HSS Journal - 2026-03-17 - Journal Article; Review
Advances in Stereotactic Navigation for Primary Spine and Pelvis Tumor Resection and Reconstruction: A Systematic Review.
Subramanian T, Oles AR, Li G, Vemu SM, Song J, Owusu-Sarpong S, Vaynrub M, Hirase T
Topics
Key Takeaway
Stereotactic navigation achieved negative surgical margins in 88.3% of primary spine/pelvic tumor resections across 21 studies (n=240), with only 1% of complications attributable to navigation itself.
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Summary
This systematic review evaluated stereotactic navigation for primary spine and pelvic tumor resection, extracting margin status, local recurrence, and complication data from 21 studies (n=240). Negative margins were achieved in 88.3% of cases; local recurrence occurred in 16% overall but reached 32.4% in chondrosarcoma. Two comparative studies suggested improved bony margins and lower recurrence risk with navigation versus nonnavigated controls.
Key Limitation
Only 2 comparative (navigated vs. nonnavigated) studies exist within the 21 included, precluding any controlled estimate of navigation's independent effect on oncologic outcomes.
Original Abstract
BACKGROUND
Primary spine/pelvic tumors are aggressive, and en bloc resection is often essential. While stereotactic navigation is increasingly used for instrumentation in spine surgery, its specific role in tumor resection remains incompletely defined.
PURPOSE
We sought to describe (1) reported rates of achieving negative margins, (2) local recurrence, (3) complications attributed to navigation, and (4) comparative outcomes from studies involving nonnavigated controls.
METHODS
We conducted a systematic review according to preferred reporting items for systematic reviews and meta-analysis guidelines. Databases were queried for studies investigating the use of stereotactic navigation in primary spine/pelvic tumor surgery. Outcomes including surgical margin status, local recurrence, and complications were extracted and qualitatively synthesized using a best-evidence approach.
RESULTS
Twenty-one studies with 240 patients were included. The mean patient age was 46 years with follow-up of 33.4 months. Tumors were most often located in the sacrum/pelvis (81.3%), followed by the thoracic (8.3%), cervical (5.8%), and lumbar spine (4.6%). Chordoma (31.7%) and chondrosarcoma (27.1%) were the most frequently reported types. Negative surgical margins were achieved in 88.3% of cases. Local recurrence was reported in 16% of patients, with the highest observed in chondrosarcoma (32.4%). Complications occurred in 30.3% of patients; however, only 1% (2 cases) were attributed to navigation use. Two comparative studies examining navigated versus nonnavigated cohorts suggested improved bony margins and lower recurrence risk with navigation.
CONCLUSION
Early studies suggest that stereotactic navigation may be a feasible and safe adjunct for the resection of primary spine/pelvic tumors, particularly in achieving adequate bony margins. However, the current evidence is limited to small retrospective studies with heterogeneity in methodology, tumor type, and follow-up.
LEVEL OF EVIDENCE
Level IV: Systematic review of level-III and level-IV studies.