Computer navigation-assisted surgery for musculoskeletal tumors: a closer look into the learning curve

Computer navigation-assisted surgery for musculoskeletal tumors has shown to reduce the risk of intra-lesional margins in resection. Experiences with this method are still limited to smaller case series.

We reviewed our first experiences in 24 patients in whom computer navigation-assisted surgery had been performed. In 7 of these patients (6 male and 1 female), this has influenced the surgical treatment plan and navigation was used for both tumor resection and reconstruction. Three of the patients suffered from a chondrosarcoma, 2 from an osteosarcoma, 1 from a fibrosarcoma and 1 from an Ewing's sarcoma. Tumors were localized in the femur (n = 2), the tibia (n = 1), the sacrum (n = 1), the humerus (n = 1), the ilium (n = 1) and in the gluteal region (n = 1).

The mean registration error was 0.9 mm. No intra-operative complications occurred. Two postoperative complications were observed which required revision surgery. Except for one marginal resection, all tumors were excised with wide margins. One patient suffered from a local recurrence, and one patient died of disease after distant metastatic dissemination.

Computer navigation-assisted surgery represents a safe and helpful tool for the resection of musculoskeletal tumors and may influence surgical treatment plans in selected cases to provide more limited resections. Surgeons should be aware of risks considering biomechanical and oncological consequences in doing so. Further investigations and the evaluation of newer techniques (e.g., computed tomography-guided navigation) are needed to assess long-term outcomes of computer navigation assistance in musculoskeletal tumor surgery.