RESEARCH ARTICLE | DOI: https://doi.org/PP-OPT-RA-0003
1. Department of Orthopedic Surgery, Central Medical Institute, Chicago, IL, USA
2. Department of Neuroscience, Western Research University, San Diego, CA, USA
3. Department of Spine Surgery, Apex Institute of Orthopedics, New Delhi, India
4. Department of Surgical Oncology, Kyoto University Hospital, Kyoto, Japan
*Corresponding Author: John M. Carter, Department of Orthopedic Surgery, Central Medical Institute, Chicago, IL, USA
Citation: John M. Carter, Meera V. Nair, Luis A. Gomez, Hana Takahashi (2025) Advances and Clinical Outcomes in the Surgical Management of Spine Disorders: A Retrospective Cohort Study J. Orthopedic Practice and Techniques1(1): dx.doi.org/OPT/PP.0003
Copyright 
:
© 2025 John M. Carter. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 20 June 2025 | Accepted: 27 June 2025 | Published: 04 July 2025
Keywords: orthopedic oncology; musculoskeletal tumors; limb salvage; osteosarcoma; neoadjuvant therapy; recurrence; surgical outcomes.
Background: Orthopedic oncology is a subspecialty that addresses the diagnosis and treatment of primary bone tumors, soft tissue sarcomas, and metastatic lesions affecting the musculoskeletal system. The field has evolved with advances in imaging, surgical techniques, and adjuvant therapies.
Objective: This study aims to evaluate clinical outcomes, recurrence rates, and limb salvage effectiveness in patients treated for musculoskeletal tumors at three tertiary care centers across different continents.
Methods: A retrospective review of 352 cases treated between 2015 and 2022 was conducted. Inclusion criteria involved patients aged 10–70 years with histologically confirmed musculoskeletal tumors undergoing surgical intervention. Data regarding demographics, tumor type, surgical modality, adjuvant therapy, recurrence, and survival were collected and analyzed.
Results: Of the 352 patients, 68% underwent limb-salvage procedures, while 32% required amputation. The five-year overall survival rate was 72%, with a recurrence rate of 18%. Osteosarcoma was the most prevalent malignancy (39%), followed by Ewing’s sarcoma (21%) and chondrosarcoma (16%). Patients treated with neoadjuvant chemotherapy followed by wide excision showed significantly better disease-free survival.
Conclusion: Multidisciplinary management and limb-salvage techniques have improved survival and functional outcomes in orthopedic oncology. Early diagnosis and tailored treatment remain critical for optimizing results.
Orthopedic oncology focuses on the management of tumors and tumor-like conditions of bone and soft tissues. While rare compared to other cancers, musculoskeletal tumors often pose significant challenges due to their aggressive nature, impact on limb function, and the complexity of surgical treatment. Over recent decades, innovations in imaging, molecular diagnostics, and treatment modalities have enhanced the prognosis and quality of life for patients with bone and soft tissue sarcomas. This study explores clinical patterns and surgical outcomes in orthopedic oncology across multiple centers in the US, India, and Japan. By comparing data across regions, the study seeks to identify global trends, assess the efficacy of various interventions, and highlight areas for further research.
Study Design and Setting
A retrospective multicenter study was conducted across three tertiary cancer centers: Midwest Cancer Center (USA), All India Institute of Medical Sciences (India), and Kyoto University Hospital (Japan).
Study Population
A total of 352 patients with confirmed primary or metastatic musculoskeletal tumors were included. Inclusion criteria:
Exclusion criteria included benign tumors, metastatic bone disease from unknown primaries, and incomplete follow-up data.
Data Collection
Electronic medical records were reviewed to obtain patient demographics, diagnosis, treatment modality (amputation vs. limb-salvage), use of chemotherapy/radiotherapy, recurrence, and overall survival.
Statistical Analysis
Data were analyzed using SPSS v26. Kaplan–Meier survival curves were constructed, and Cox regression was used to identify prognostic factors. A p-value <0>
Patient Characteristics
Among 352 patients, the median age was 27 years. The male-to-female ratio was 1.3:1. Most patients presented with stage II disease at diagnosis.
Tumor Types
Treatment Modalities
Outcomes
This study supports previous findings that limb-salvage procedures, when feasible, offer comparable oncologic outcomes to amputation while preserving function and quality of life. The data reinforces the role of neoadjuvant chemotherapy, especially in osteosarcoma and Ewing’s sarcoma, in improving tumor resectability and survival. High recurrence rates in certain subtypes underscore the need for improved margin control, precise preoperative planning, and postoperative surveillance. Cultural and healthcare disparities between countries were observed in treatment choices, reflecting availability of technology, early diagnosis, and patient awareness. This study is among the few to offer a cross-continental comparison, adding depth to the understanding of global orthopedic oncology practices.
Orthopedic oncology has made significant strides with the evolution of multidisciplinary approaches and limb-sparing surgeries. Survival outcomes continue to improve, especially with the integration of chemotherapy and radiotherapy protocols. However, recurrence and late presentation remain challenges. International collaboration and investment in early diagnostic tools are essential for continuing progress.
