Robot-Assisted "Postage-Stamp" Vertebrotomy for Spinal Tumor Resection: Case Report

Background: Achieving adequate oncological margins in tumors involving the thoracic costovertebral junction is technically challenging because of complex regional anatomy and the need to preserve neurological and biomechanical integrity. This case report describes a robot-assisted margin-extension strategy after incomplete resection of a thoracic costovertebral chondrosarcoma. Methods: A 31-year-old man with grade 1 chondrosarcoma of the left sixth rib underwent second-stage surgical radicalization after prior incomplete resection with positive medial margins. Following multidisciplinary discussion, a single-stage posterior procedure was performed, including robot-assisted T4-T8 stabilization with radiolucent CFR-PEEK instrumentation and robot-assisted sagittal vertebral osteotomy ("Postage-Stamp Osteotomy") of T6 to achieve en bloc removal of the involved costovertebral segment. Results: The osteotomy was executed using a pedicle-referenced robotic trajectory workflow with sequential navigated drilling and controlled completion with a navigated osteotome. Total operative time was 379 min, with estimated blood loss of 800 mL. No major intraoperative neurovascular complications occurred. Histopathology confirmed negative margins. The patient was mobilized on postoperative day 1 and discharged on postoperative day 6 without new neurological deficits. Radiological follow-up at 3 months showed no recurrence, while clinical follow-up at 5 months demonstrated full return to baseline activities. Conclusions: This report describes a technically feasible robot-assisted margin-extension strategy in a highly selected thoracic spinal oncology scenario. Although long-term oncological conclusions cannot be drawn from a single case, tailored technology-enabled margin-oriented approaches may represent a case-specific option in carefully selected patients.