Explain the Weinstein tumor zone system

This zone system was developed to guide the selection of the most appropriate approach to the spine for excision and stabilization of primary bone tumors (Fig. 63-2). Four zones (I—IV) are identified and tumor extension is denoted as:

A. Intraosseous

B. Extraosseous

C. Distant tumor spread

Spinous process

Superior articular facet

Spinous process

Superior articular facet

Transverse process

Vertebral body

IIIB

C: Regional or distant metastasis

Superior articular facet

Transverse process

Vertebral body

IIIB

C: Regional or distant metastasis

Superior articular facet

Transverse process

Inferior articular facet

Spinous process

Inferior articular facet

Spinous process

Transverse process

Pars/Interarticularis

C: Regional or distant metastasis

Figure 63-2. Weinstein's zones. A, Axial view. Zone I is composed of the spinous process, inferior articular process, and the lamina. Zone II is composed of the superior articular process, pedicle, and transverse process. Zone III is the anterior column. Zone IV is composed of the middle column and neural canal. B, Posterior view. C, Lateral view. (From Weinstein JN. Differential diagnosis and surgical treatment of primary benign and malignant neoplasms. In Frymoyer JW, editor. The Adult Spine: Principles and Practice. New York: Raven Press; 1991. p. 829-60, with permission.)

Superior facet Transverse process

Pars/Inter-articularis

Pars/Inter-articularis

Inferior facet

Vertebral body

Inferior facet

C: Regional or distant metastasis

Surgical outcome depends on the zones involved, the extent of local or distant tumor spread, tumor type, and tumor grade. The appropriate surgical procedure must permit appropriate resection, adequate neural decompression, and spinal stabilization.

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