Clinical Decision Making and Outcomes of Sagittal Vertebral Resection: A Head-to-Head Comparison With Total Vertebral Resection.

OBJECTIVE

To compare perioperative burden, hardware outcomes, and oncologic control between sagittal vertebral resection (SVR) and total vertebral resection (TVR) for thoracolumbar tumors, and to propose a practical framework for SVR surgical decision making.

METHODS

Clinical data, operative parameters, and follow-up outcomes were retrospectively analyzed. To address baseline imbalances in tumor volume and preoperative embolization, a 1:1 propensity score matching was performed based on 5 critical covariates, resulting in a matched cohort of 78 patients (39 per group). Groups were compared using Student t-test or Mann-Whitney U-test for continuous variables and chi-square/Fisher exact test for categorical variables.

RESULTS

In the total cohort (39 SVR vs. 84 TVR), SVR significantly reduced blood loss (median 1,200 mL vs. 1,500 mL, p=0.016), transfusion (800 mL vs. 1,200 mL, p<0.001), complication rate (51.3% vs. 77.4%, p=0.004), and hospital stay (13.7 days vs. 19.0 days, p=0.012). Bilateral nerve root sacrifice was less frequent in SVR (41.0% vs. 69.0%, p<0.001). Negative surgical margins (71.8% vs. 73.8%, p=0.814) and local recurrence (12.8% vs. 13.1%, p=0.965) were comparable. Postmatching analysis (n=78) confirmed that even after balancing for tumor volume and embolization, the SVR group maintained significant advantages in blood loss (p=0.035) and operation time (p=0.041). Hardware failure occurred in 3 TVR patients (3.6%) but in none after SVR.

CONCLUSION

SVR significantly reduces perioperative morbidity while maintaining comparable oncologic outcomes relative to TVR. The superiority of SVR remains robust after propensity score adjustment for tumor complexity. By formalizing a type-based surgical decision-making framework, this study provides practical guidance for when and how SVR may be safely adopted as a standardized alternative to TVR in appropriately selected thoracolumbar tumors.