Initial Outcomes of Zap-X Stereotactic Radiosurgery for the Treatment of Spinal Tumors: A Case Series.

Stereotactic radiosurgery (SRS) is an established modality for managing spinal tumors, offering targeted radiation while preserving adjacent critical structures. The ZAP-X gyroscopic SRS system (ZAP Surgical Systems, Inc., San Carlos, CA) introduces a novel, self-shielded, non-isocentric platform that may expand access to SRS and streamline treatment delivery. This study presents initial clinical outcomes and technical feasibility of ZAP-X in treating spinal tumors. Three patients with spinal tumors, including schwannoma, meningioma, and spinal metastasis, were treated using ZAP-X SRS between February and June 2024. All patients underwent single-session treatment with no acute complications or radiation-related side effects. One patient with spinal metastasis and advanced comorbidities experienced significant pain relief, and another demonstrated a complete resolution of neurological symptoms with no radiographic tumor progression at three- and five-month follow-up. The third patient expired due to unrelated causes, but tolerated treatment without complications. Early experience suggests that ZAP-X SRS is a safe, accurate, and effective option for treating spinal tumors. Its compact design and streamlined workflow offer potential advantages in both definitive and palliative care settings. Further investigation in larger cohorts with extended follow-up is warranted to validate long-term efficacy and broader clinical utility.