Current status and future directions of stability reconstruction following spinal tumor resection_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Jian ,  DONG Jian

Department of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China;

Corresponding?author：

DONG Jian, Email: doctor_dong@126.com

Keywords：

Spine tumor; spinal stability reconstruction; reconstruction strategy

DOI：

10.7507/1002-1892.202512060

Video：

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Postoperative stability reconstruction following spinal tumor resection is a critical step to ensure functional recovery and quality of life for patients. This article systematically reviews the current status of anterior and posterior column reconstruction techniques after spinal tumor resection, including strategies such as bone cement augmentation, structural implants, and three-dimensional-printed personalized prostheses. It emphasizes the need for individualized treatment plans based on tumor type, anatomical location, and the patient’s overall condition. The article also highlights the importance of restoring sagittal balance, multidisciplinary collaboration, and complication prevention for long-term outcomes. In the future, innovations in biomaterials, along with the minimally invasive and intelligent evolution of surgical techniques, will further advance the goal of achieving stable, pain-free, and functionally effective spinal reconstruction for each patient, ultimately enhancing their quality of life.

1.	Liu WKT, Wong YW, Kwan KYH. Outcomes after total en bloc spondylectomy at a mean follow-up of 11 years. J Neurosurg Spine, 2025, 43(3): 265-272.
2.	Yu W, Chen D, Ding X, et al. A critical appraisal of clinical practice guidelines on surgical treatments for spinal metastasis. Eur Spine J, 2024, 33(5): 1868-1898.
3.	Barzilai O, Laufer I, Robin A, et al. Hybrid therapy for metastatic epidural spinal cord compression: technique for separation surgery and spine radiosurgery. Oper Neurosurg, 2019, 16(3): 310-318.
4.	Ahangar P, Aziz M, Rosenzweig DH, et al. Advances in personalized treatment of metastatic spine disease. Ann Transl Med, 2019, 7(10): 223. doi: 10.21037/atm.2019.04.41.
5.	Marcia S, Marini S, Anselmetti GC, et al. Vertebral augmentation for cancer patients. Br J Radiol, 2025, 98(1170): 817-827.
6.	Pusceddu C, Morera Fuster I, Ares-Vidal J, et al. Combined use of SpineJack and microwave ablation with CT and C-arm in the treatment of vertebral fractures in oncologic patients: a case- based technical note. Oxf Med Case Reports, 2025, 2025(4): omaf019. doi: 10.1093/omcr/omaf019.
7.	Zheng C, Qiu J, Zhou X, et al. Safety and efficacy of combined acetabular reconstruction and microwave ablation in the treatment of periacetabular metastatic disease: a retrospective clinical evaluation. Front Oncol, 2024, 14: 1484876. doi: 10.3389/fonc.2024.1484876.
8.	Pal K, Sheth RA, Patel MN. Keeping it “straight”: how to do spinal tumor ablation with vertebral augmentation. Tech Vasc Interv Radiol, 2024, 27(3): 100988. doi: 10.1016/j.tvir.2024.100988.
