{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:03:07Z","timestamp":1785420187279,"version":"3.56.0"},"reference-count":39,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health\u2019s \u2018Ricerca Corrente\u2019"},{"name":"IRCCS Humanitas Research Hospital"},{"id":[{"id":"https:\/\/ror.org\/05d538656","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Achieving adequate oncological margins in tumors involving the thoracic costovertebral junction is technically challenging because of complex regional anatomy and the need to preserve neurological and biomechanical integrity. This case report describes a robot-assisted margin-extension strategy after incomplete resection of a thoracic costovertebral chondrosarcoma. Methods: A 31-year-old man with grade 1 chondrosarcoma of the left sixth rib underwent second-stage surgical radicalization after prior incomplete resection with positive medial margins. Following multidisciplinary discussion, a single-stage posterior procedure was performed, including robot-assisted T4\u2013T8 stabilization with radiolucent CFR-PEEK instrumentation and robot-assisted sagittal vertebral osteotomy (\u201cPostage-Stamp Osteotomy\u201d) of T6 to achieve en bloc removal of the involved costovertebral segment. Results: The osteotomy was executed using a pedicle-referenced robotic trajectory workflow with sequential navigated drilling and controlled completion with a navigated osteotome. Total operative time was 379 min, with estimated blood loss of 800 mL. No major intraoperative neurovascular complications occurred. Histopathology confirmed negative margins. The patient was mobilized on postoperative day 1 and discharged on postoperative day 6 without new neurological deficits. Radiological follow-up at 3 months showed no recurrence, while clinical follow-up at 5 months demonstrated full return to baseline activities. Conclusions: This report describes a technically feasible robot-assisted margin-extension strategy in a highly selected thoracic spinal oncology scenario. Although long-term oncological conclusions cannot be drawn from a single case, tailored technology-enabled margin-oriented approaches may represent a case-specific option in carefully selected patients.<\/jats:p>","DOI":"10.3390\/jcm15114268","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T11:25:31Z","timestamp":1780399531000},"page":"4268","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Robot-Assisted \u201cPostage-Stamp\u201d Vertebrotomy for Spinal Tumor Resection: Case Report"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3356-3144","authenticated-orcid":false,"given":"Carlo","family":"Brembilla","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, IRCSS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Capo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCSS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5669-2286","authenticated-orcid":false,"given":"Mario","family":"De Robertis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCSS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Cariboni","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, IRCSS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6081-5963","authenticated-orcid":false,"given":"Ali","family":"Baram","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCSS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donato","family":"Creatura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCSS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8805-6484","authenticated-orcid":false,"given":"Emanuele","family":"Stucchi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCSS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5968-1986","authenticated-orcid":false,"given":"Leonardo","family":"Anselmi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCSS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Pessina","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCSS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Fornari","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, IRCSS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1530\/EOR-2025-0032","article-title":"Robot-assisted pedicle screw placement in spinal surgery: An updated systematic umbrella review and meta-meta-analysis of comparisons against freehand and navigation-guided techniques","volume":"11","author":"Du","year":"2026","journal-title":"EFORT Open Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"196","DOI":"10.3171\/2013.11.SPINE13413","article-title":"The accuracy of pedicle screw placement using intraoperative image guidance systems: A systematic review","volume":"20","author":"Mason","year":"2014","journal-title":"J. Neurosurg. Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1097\/BRS.0000000000003827","article-title":"Use of Intraoperative CT Improves Accuracy of Spinal Navigation during Screw Fixation in Cervico-thoracic Region","volume":"46","author":"Habib","year":"2021","journal-title":"Spine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jor.2023.08.007","article-title":"Robotics and navigation in spine surgery: A narrative review","volume":"44","author":"Zawar","year":"2023","journal-title":"J. Orthop."