Column, Line-of-Sight, Margins, Ring: A Framework for Planning En Bloc Spondylectomies

Area of Science:

• Spine surgery
• Surgical oncology
• Orthopedic oncology

Background:

• En bloc spondylectomies are vital for malignant spinal tumor resection.
• Existing classification systems for these complex procedures are often impractical.
• A need exists for a standardized, user-friendly system for planning and classification.

Purpose of the Study:

• To introduce and evaluate the CLiMR (Column, Line-of-Sight, Margins, Ring) framework.
• To simplify and standardize the planning and classification of en bloc spondylectomies.
• To assess the correlation between the CLiMR framework and surgical outcomes.

Main Methods:

• Retrospective review of en bloc spinal tumor resections (October 2019-December 2024).
• Application of the CLiMR framework assessing four components: Column, Line-of-Sight, Margins, and Ring.
• Correlation of CLiMR scores with operative details, hospital stay, case duration, blood loss, and patient outcomes.

Main Results:

• The CLiMR framework demonstrated variability in scores across different surgical components.
• Higher CLiMR scores correlated significantly with longer hospital stays (R=0.64, P=.0012) and case durations (R=0.61, P=.0023).
• Increased CLiMR scores trended towards higher rates of local recurrence, positive margins, and complications.

Conclusions:

• The CLiMR framework offers a novel, practical method for planning and communicating en bloc spondylectomies.
• This system aids in standardizing assessment and surgical decision-making for complex spinal tumor resections.
• The CLiMR framework shows feasibility and provides a foundation for future validation studies.