9.	Liu Q, He Y, Lei X, et al. Container plasty in advanced painful osteolytic vertebral metastases with posterior wall defect: a retrospective observational study. Clin Spine Surg, 2025, 38(3): E193-E199.
10.	Yang Z, Ma L, Gu Z, et al. Application of separation surgery combined with radiofrequency ablation and bone cement strengthening in thoracolumbar metastasis. J Vis Exp, 2024, (209). doi: 10.3791/67185.
11.	Chen Z, Lü G, Wang X, et al. Is 3D-printed prosthesis stable and economic enough for anterior spinal column reconstruction after spinal tumor resection? A retrospective comparative study between 3D-printed off-the-shelf prosthesis and titanium mesh cage. Eur Spine J, 2023, 32(1): 261-270.
12.	Glennie RA, Rampersaud YR, Boriani S, et al. A systematic review with consensus expert opinion of best reconstructive techniques after osseous en bloc spinal column tumor resection. Spine (Phila Pa 1976), 2016, 41 Suppl 20: S205-S211.
13.	Lewandrowski KU, Hecht AC, DeLaney TF, et al. Anterior spinal arthrodesis with structural cortical allografts and instrumentation for spine tumor surgery. Spine (Phila Pa 1976), 2004, 29(10): 1150-1158.
14.	黃杜軍, 陳秋洪, 陳雷. 脊柱腫瘤切除術后 3D 打印假體重建的近期療效. 中國修復重建外科雜志, 2021, 35(6): 786-788.
15.	李柘黃, 韋峰, 劉忠軍. 3D打印假體在脊柱腫瘤切除后脊柱重建中的應用. 中國脊柱脊髓雜志, 2020, 30(9): 833-837.
16.	Shen J, Yang M, Zhong N, et al. 3D-printed titanium prosthetic reconstruction of unilateral bone deficiency after surgical resection of tumor lesions in the upper cervical spine: clinical outcomes of three consecutive cases and narrative review. Clin Spine Surg, 2023, 36(7): 256-264.
17.	Zhou H, Liu S, Li Z, et al. 3D-printed vertebral body for anterior spinal reconstruction in patients with thoracolumbar spinal tumors. J Neurosurg Spine, 2022, 37(2): 274-282.
18.	Hirase T, Vemu SM, Boddapati V, et al. Customized 3-dimensional-printed vertebral implants for spinal reconstruction after tumor resection: a systematic review. Clin Spine Surg, 2024, 37(1): 31-39.
19.	Kato S, Yokogawa N, Shimizu T, et al. Posterior column reconstruction of the lumbar spine using en bloc resected vertebral arch in spinal tumor and deformity surgeries. Spine Surg Relat Res, 2024, 8(5): 534-539.
20.	Cecchinato R, Compagnone D, Verlaan JJ, et al. Does sagittal alignment after spinal reconstruction following en bloc tumor resection impact revision rate? A preliminary long-term retrospective study. Eur Spine J, 2025. doi: 10.1007/s00586-025-08789-x.
21.	Ehresman J, Pennington Z, Elsamadicy AA, et al. Fenestrated pedicle screws for thoracolumbar instrumentation in patients with poor bone quality: Case series and systematic review of the literature. Clin Neurol Neurosurg, 2021, 206: 106675. doi: 10.1016/j.clineuro.2021.106675.
22.	Archie AT, Waldrop RP, Kisinde S, et al. Modalities of failure of cement-augmented pedicle screws. Eur Spine J, 2025, 34(9): 3962-3977.
23.	Newman WC, Amin AG, Villavieja J, et al. Short-segment cement-augmented fixation in open separation surgery of metastatic epidural spinal cord compression: initial experience. Neurosurg Focus, 2021, 50(5): E11. doi: 10.3171/2021.2.FOCUS217.
