3D virtual models versus 2D imaging in preoperative planning for spinal En bloc resections: a comparative cohort study

En bloc resection (EBR) of spinal tumors requires precise anatomical understanding for safe and complete excision. Conventional 2D imaging (CT/MRI) can limit spatial comprehension, particularly for less experienced surgeons. Patient-specific 3D virtual models (3DVMs) may enhance preoperative planning, but evidence in spinal oncology remains limited. This study aimed to evaluate the accuracy and clinical utility of 3DVMs using a novel quantitative Scale of Anatomical Disruption (SAD) and assess their integration into surgical workflows. In a single-center retrospective cohort, 31 patients undergoing spinal EBR (2019–2024) were included. 3DVMs were generated by fusing CT and MRI datasets using Brainlab Elements. Six spinal surgeons of varying experience assessed anatomical disruption using both 2D imaging and 3DVMs, with neuroradiologist-derived SAD scores as benchmarks. Accuracy, inter-rater reliability, scoring time, and tumor volume estimation were analyzed. Surgeon perceptions were captured via an 11-item Likert questionnaire. Statistical analysis included Spearman correlation, Wilcoxon tests, and Cohen’s kappa. 3DVMs accurately represented tumor-related anatomical disruption (ρ = 0.771, p < 0.0001), with moderate agreement across neural, bony, and soft-tissue domains. 3DVMs improved concordance with radiologist benchmarks, particularly among trainees (κ: 0.49→0.57). Scoring time was similar or faster with 3DVMs. Radiologists overestimated, and surgeons underestimated, tumor volumes relative to the 3DVM-derived (Brainlab) segmented volumes. Trainees and fellows reported enhanced anatomical understanding, procedural confidence, and educational value; consultants were more reserved. 3DVMs provide reliable, high-fidelity visualization of complex spinal tumors, supporting accurate preoperative planning, volume estimation, and trainee education. While not a replacement for conventional imaging, 3DVMs serve as a valuable adjunct, particularly for enhancing spatial understanding and multidisciplinary communication in spinal oncology.