Neurosurgery notes/Spine/Spinal tumours/Primary spinal tumour classification

Primary spinal tumour classification

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Spinal tumours

General

  • Anatomical classifications are useful for surgical planning but may be more suitable for primary tumours rather than metastases, as the anatomical context alone is often insufficient for deciding the type of operation.

Tomita’s anatomical surgical classification

  • General
    • Not to be confused with the prognostic score
    • Describes the relationship of the tumor to vertebral compartments and, importantly, major vasculature involvement when planning en bloc resections:
  • Intracompartmental
    • Type 1: Tumor is confined within a single vertebral body (intracompartmental)
    • Type 2: Tumor extends into the pedicles (but not through cortex)
    • Type 3: Tumor extends through the cortex into the posterior elements
  • Extracompartmental
    • Type 4: Tumor occupies entire vertebra and paravertebral muscle (no contact with major vessels)
    • Type 5: Tumor invades extraosseous paravertebral space, contacting but not encasing major vessels
    • Type 6: Tumor forms a mass that surrounds or encases the aorta, vena cava, or other major vessels
      • making en bloc resection hazardous or impossible
  • Type 7: Multiple vertebral involvement or non-contiguous lesions
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McLain and Weinstein Classification

  • This scheme defines vertebral anatomy using four zones and three concentric levels:
  • Zones 1–4:
    • Define location across the vertebra, from the spinous process (Zone 1) to the anterior three-fourths of the vertebral body (Zone 3).
  • Levels A–C:
    • Define radial extent: Intraosseous (A), Extraosseous (B), and Distant tumour spread (C).
  • This system is very simple but has limited discriminatory value for spinal metastases, as most cases fall into categories 3 and 4.
Zone/Level
Description
Zone 1
The spinous process to the pars and inferior facet
Zone 2
The superior facet, transverse process and pedicle
Zone 3
Anterior three-fourth of the vertebral body
Zone 4
Posterior one-fourth of the vertebral body
Level A
Intraosseous
Level B
Extraosseous
Level C
Distant tumour spread

Enneking Classification (Adapted)

  • Originally developed for primary long-bone tumours, this system has been adapted for spinal tumours.
  • It requires prior knowledge of the tumour's histology and degree of spread.
  • However, it is not the most useful classification for metastases because it does not specifically document extradural spinal involvement or potential cord compression.
  • Benign tumours
    • Stages I, II and III, depending on the tumour growth and aggressiveness
    • 1 tumour capsule
    • 2 adjacent tissue reaction
  • Malignant tumours
    • IA, IB, IIA and IIB depending on degree of spread
    • 1 tumour capsule
    • 2 tissue reaction
    • 3 island of tumour within adjacent tissue reaction
    • 4 skip metastasis
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Boriani, Weinstein, Biagini (WBB) Classification

  • This system was designed for the anatomical staging of primary bone tumours of the spine to overcome shortcomings in other systems, though it is sometimes applied to spinal metastases.
  • Zones (1–12):
    • Describe axial tumour involvement as sections of a clock face centred on the spinal cord (e.g., Zone 1 is the left spinous process/lamina, Zone 6 is the left anterior wedge of the vertebral body).
  • Radial Levels/Layers (A–E):
    • Describe the depth of involvement, from extraosseous paraspinal tissues (Layer A) through to extradural (Layer D) and intradural (Layer E).
  • The WBB system is accurate for describing axial tumour involvement, and was designed to aid surgical planning, particularly for en bloc resection.
 
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