24.	周健, 林紅, 李熙雷, 等. 在胸腰椎轉移瘤分離手術中應用短節段骨水泥強化椎弓根螺釘固定的臨床研究. 中國脊柱脊髓雜志, 2023, 33(4): 315-321.
25.	Yang M, Zhong N, Lou Y, et al. A novel and reproducible classification of cervical dumbbell tumors to inform surgical approach and reconstruction techniques. Spine (Phila Pa 1976), 2024, 49(10): 715-725.
26.	Zeng Y, Huang Z, Huang Z, et al. Ipsilateral fixation and reconstruction of the cervical spine after resection of a dumbbell tumor via a unilateral posterior approach: a case report and biomechanical study. Orthop Surg, 2023, 15(9): 2435-2444.
27.	Kwok M, Zhang AS, DiSilvestro KJ, et al. Dual expandable interbody cage utilization for enhanced stability in vertebral column reconstruction following thoracolumbar corpectomy: A report of two cases. N Am Spine Soc J, 2021, 8: 100081. doi: 10.1016/j.xnsj.2021.100081.
28.	Eltes PE, Turbucz M, Fayad J, et al. A novel three-dimensional computational method to assess rod contour deformation and to map bony fusion in a lumbopelvic reconstruction after en-bloc sacrectomy. Front Surg, 2022, 8: 698179. doi: 10.3389/fsurg.2021.698179.
29.	Kreatsoulas D, George A, Kolawole S, et al. Early versus late construct failure in spine metastatic disease: implications for surgical strategy and oncologic outcome. J Neurooncol, 2025, 171(3): 705-714.
30.	Turbucz M, Pokorni AJ, Hajnal B, et al. The biomechanical effect of lumbopelvic distance reduction on reconstruction after total sacrectomy: a comparative finite element analysis of four techniques. Spine J, 2024, 24(10): 1981-1992.
31.	Cherry A, Oitment C, Wunder J, et al. Lumbopelvic shortening and local host bone-to-host bone reconstruction: a surgical method for lumbopelvic fusion following total sacrectomy. Eur Spine J, 2022, 31(12): 3759-3767.
32.	Raso J, Chi J, Labaran LA, et al. Carbon fiber lumbopelvic reconstruction following sacral giant cell tumor resection: illustrative case. J Neurosurg Case Lessons, 2023, 5(11): CASE22555. doi: 10.3171/CASE22555.
33.	Hu P, Du S, Wei F, et al. Reconstruction after resection of C₂ vertebral tumors: A comparative study of 3D-printed vertebral body versus titanium mesh. Front Oncol, 2022, 12: 1065303. doi: 10.3389/fonc.2022.1065303.
34.	Wang Z, Truong VT, Liberman M, et al. Single-stage posterior approach for the en bloc resection and spinal reconstruction of T₄ pancoast tumors invading the spine. Asian Spine J, 2022, 16(5): 702-711.
35.	Caso R, Sutton W, Bains MS, et al. Chest wall resection and reconstruction for t4 non-small cell lung cancer. Semin Thorac Cardiovasc Surg, 2025. doi: 10.1053/j.semtcvs.2025.05.012.
36.	Lenga P, Bajwa AA, Schneider T, et al. High rate of pulmonary cement embolism after cement-augmented pedicle screw fixation: a 12-year single-center study. J Neurol Surg A Cent Eur Neurosurg, 2024, 85(2): 117-125.
37.	Wu C, Lee CY, Huang TJ, et al. Cement-augmented pedicle screw insertion assisted by spinal robotic systems for widespread spinal metastases. J Robot Surg, 2019, 13(4): 595-598.

