just when it’s the weekend, the hospital is less staffed, making healthcare at that specific moment more demanding and more expensive.”
Collaborating for faster recognition
To recognize and treat spinal metastases earlier on, Jorrit-Jan and his team established a multidisciplinary outpatient clinic in 2017. Here, spinal surgeons and radiotherapists see patients together. People with back pain or instability –but no disability yet – are assessed in one day and immediately receive a treatment plan.
“This collaboration, which we now call ‘the Utrecht Approach’, has proven to be successful,” says Jorrit-Jan. ”We treat patients in time more often, with fewer complications. They go home faster, retain more control over their lives, and experience fewer limitations. And we can treat more precisely, without over- or under-treatment.”
Regional effort: OBI
To expand this approach, the ‘Oncomid Bone Metastasis Initiative’ (OBI: Oncomid Botmetastasen Initiatief) was started in 2022. This collaboration brings together the strength of hospitals in the Central Netherlands region, supported by the Oncomid oncology network. The initiative aligns perfectly with the ‘Integral Healthcare Agreement’ (IZA: Integraal Zorgakkoord): the agreements made between the Dutch Ministry of Health, Welfare, and Sports and a large number of healthcare stakeholders to keep healthcare good, accessible, and affordable.
“The idea behind OBI is simple,” says Jorrit-Jan. ”We want to recognize high-risk patients faster, treat them more effectively, and learn from each other’s experiences. Through good agreements and short lines of communication, we can save time and prevent unnecessary damage.”
An important part of OBI is the weekly digital meeting. Here, healthcare professionals from the entire region discuss patients. They share insights and coordinate treatments. ”We see that this collaboration is constantly improving. And the enthusiasm is contagious. Not just in the Central Netherlands, but even outside our region.”
“We all want to enjoy a carefree weekend, don’t we? Including our patients.”
Three red flags
To help healthcare professionals recognize and assess risk, the OBI network is developing two new tools.
The first tool is a recognition model with three key signals. ”What diagnosis corresponds to a drooping mouth corner, confused speech, and an arm that no longer functions well? These signals point to a stroke. And what should you do then? You call 112. The Dutch Heart Foundation has done excellent work with this ‘Mouth – Speech – Arm = Stroke alarm,’ by embedding those three simple characteristics and the corresponding call to action in healthcare professionals and the broader public. We want to develop a similar recognizable tool.”
Three easy characteristics/signals, followed by a call to action… What does this look like in the case of spinal metastases, according to Jorrit-Jan?
Signal 1: New back pain?
“This should be the first characteristic, as back pain often occurs in the natural course of the disease.”
Signal 2: History of cancer?
“With this characteristic, we reduce the chance that we are dealing with non-specific back pain.”
Signal 3: Does the back pain worsen with walking or changes in posture?
“This indicates instability, which significantly increases urgency.”
Is the answer to all signals ‘yes’?
“Then our call to action is: make a CT scan of the spine!” says Jorrit-Jan.
SMS system
The second tool, in addition to the signaling system, that Jorrit-Jan and his regional colleagues are working on is a so-called ‘SMS system’, with ‘SMS’ referring to Spinale Metastase Stadiëring (‘Spinal Metastasis Staging’).
“We’ve made a classification into four stages, from asymptomatic to neurological impairment. This allows healthcare professionals to determine how quickly they need to act with a patient and what to do,” explains Jorrit-Jan.
Both the signaling system and the SMS system are currently being tested in practice by PhD candidate Harmen Kuijten. Pilot studies will be launched this summer. In the second half of 2025, Jorrit-Jan and his team expect their first scientific publication. There is already significant international interest in both systems.
“We expect that these system will make a significant difference, in both the Netherlands and abroad. They will provide clarity and force healthcare professionals to act when it’s really necessary. But we also aim to raise awareness among patients and their families about changes in their bodies,” says Jorrit-Jan.
Technological acceleration
UMC Utrecht is also investing in innovative ‘predictive models’: with the help of AI and data from scans, algorithms will soon automatically recognize ‘red flags.’
“Imagine a system that automatically triggers an alert in the patient’s file when a scan shows something suspicious. That will greatly help us with early detection,” says Jorrit-Jan.
Furthermore, Jorrit-Jan’s team is researching factors that increase the risk of impairment or fractures. ”The work of PhD candidates like Bas Bindels, Netanja Harlianto, and Eline Huele lays the foundation for the technology of tomorrow. Smart healthcare that really helps.”
Better quality, lower costs
Earlier intervention does not only result in better but also less expensive healthcare. Emergency surgeries, rehabilitation, and home modifications can quickly add up to tens of thousands of euros per patient. By intervening earlier, treatments will be simpler, hospital stays shorter, and patients will recover faster.
“We’ve calculated that we save nearly two million euros annually with the Utrecht Approach,” says Jorrit-Jan. ”And that’s without upscaling nationally. If other regions adopt this approach, the savings could run into tens of millions per year. Proven better care at lower costs: that’s where we want to go.”
Shared responsibility
For Jorrit-Jan, it’s clear: this is not just a problem for one hospital, one medical specialty, or one region. ”Everyone working in healthcare – from general practitioners to specialists, from nurses to policymakers – has a role in this. We need to find each other, share knowledge, dare to collaborate, and invest in better structures.”
He sees a key role for young healthcare professionals. ”They can help spread the approach as pioneers. Not just in our region, but throughout the Netherlands. Because this problem exists everywhere.”
According to Jorrit-Jan, we have the knowledge, resources, and collaborative potential in the Netherlands to address these issues.
“We all want to enjoy a carefree weekend, don’t we? Including our patients. Let’s make sure they are seen in time, and let’s start today. Then, we can truly improve the quality of healthcare together.”
Who is Jorrit-Jan?
Jorrit-Jan Verlaan (1971) studied medicine in Leiden.
In Utrecht, he did his PhD research, and trained as an orthopedic surgeon.
Jorrit-Jan obtained his PhD in 2004, having researched a new minimally-invasive treatment of traumatic vertebral fractures.
In December 2020, he was appointed professor of Orthopedics at UMC Utrecht, with the chair ‘Mobility with spinal metastases’.
Jorrit-Jan also works with SentryX. He co-founded this spin-off company. It is closely linked to UMC Utrecht.
SentryX is developing a local, implantable painkiller without morphine, intended for patients who have just undergone back surgery. With this invention, he hopes patients will get on their feet faster and will be able to go home sooner. It is also meant to prevent people from becoming dependent on addictive painkillers. Initial results in patients are hopeful. Jorrit-Jan and his team hope to use the pain-relieving implant in other conditions as well, such as after hip surgery.
Jorrit-Jan lives in Zeist with his wife Willemijn, children Philip (15) and Oscar (11), and dog Nouschka.
Why did you choose oncological orthopedics?
“In my third year of medicine, I saw on TV how a ‘reversalplasty’ was performed at LUMC (university hospital at Leiden): a young patient had to give up his knee because of cancer but walked around again a few weeks later. You couldn’t see a thing!
A week or so later, I sat down with the orthopedist who had performed the operation (Professor Antonie Taminiau) to ask if I could do research with him. After that, I knew for sure that I wanted to become an orthopedist with a focus on oncology.”