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Li, Y., Chen, L., Liu, Y., Ding, H., Lu, H., Pan, A., Zhang, X., Hai, Y., and Guan, L. (2022). Accuracy and safety of robot-assisted cortical bone trajectory screw placement: A comparison of robot-assisted technique with fluoroscopy-assisted approach. BMC Musculoskelet. Disord., 23.","DOI":"10.1186\/s12891-022-05206-y"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Keraudy, A., De Buck, P., Haettel, P., Ghannam, B., Assaker, R., and Leroy, H.A. (2026). 2-staged robot-assisted vertebrectomy for metastatic lumbar spine lesion: A proof-of-concept case. Eur. Spine J., 1\u20137.","DOI":"10.1007\/s00586-025-09713-z"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Stucchi, E., De Robertis, M., Capo, G., Baram, A., De Gennaro Aquino, G., Creatura, D., Anselmi, L., Fornari, M., Pessina, F., and Brembilla, C. (2026). Robot-Assisted Placement of Thoracic Carbon-Fiber-Reinforced Polyetheretherketone (CFR-Peek) Pedicle Screws in the Cervical Spine for Giant Cell Tumor: Technical Note. Bioengineering, 13.","DOI":"10.3390\/bioengineering13030361"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e1892","DOI":"10.1002\/rcs.1892","article-title":"Robot-assisted vs freehand pedicle screw fixation in spine surgery\u2014A systematic review and a meta-analysis of comparative studies","volume":"14","author":"Yu","year":"2018","journal-title":"Int. J. Med. Robot. Comput. Assist. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e10970","DOI":"10.1097\/MD.0000000000010970","article-title":"Accuracy of pedicle screw placement comparing robot-Assisted technology and the free-hand with fluoroscopy-guided method in spine surgery","volume":"97","author":"Fan","year":"2018","journal-title":"Medicine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e194","DOI":"10.1093\/ejcts\/ezu095","article-title":"Primary chest wall chondrosarcomas: Results of surgical resection and analysis of prognostic factors","volume":"45","author":"Marulli","year":"2014","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Del Grande, F., Ahlawat, S., McCarthy, E., and Fayad, L.M. (2022). Grade 1 and 2 Chondrosarcomas of the Chest Wall: CT Imaging Features and Review of the Literature. Diagnostics, 12.","DOI":"10.3390\/diagnostics12020292"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1016\/j.hoc.2013.07.012","article-title":"Update on Targets and Novel Treatment Options for High-Grade Osteosarcoma and Chondrosarcoma","volume":"27","author":"Anninga","year":"2013","journal-title":"Hematol.\/Oncol. Clin. N. Am."},{"key":"ref_13","first-page":"e708","article-title":"Excision of Thoracic Chondrosarcoma: Case Report and Review of Literature","volume":"8","author":"Le","year":"2016","journal-title":"Cureus"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1093\/ons\/opaa239","article-title":"Use of navigated ultrasonic bone cutting tool for en bloc resection of thoracic chondrosarcoma: Technical report","volume":"19","author":"Vedantam","year":"2020","journal-title":"Oper. Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"9069272","DOI":"10.1155\/2019\/9069272","article-title":"Prognostic Factors in Dedifferentiated Chondrosarcoma: A Retrospective Analysis of a Large Series Treated at a Single Institution","volume":"2019","author":"Miao","year":"2019","journal-title":"Sarcoma"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1186\/s12957-024-03494-3","article-title":"Efficacy and safety of en-bloc resection versus debulking for spinal tumor: A systematic review and meta-analysis","volume":"22","author":"Zhang","year":"2024","journal-title":"World J. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"858","DOI":"10.1007\/s11999-014-3578-x","article-title":"Multilevel En Bloc Spondylectomy for Tumors of the Thoracic and Lumbar Spine Is Challenging But Rewarding","volume":"473","author":"Luzzati","year":"2015","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"124129","DOI":"10.1016\/j.wneu.2025.124129","article-title":"En Bloc Spondylectomy versus Separation Surgery for Spinal Metastases: A Systematic Review and Meta-Analysis","volume":"200","author":"AlMekkawi","year":"2025","journal-title":"World Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3572","DOI":"10.1245\/s10434-014-3745-z","article-title":"Prognostic Factors of Patients with Spinal Chondrosarcoma: A Retrospective Analysis of 98 Consecutive Patients in a Single Center","volume":"21","author":"Yin","year":"2014","journal-title":"Ann. Surg. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2608","DOI":"10.1016\/j.spinee.2014.02.030","article-title":"En bloc resections for primary spinal tumors in 20 years of experience: Effectiveness and safety","volume":"14","author":"Amendola","year":"2014","journal-title":"Spine J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.1097\/BRS.0b013e3181b8b796","article-title":"Feasibility and Safety of En Bloc Resection for Primary Spine Tumors","volume":"34","author":"Yamazaki","year":"2009","journal-title":"Spine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1227\/01.NEU.0000371987.85090.FF","article-title":"En bloc resection for primary and metastatic tumors of the spine: A systematic review of the literature","volume":"67","author":"Cloyd","year":"2010","journal-title":"Neurosurgery"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.spinee.2015.10.045","article-title":"Management of spinal giant cell tumors","volume":"16","author":"Luksanapruksa","year":"2016","journal-title":"Spine J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1097\/BSD.0000000000000809","article-title":"Image-guidance, Robotics, and the Future of Spine Surgery","volume":"33","author":"Ahern","year":"2020","journal-title":"Clin. Spine Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.14245\/ns.2346610.305","article-title":"Spine Surgical Robotics: Current Status and Recent Clinical Applications","volume":"20","author":"Wang","year":"2023","journal-title":"Neurospine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"9","DOI":"10.2147\/RSRR.S190720","article-title":"Robotic-Assisted Spine Surgery: History, Efficacy, Cost, And Future Trends","volume":"6","author":"Gendreau","year":"2019","journal-title":"Robot. Surg. Res. Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4415","DOI":"10.1002\/cam4.4019","article-title":"Prognostic importance of IDH mutations in chondrosarcoma: An individual patient data meta-analysis","volume":"10","author":"Vuong","year":"2021","journal-title":"Cancer Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Gazendam, A., Popovic, S., Parasu, N., and Ghert, M. (2023). Chondrosarcoma: A Clinical Review. J. Clin. Med., 12.","DOI":"10.3390\/jcm12072506"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Gasbarrini, A., Pasini, S., Fu, Z., Ghermandi, R., Pipola, V., Gargiulo, M., Innocenti, M., and Boriani, S. (2025). EnBloc Resection of a Chordoma of the Thoracic Spine by \u201cL\u201d-Shaped Osteotomy for Spinal Canal Preservation. J. Clin. Med., 14.","DOI":"10.3390\/jcm14020349"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1007\/s00586-017-5258-5","article-title":"Carbon-fiber-reinforced PEEK fixation system in the treatment of spine tumors: A preliminary report","volume":"27","author":"Boriani","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e0020","DOI":"10.2106\/JBJS.ST.19.00020","article-title":"Robotic-Assisted Pedicle Screw Placement During Spine Surgery","volume":"10","author":"Lieberman","year":"2020","journal-title":"JBJS Essent. Surg. Tech."},{"key":"ref_32","first-page":"241","article-title":"Robotic technology in spine surgery: Current applications and future developments","volume":"109","author":"Ringel","year":"2010","journal-title":"Intraoperative Imaging"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1097\/BRS.0000000000004357","article-title":"Robotic Spine Surgery: Past, Present, and Future","volume":"47","author":"Perfetti","year":"2022","journal-title":"Spine"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e70195","DOI":"10.1002\/lio2.70195","article-title":"Computer-Assisted Planning and Navigation of Osteotomies in Rhinoplasty: An Innovative Technique","volume":"10","author":"Chaput","year":"2025","journal-title":"Laryngoscope Investig. Otolaryngol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1001\/archfaci.2010.14","article-title":"Quantitative Comparison Between Microperforating Osteotomies and Continuous Lateral Osteotomies in Rhinoplasty","volume":"12","author":"Zoumalan","year":"2010","journal-title":"Arch. Facial Plast. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1055\/s-0045-1802642","article-title":"Postage Stamp Precision Technique of Dorsal Hump Reduction","volume":"58","author":"Bhat","year":"2025","journal-title":"Indian J. Plast. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"534","DOI":"10.3171\/2023.5.SPINE23106","article-title":"Carbon fiber\u2013reinforced PEEK spinal implants for primary and metastatic spine tumors: A systematic review on implant complications and radiotherapy benefits","volume":"39","author":"Khan","year":"2023","journal-title":"J. Neurosurg. Spine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1775","DOI":"10.1007\/s00586-018-5538-8","article-title":"Pedicle screw anchorage of carbon fiber-reinforced PEEK screws under cyclic loading","volume":"27","author":"Lindtner","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Joerger, A.K., Seitz, S., Lange, N., Aftahy, A.K., Wagner, A., Ryang, Y.M., Bernhardt, D., Combs, S.E., Wostrack, M., and Gempt, J. (2022). CFR-PEEK Pedicle Screw Instrumentation for Spinal Neoplasms: A Single Center Experience on Safety and Efficacy. 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