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.