The Cardiovascular
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Spinal Instability Neoplastic Scale (SINS) Score

Grades mechanical spinal instability caused by vertebral metastases or other neoplasms.

Spinal Instability Neoplastic Scale (SINS) Score
Spinal segment involved
Pain relative to lesion
Bone lesion quality
Radiographic spinal alignment
Vertebral body collapse
Posterolateral involvement of spinal elements
Result0 points (Stable)

Lesion is radiographically stable; surgical consultation for instability is not routinely required.

Category
Stable

When to use

  • Grading mechanical instability of the spine in patients with vertebral neoplastic (metastatic or primary) disease, to help decide whether surgical consultation is warranted.

Formula

Sum of points across 6 domains - location, pain, bone lesion quality, spinal alignment, vertebral body collapse, and posterolateral element involvement. Range 0-18: 0-6 stable, 7-12 potentially unstable, 13-18 unstable.

Pearls and pitfalls

  • Developed and validated by the Spine Oncology Study Group with good inter- and intra-observer reliability.
  • A score >=7 is the threshold generally used to trigger surgical consultation.

References

  1. Fisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010;35(22):E1221-9.