1. Liu WKT, Wong YW, Kwan KYH. Outcomes after total en bloc spondylectomy at a mean follow-up of 11 years. J Neurosurg Spine, 2025, 43(3): 265-272.
2. Yu W, Chen D, Ding X, et al. A critical appraisal of clinical practice guidelines on surgical treatments for spinal metastasis. Eur Spine J, 2024, 33(5): 1868-1898.
3. Barzilai O, Laufer I, Robin A, et al. Hybrid therapy for metastatic epidural spinal cord compression: technique for separation surgery and spine radiosurgery. Oper Neurosurg, 2019, 16(3): 310-318.
4. Ahangar P, Aziz M, Rosenzweig DH, et al. Advances in personalized treatment of metastatic spine disease. Ann Transl Med, 2019, 7(10): 223. doi: 10.21037/atm.2019.04.41.
5. Marcia S, Marini S, Anselmetti GC, et al. Vertebral augmentation for cancer patients. Br J Radiol, 2025, 98(1170): 817-827.
6. Pusceddu C, Morera Fuster I, Ares-Vidal J, et al. Combined use of SpineJack and microwave ablation with CT and C-arm in the treatment of vertebral fractures in oncologic patients: a case- based technical note. Oxf Med Case Reports, 2025, 2025(4): omaf019. doi: 10.1093/omcr/omaf019.
7. Zheng C, Qiu J, Zhou X, et al. Safety and efficacy of combined acetabular reconstruction and microwave ablation in the treatment of periacetabular metastatic disease: a retrospective clinical evaluation. Front Oncol, 2024, 14: 1484876. doi: 10.3389/fonc.2024.1484876.
8. Pal K, Sheth RA, Patel MN. Keeping it “straight”: how to do spinal tumor ablation with vertebral augmentation. Tech Vasc Interv Radiol, 2024, 27(3): 100988. doi: 10.1016/j.tvir.2024.100988.
9. Liu Q, He Y, Lei X, et al. Container plasty in advanced painful osteolytic vertebral metastases with posterior wall defect: a retrospective observational study. Clin Spine Surg, 2025, 38(3): E193-E199.
10. Yang Z, Ma L, Gu Z, et al. Application of separation surgery combined with radiofrequency ablation and bone cement strengthening in thoracolumbar metastasis. J Vis Exp, 2024, (209). doi: 10.3791/67185.
11. Chen Z, Lü G, Wang X, et al. Is 3D-printed prosthesis stable and economic enough for anterior spinal column reconstruction after spinal tumor resection? A retrospective comparative study between 3D-printed off-the-shelf prosthesis and titanium mesh cage. Eur Spine J, 2023, 32(1): 261-270.
12. Glennie RA, Rampersaud YR, Boriani S, et al. A systematic review with consensus expert opinion of best reconstructive techniques after osseous en bloc spinal column tumor resection. Spine (Phila Pa 1976), 2016, 41 Suppl 20: S205-S211.
13. Lewandrowski KU, Hecht AC, DeLaney TF, et al. Anterior spinal arthrodesis with structural cortical allografts and instrumentation for spine tumor surgery. Spine (Phila Pa 1976), 2004, 29(10): 1150-1158.
14. 黃杜軍, 陳秋洪, 陳雷. 脊柱腫瘤切除術后 3D 打印假體重建的近期療效. 中國修復重建外科雜志, 2021, 35(6): 786-788.
15. 李柘黃, 韋峰, 劉忠軍. 3D打印假體在脊柱腫瘤切除后脊柱重建中的應用. 中國脊柱脊髓雜志, 2020, 30(9): 833-837.
16. Shen J, Yang M, Zhong N, et al. 3D-printed titanium prosthetic reconstruction of unilateral bone deficiency after surgical resection of tumor lesions in the upper cervical spine: clinical outcomes of three consecutive cases and narrative review. Clin Spine Surg, 2023, 36(7): 256-264.
17. Zhou H, Liu S, Li Z, et al. 3D-printed vertebral body for anterior spinal reconstruction in patients with thoracolumbar spinal tumors. J Neurosurg Spine, 2022, 37(2): 274-282.
18. Hirase T, Vemu SM, Boddapati V, et al. Customized 3-dimensional-printed vertebral implants for spinal reconstruction after tumor resection: a systematic review. Clin Spine Surg, 2024, 37(1): 31-39.
19. Kato S, Yokogawa N, Shimizu T, et al. Posterior column reconstruction of the lumbar spine using en bloc resected vertebral arch in spinal tumor and deformity surgeries. Spine Surg Relat Res, 2024, 8(5): 534-539.
