Advances in Stereotactic Navigation for Primary Spine and Pelvis Tumor Resection and Reconstruction: A Systematic Review

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.

Plain Language Summary

Current evidence regarding navigation technology for surgical resection of complex spine and pelvic tumors

Primary tumors of the spine and pelvis are rare and often aggressive. Removing them completely with negative margins is important for preventing recurrence, but surgery in these areas is technically challenging because of nearby nerves, blood vessels, and the irregular shape of the bones. The review included 21 studies with 240 patients who underwent surgery for primary spine or pelvic tumors using navigation systems across these studies, navigation was associated with a high rate of negative margins and a relatively low rate of local recurrence compared with historical reports with only a small number of complications were attributed directly to the navigation systems themselves. While preliminary data is promising, most studies were small, retrospective, heterogenous, and had limited follow-up significantly limiting our ability to draw clinically meaningful conclusions regarding navigation technology use.