European Spine Journal

, Volume 27, Issue 4, pp 868–873 | Cite as

Surgeon’s perception of margins in spinal en bloc resection surgeries: how reliable is it?

  • Ran Lador
  • Alessandro Gasbarrini
  • Marco Gambarotti
  • Stefano Bandiera
  • Riccardo Ghermandi
  • Stefano Boriani
Original Article


Purpose and Background

En bloc resections aim at surgically removing a tumor in a single, intact piece, fully encased by a continuous shell of healthy tissue—the “margin”. Intraoperative continuous assessment of the plane of resection regarding the tumor’s margins is paramount. The goal of this study was to evaluate the accuracy of experienced spinal tumor surgeons’ perception of these margins.


A retrospective analysis of a prospectively collected data of 1681 patients affected by spine tumors of whom 217 en bloc resections was performed. Surgeons’ intraoperative assessment was compared to the histopathological assessment.


Most were primary—163 (42 benign and 121 malignant), metastases occurred in 54 cases. ‘Wide’ margins were obtained in 126 cases; ‘marginal’ in 60 cases, and ‘intralesional’ in 31 cases. Surgeons assessed clear margins in 109 cases and contaminated in 108 cases. When considering marginal margins as a contaminated resection, the surgeon’s assessment of clear resection had a sensitivity of 76.89%, specificity of 86.81%, PPV and NPV (positive and negative predictive values) were 88.99 and 73.15%, respectively. Inter-observer agreement was 0.62. When considering marginal margins as a clear resection, the surgeon’s assessment of clear resection had a sensitivity of 64.5%, specificity of 100%, PPV and NPV were 100 and 0%, respectively. Inter-observer agreement was 0.29.


Surgeons are fairly accurate in their intraoperative assessment of clear margins achieved; however, this accuracy is not perfect and exploring ways to improve this intraoperative assessment is of major importance possibly impacting the outcome of the treatment.


Margins Spine tumors En bloc resection Intraoperative assessment Recurrence 


Compliance with ethical standards

Conflict of interest


Financial disclosure

There are no financial disclosures that relate to this paper by any of the attributing authors. There was no material support related to this study.


No funding or Grant was received for this study, and no NIH Grant was applied for or received.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Ran Lador
    • 1
  • Alessandro Gasbarrini
    • 2
  • Marco Gambarotti
    • 3
  • Stefano Bandiera
    • 2
  • Riccardo Ghermandi
    • 2
  • Stefano Boriani
    • 2
  1. 1.Unit of Spine SurgeryTel-Aviv Medical CenterTel-AvivIsrael
  2. 2.Unit of Oncologic Spine Surgery, Department of Oncologic and Degenerative Spine SurgeryRizzoli InstituteBolognaItaly
  3. 3.Unit of PathologyRizzoli InstituteBolognaItaly

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