ReviewEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
Is survival in primary spinal osteosarcoma determined by surgical margins or tumour biology? A systematic review.
Review in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
STUDY
designSystematic review.
objectiveTo 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.
methodsA 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.
resultsEighteen 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.
conclusionsPrimary 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.
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Registered trials
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