Image Stereotactic Navigation for Primary Spine and Pelvis Tumor Resection and Reconstruction: A Narrative Review

Abstract

Primary tumors of the mobile spine, sacrum, and pelvis are rare but biologically aggressive lesions for which en bloc resection with tumor-free margins remains the single most important determinant of local control and long-term survival. The complex three-dimensional anatomy of these regions — dense neurovascular structures, visceral organs, and irregular bony corridors — has historically made it difficult to translate meticulous preoperative planning into an equally precise intraoperative cut. Stereotactic (image-guided) navigation, long established for pedicle screw placement in degenerative spine surgery, has increasingly been repurposed as an oncologic tool to guide osteotomies and reproduce preoperative resection plans in real time. This review synthesizes the current evidence base — anchored by a 2026 systematic review of 21 studies and 240 patients — describing how navigation is used in spine and pelvic tumor surgery, what outcomes have been reported, and where the technology is heading.