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Published on: July 28, 2020
Is survival in primary spinal osteosarcoma determined by surgical margins or tumour biology? A systematic review
Vibhu Krishnan Viswanathan1,2, Sathish Muthu3,4, Dhibin Vikash Kolarpatti Ponnusamy3,5
1Department of Orthopaedic Surgery, University of Alabama, Birmingham, Alabama, USA, Birmingham, USA. drvibu007@gmail.com.
Study Design:
Systematic review.
Objective:
To synthesise evidence on surgical management, reconstruction strategies, adjuvant therapies, survival outcomes, local recurrence, and prognostic factors in primary spinal osteosarcoma, with emphasis on margin status and multimodal therapy.
Methods:
A PRISMA 2020-compliant systematic review was performed. PubMed/ MEDLINE, Scopus, Web of Science and Cochrane Library were searched through January 2026. Studies reporting outcomes in histologically confirmed primary spinal osteosarcoma were included. Institutional series and registry-based analyses were eligible. Extracted variables included surgical approach (en-bloc versus intralesional), reconstruction, chemotherapy, radiotherapy, survival, recurrence and prognostic factors. Owing to heterogeneity, qualitative synthesis was undertaken.
Results:
Eighteen studies comprising 2,239 patients were included. Registry cohorts reported median overall survival of 15-23 months and 5-year survival below 20%. In contrast, selected Institutional surgical series demonstrated median survival exceeding 4-6 years in patients undergoing aggressive resection. En bloc or Enneking-appropriate resection was associated with improved local control and superior unadjusted survival; however, multivariable analyses did not consistently confirm an independent survival benefit. Local recurrence ranged from approximately 10% following en-bloc resection to more than 40% after intralesional resection. Multimodal chemotherapy remained standard. Modern radiotherapy techniques, including intensity-modulated radiation therapy (IMRT), stereotactic body radiotherapy (SBRT), proton-beam therapy and carbon-ion therapy, were increasingly utilised, especially in anatomically unresectable disease.
Conclusions:
Primary spinal osteosarcoma carries poor population-level survival. Margin-negative resection improves local control, but outcomes are strongly influenced by tumour biology and stage. Multidisciplinary management at specialised centres is essential to optimise survival.
