Tejas Subramanian, Alexander R Oles, George Li, Sree M Vemu, Junho Song, Stephane Owusu-Sarpong, Max Vaynrub, Takashi Hirase
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引用次数: 0
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.
期刊介绍：
The HSS Journal is the Musculoskeletal Journal of Hospital for Special Surgery. The aim of the HSS Journal is to promote cutting edge research, clinical pathways, and state-of-the-art techniques that inform and facilitate the continuing education of the orthopaedic and musculoskeletal communities. HSS Journal publishes articles that offer contributions to the advancement of the knowledge of musculoskeletal diseases and encourages submission of manuscripts from all musculoskeletal disciplines.
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