JMIR Publications

ABSTRACT

Background:

Surgical resection and reconstruction for primary bone tumours of the spine aim to achieve en‑bloc or margin‑negative excision and restore spinal stability. Recent case series report mechanical complication rates of around 10 % to 24 % following spinal tumour surgery. Mechanical failures included rod fracture, cage subsidence, and junctional failure. Reported factors associated with mechanical complications in individual studies include spinal level, extent of vertebral resection, reconstructive strategy, intraoperative cage subsidence and duration of follow-up. Radiotherapy and impaired fusion are biologically plausible contributors to construct failure, although their independent effects remain uncertain in the available small and heterogeneous cohorts. Evidence regarding the incidence, distribution and determinants of mechanical complications following resection and reconstruction of primary osseous spinal tumours remains limited.

Objective:

To summarise and quantify the incidence of mechanical complications and construct failure in patients undergoing resection and reconstruction for primary bone tumours affecting spine. To classify the types of complications, identify patient and tumour‑related predictors, and explore how outcomes vary by tumour etiology, spinal level, and reconstructive technique.

Methods:

The review protocol adheres to the PRISMA guidelines and will be registered prospectively. MEDLINE, EMBASE, CINAHL, Scopus and the Cochrane Library will be searched from inception to 2026 for English‑language studies reporting mechanical complications following resection of benign or malignant primary bone tumours of the spine. Two reviewers will independently screen articles and extract data. Risk of bias will be assessed using Joanna Briggs Institute checklists. Mechanical complications will be summarised descriptively, and, if sufficiently homogenous, pooled incidence and risk estimates will be calculated using random‑effects meta‑analysis. Subgroup analyses will examine the influence of tumour type, spinal level, and reconstructive strategy on failure rates.

Results:

This review will provide a structured synthesis of the incidence, type, timing and clinical consequences of mechanical complications following resection and reconstruction for primary osseous spinal tumours. It will examine reported associations with tumour location, extent of resection, reconstructive strategy, adjuvant treatment and duration of follow-up, while identifying limitations in current reporting and priorities for future multicentre research.

Conclusions:

By systematically summarising the available evidence, this review aims to characterise the incidence and predictors of mechanical complications following resection and reconstruction of primary spinal bone tumours. The findings will hopefully inform interpretation of current evidence relevant to preoperative counselling, reconstructive planning and future research, while highlighting uncertainties that require investigation in larger multicentre cohorts.