Spinal Instability Neoplastic Score (SINS)

Assesses stability of the spine in patients with metastatic or primary spine tumor.

Refer to the text below the score for more information on its components, development and validation studies.


The Spinal Instability Neoplastic Score (SINS) is a multidisciplinary validated scoring system that evaluates the stability of the spine in patients with metastatic or primary spine tumor. It consists of 6 components, from location of the tumour to presence of pain, bone lesions and other radiographic evidence.


SINS scores vary from 0 to 18, with higher scores indicating a greater likelihood of spinal instability and the need for neurosurgery.

Scores  ≥7 are an indication for neurosurgical referral to assess spinal stability and need for neurosurgical intervention.

The score has near-perfect inter- and intra-observer reliability in determining three clinically relevant categories of stability and demonstrated a sensitivity and specificity for potentially unstable or unstable lesions of 95.7% and 79.5% respectively.

It has been validated and achieved a sensitivity and specificity of 96% and 80% respectively for potentially unstable lesions.


1

Location

2

Mechanical pain

3

Bone lesion

4

Radiographic spinal alignment

5

Vertebral body collapse

6

Posterolateral involvement

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The Scoring System Explained

The Spinal Instability Neoplastic Score helps evaluate tumour related instability in the vertebral column with the purpose to identify spinal neoplastic disease patients who may require surgical intervention.

It consists of 6 components, from location of the tumour to presence of pain, bone lesions and other radiographic evidence.

SINS item Answer choices Points
Location Junctional (O-C2; C7 - T2; T11 - L1; L5 - S1) 3
Mobile spine (C3 - C6; L2 - L4) 2
Semirigid (T3 - T10) 1
Rigid (S2 - S5) 0
Mechanical pain Yes 3
Occasional pain but not mechanical 1
Pain free lesion 0
Bone lesion Lytic 2
Mixed (lytic/blastic) 1
Blastic 0
Radiographic spinal alignment Subluxation/translation present 4
Deformity (kyphosis/scoliosis) 2
Normal alignment 0
Vertebral body collapse >50% collapse 3
<50% collapse 2
No collapse with >50% body involved 1
None of the above 0
Posterolateral involvement Bilateral 3
Unilateral 1
None of the above 0

SINS has proven effective in directing the mobilization or surgical management of patients with neoplastic spinal disease. Other factors that may contribute to surgical decision making in these oncology patients include neurologic symptoms, oncologic subtype and extent, and patient comorbidities, as well as prognosis.

Several studies have shown good inter-observer agreement among both radiologists and radiation oncologists.

 

SINS Result Interpretation

SINS scores vary from 0 to 18, with higher scores indicating a greater likelihood of spinal instability and the need for neurosurgery. Scores of 7 and higher warrant a surgical consultation before proceeding with radiation treatment.

SINS score Interpretation Recommendation
0 – 6 Stable
7 – 12 Potentially unstable Scores ≥7 are an indication for neurosurgical referral to assess spinal stability and need for neurosurgical intervention*
13 – 18 Unstable

* Fisher 2010

 

Development and Validation Studies

Fisher et al. have employed a systematic review and modified Delphi technique research design to develop the SINS, a comprehensive classification system to aid in the diagnosis of neoplastic spinal instability.

The score evaluates neoplastic lesions in the context of spinal stability and is based on patient symptoms and radiographic criteria of the spine. Qualitative scores are assigned to each of the 6 items, which were set out based on the relative importance of particular factors from the literature and refined by expert consensus.

The score has near-perfect inter- and intra-observer reliability in determining three clinically relevant categories of stability.

It has been validated in a cohort of 30 cases with spine tumors and achieved a sensitivity and specificity of 95.7% and 79.5% respectively for potentially unstable lesions.

 

References

Original reference

Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, Harrop JS, Fehlings MG, Boriani S, Chou D, Schmidt MH, Polly DW, Biagini R, Burch S, Dekutoski MB, Ganju A, Gerszten PC, Gokaslan ZL, Groff MW, Liebsch NJ, Mendel E, Okuno SH, Patel S, Rhines LD, Rose PS, Sciubba DM, Sundaresan N, Tomita K, Varga PP, Vialle LR, Vrionis FD, Yamada Y, Fourney DR. 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.

Other references

Fox S, Spiess M, Hnenny L, Fourney DR. Spinal Instability Neoplastic Score (SINS): Reliability Among Spine Fellows and Resident Physicians in Orthopedic Surgery and Neurosurgery. Global Spine J. 2017; 7(8):744-748.

Fourney DR, Frangou EM, Ryken TC, Dipaola CP, Shaffrey CI, Berven SH, Bilsky MH, Harrop JS, Fehlings MG, Boriani S, Chou D, Schmidt MH, Polly DW, Biagini R, Burch S, Dekutoski MB, Ganju A, Gerszten PC, Gokaslan ZL, Groff MW, Liebsch NJ, Mendel E, Okuno SH, Patel S, Rhines LD, Rose PS, Sciubba DM, Sundaresan N, Tomita K, Varga PP, Vialle LR, Vrionis FD, Yamada Y, Fisher CG. Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol. 2011; 29(22):3072-7.


Specialty: Oncology

Objective: Risk Prediction

Type: Score

No. Of Items: 6

Year Of Study: 2010

Abbreviation: SINS

Article By: Denise Nedea

Published On: May 20, 2024

Last Checked: May 20, 2024

Next Review: May 20, 2029