Spine - 2026-08-05 - Journal Article
Revision Negative Margin Resection Improves Prognosis After Enneking-Inappropriate Surgery in Primary Spinal Tumors.
Schaffer ED, Wilcoxon TA, Osgood A, Zhang AT, DeLaney TF, Passias PG, Schwab J, Hornicek FJ, Pedlow FX, Tobert DG
Topics
Key Takeaway
R0 revision resection after Enneking-inappropriate primary spine tumor surgery yielded 72.4% survival vs 23.1% for R1/R2 margins (P=0.04), but local recurrence still occurred in 37.5% of R0 cases.
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Summary
This study examined oncologic and surgical outcomes in 42 patients who underwent revision gross total resection for locally recurrent primary spine tumors (thoracic/lumbar) after Enneking-inappropriate index surgery at referring institutions. Overall local recurrence was 50% and 5-year survival was 66.7%. R0 margin status was the dominant prognostic factor: survival 72.4% vs 23.1% for R1/R2 (P=0.04), though local recurrence still reached 37.5% even with R0 margins, and the revision surgery rate was 40.5%.
Key Limitation
The 40% revision surgery rate and heterogeneous tumor histologies across a 28-year single-institution series introduce significant selection bias and limit generalizability of survival estimates.
Original Abstract
STUDY DESIGN
Retrospective cohort study of 42 patients with locally recurrent PST of the thoracic or lumbar spine after an EI resection performed by a referring institution. Patients were subsequently treated with gross total resection between 1995 and 2023. Outcome measures included local recurrence (LR), overall survival, mechanical complications, and functional outcomes.
OBJECTIVE
To report the outcomes of revision resection for PST after prior Enneking inappropriate (EI) resection and to compare these outcomes with published controls for index en bloc resection.
SUMMARY OF BACKGROUND DATA
En bloc resection is the preferred treatment for primary spine tumors (PST). This recommendation is supported by improvements in local control and overall survival in prior studies. Outcomes in the revision resection setting remain unclear.
METHODS
Demographic, clinical, oncologic, and surgical variables were abstracted from medical records. Margin status was graded R0, R1, or R2 per pathology report. Overall survival and LR were estimated using the Kaplan Meier method. Between-group comparisons utilized Chi-square and Wilcoxon rank-sum testing.
RESULTS
Local recurrence occurred in 50.0% of patients. Five-year overall survival was 66.7% and to-date overall survival was 54.8%. Surgical margin was the strongest predictor of outcome: local recurrence occurred in 37.5% of R0 resections, 50% of R1 resections, and 100% of R2 resections (P=0.20). R0 survival to-date was 21 of 29 patients (72.4%) and R1/R2 survival was 3 of 13 (23.1%) (P=0.04). The perioperative complication rate was 28.6% and the revision surgery rate was 40.5%.
CONCLUSIONS
Patients undergoing resection for PST following local recurrence after prior EI surgery experienced higher local recurrence rates and inferior survival compared with published cohorts for index en bloc resection. Yet, a negative margin revision resection improves oncologic prognosis. These data support early referral to a comprehensive spine tumor program as the standard of care for PST.