OBJECTIVE: To generate pooled estimates of instrumentation failure (IF), complication, mortality, and local recurrence rates after total en bloc spondylectomy (TES), and to quantify the influence of follow-up duration on reported IF rates.
SUMMARY OF BACKGROUND DATA: TES offers margin-free resection for primary spinal malignancies and selected solitary metastases but carries substantial perioperative hazards and a delayed risk of IF. How the duration of postoperative observation shapes reported IF rates has not been formally quantified.
METHODS: Four databases (PubMed, EMBASE, Cochrane CENTRAL, OVID Medline) were searched from database inception through June 2026 for English-language studies reporting TES outcomes in adults. Event rates were pooled using DerSimonian-Laird random-effects models. Meta-regression tested whether mean follow-up duration explained heterogeneity in IF rates. Methodological quality was graded with MINORS.
RESULTS: Twenty-three studies enrolling 1,416 patients were included. IF occurred in 16.8% of patients (95% CI 12.2-22.8%; I²=76.7%); among the 81 failures with a reported failure type (six studies), rod fracture accounted for 84.0%, and the median time to failure was 26.7 months. Each additional 12 months of mean follow-up increased the odds of IF by 24% (OR 1.24; β=0.018; P=0.005), accounting for 35% of between-study variance. Pooled complication rate was 43.8% (95% CI 34.7-53.2%), perioperative mortality 2.7% (95% CI 1.9-4.0%), and local recurrence 13.4% (95% CI 10.6-16.8%). Among patients with confirmed IF, 58.4% (143/245) required reoperation.
CONCLUSION: Roughly one in six patients sustains IF after TES, and recorded failure accumulates with longer observation rather than concentrating early. Postoperative radiographic surveillance should extend to at least five years, and a shared complication taxonomy is needed for cross-institutional comparison.
STUDY DESIGN: Systematic review and meta-analysis.
LEVEL OF EVIDENCE: 4.
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