Single-stage percutaneous biopsy and stabilization accelerate oncologic care and improve patient-reported outcomes in spinal neoplastic lesions

Background: Spinal neoplastic lesions are traditionally managed through staged procedures, potentially introducing delays in oncologic care. Single-stage percutaneous approaches may optimize treatment timelines while maintaining diagnostic accuracy and structural stability. Objective: This study aimed to evaluate whether single-stage percutaneous biopsy and stabilization reduce time to definitive oncologic therapy and improve patient-reported outcomes compared with staged procedures in adults with mechanically unstable spinal neoplastic lesions of uncertain histology. Methods: A retrospective cohort study analyzed 65 consecutive patients with spinal neoplastic lesions managed between November 2020 and May 2025. Patients were categorized into single-stage ( n = 21) and staged ( n = 44) groups based on whether percutaneous biopsy and stabilization were performed during the same operative session or as separate procedures. Primary outcome was the time from biopsy to initiation of definitive oncologic therapy. Secondary outcomes included changes in health-related quality of life assessed using visual analogue scale and Spine Oncology Study Group Outcomes Questionnaire, measured at baseline and at histopathological diagnosis availability. Results: Baseline characteristics were comparable between groups. Mean time from biopsy to definitive therapy was significantly shorter in the single-stage cohort (30.2 days, 95% confidence interval: 24.5–35.9) versus staged cohort (40.1 days, 95% confidence interval: 36.7–43.5), representing a 9.9-day reduction ( p = 0.008). At histopathological diagnosis, single-stage patients reported significantly lower pain scores (visual analogue pain assessment scale 4.3 vs 6.9, p < 0.001), superior physical function (77.7 vs 65.5, p = 0.002), and higher overall quality of life (SOSGOQ2.0 total 63.2 vs 57.0, p = 0.015). Adverse event rates were comparable between groups, with no significant difference in complications or repeat procedures. Conclusions: Single-stage percutaneous biopsy and stabilization accelerate oncologic care initiation and improve early patient-reported outcomes without compromising safety, representing a preferred pathway for managing mechanically unstable spinal neoplastic lesions.