20. Cecchinato R, Compagnone D, Verlaan JJ, et al. Does sagittal alignment after spinal reconstruction following en bloc tumor resection impact revision rate? A preliminary long-term retrospective study. Eur Spine J, 2025. doi: 10.1007/s00586-025-08789-x.
21. Ehresman J, Pennington Z, Elsamadicy AA, et al. Fenestrated pedicle screws for thoracolumbar instrumentation in patients with poor bone quality: Case series and systematic review of the literature. Clin Neurol Neurosurg, 2021, 206: 106675. doi: 10.1016/j.clineuro.2021.106675.
22. Archie AT, Waldrop RP, Kisinde S, et al. Modalities of failure of cement-augmented pedicle screws. Eur Spine J, 2025, 34(9): 3962-3977.
23. Newman WC, Amin AG, Villavieja J, et al. Short-segment cement-augmented fixation in open separation surgery of metastatic epidural spinal cord compression: initial experience. Neurosurg Focus, 2021, 50(5): E11. doi: 10.3171/2021.2.FOCUS217.
24. 周健, 林紅, 李熙雷, 等. 在胸腰椎轉移瘤分離手術中應用短節段骨水泥強化椎弓根螺釘固定的臨床研究. 中國脊柱脊髓雜志, 2023, 33(4): 315-321.
25. Yang M, Zhong N, Lou Y, et al. A novel and reproducible classification of cervical dumbbell tumors to inform surgical approach and reconstruction techniques. Spine (Phila Pa 1976), 2024, 49(10): 715-725.
26. Zeng Y, Huang Z, Huang Z, et al. Ipsilateral fixation and reconstruction of the cervical spine after resection of a dumbbell tumor via a unilateral posterior approach: a case report and biomechanical study. Orthop Surg, 2023, 15(9): 2435-2444.
27. Kwok M, Zhang AS, DiSilvestro KJ, et al. Dual expandable interbody cage utilization for enhanced stability in vertebral column reconstruction following thoracolumbar corpectomy: A report of two cases. N Am Spine Soc J, 2021, 8: 100081. doi: 10.1016/j.xnsj.2021.100081.
28. Eltes PE, Turbucz M, Fayad J, et al. A novel three-dimensional computational method to assess rod contour deformation and to map bony fusion in a lumbopelvic reconstruction after en-bloc sacrectomy. Front Surg, 2022, 8: 698179. doi: 10.3389/fsurg.2021.698179.
29. Kreatsoulas D, George A, Kolawole S, et al. Early versus late construct failure in spine metastatic disease: implications for surgical strategy and oncologic outcome. J Neurooncol, 2025, 171(3): 705-714.
30. Turbucz M, Pokorni AJ, Hajnal B, et al. The biomechanical effect of lumbopelvic distance reduction on reconstruction after total sacrectomy: a comparative finite element analysis of four techniques. Spine J, 2024, 24(10): 1981-1992.
31. Cherry A, Oitment C, Wunder J, et al. Lumbopelvic shortening and local host bone-to-host bone reconstruction: a surgical method for lumbopelvic fusion following total sacrectomy. Eur Spine J, 2022, 31(12): 3759-3767.
32. Raso J, Chi J, Labaran LA, et al. Carbon fiber lumbopelvic reconstruction following sacral giant cell tumor resection: illustrative case. J Neurosurg Case Lessons, 2023, 5(11): CASE22555. doi: 10.3171/CASE22555.
33. Hu P, Du S, Wei F, et al. Reconstruction after resection of C₂ vertebral tumors: A comparative study of 3D-printed vertebral body versus titanium mesh. Front Oncol, 2022, 12: 1065303. doi: 10.3389/fonc.2022.1065303.
34. Wang Z, Truong VT, Liberman M, et al. Single-stage posterior approach for the en bloc resection and spinal reconstruction of T₄ pancoast tumors invading the spine. Asian Spine J, 2022, 16(5): 702-711.
35. Caso R, Sutton W, Bains MS, et al. Chest wall resection and reconstruction for t4 non-small cell lung cancer. Semin Thorac Cardiovasc Surg, 2025. doi: 10.1053/j.semtcvs.2025.05.012.
36. Lenga P, Bajwa AA, Schneider T, et al. High rate of pulmonary cement embolism after cement-augmented pedicle screw fixation: a 12-year single-center study. J Neurol Surg A Cent Eur Neurosurg, 2024, 85(2): 117-125.
37. Wu C, Lee CY, Huang TJ, et al. Cement-augmented pedicle screw insertion assisted by spinal robotic systems for widespread spinal metastases. J Robot Surg, 2019, 13(4): 595-598.

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