A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus From the Spine Oncology Study Group

  title={A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus From the Spine Oncology Study Group},
  author={Charles G. Fisher and Christian P. Dipaola and Timothy Ryken and Mark H Bilsky and Christopher I Shaffrey and Sigurd H. Berven and James S. Harrop and Michael G. Fehlings and Stefano Boriani and Dean Chou and Meic H. Schmidt and David W Polly and Roberto Biagini and Shane Burch and Mark B. Dekutoski and Aruna Ganju and Peter C. Gerszten and Ziya L. Gokaslan and Michael W Groff and Norbert J. Liebsch and Ehud Mendel and Scott H. Okuno and Shreyaskumar R Patel and Laurence D. Rhines and Peter S Rose and Daniel M. Sciubba and Narayan Sundaresan and Katsuro Tomita and Peter Pal Varga and Luiz Roberto Gomes Vialle and Frank D. Vrionis and Yoshiya Josh Yamada and Daryl R. Fourney},
Study Design. Systematic review and modified Delphi technique. Objective. To use an evidence-based medicine process using the best available literature and expert opinion consensus to develop a comprehensive classification system to diagnose neoplastic spinal instability. Summary of Background Data. Spinal instability is poorly defined in the literature and presently there is a lack of guidelines available to aid in defining the degree of spinal instability in the setting of neoplastic spinal… 

The Spinal Instability Neoplastic Score: Impact on Oncologic Decision-Making

No consensus could be determined regarding the definition, assessment, or reporting of neoplastic-related instability before introduction of S INS, and the prognostic value of SINS is controversial.

Classifications in Brief: The Spinal Instability Neoplastic Score.

Difficulty diagnosing spinal instability can lead to inappropriate referrals of patients without instability or undertreatment of patients with instability, which highlights the need for a classification system to facilitate communication and to help identify which lesions are unstable and may benefit from evaluation by a spine surgeon.

A novel scoring system concept for de novo spinal infection treatment, the Spinal Infection Treatment Evaluation Score (SITE Score): a proof-of-concept study.

The conceptual SITE scoring system combines the key variables of neurological symptoms, infection location, radiological variables for instability and impingement of neural elements, pain, and patient comorbidities and showed promising inter- and intraobserver reliability.

Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group.

  • D. FourneyE. Frangou C. Fisher
  • Medicine
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • 2011
SINS demonstrated near-perfect inter- and intraobserver reliability in determining three clinically relevant categories of stability in patients with spinal tumor-related spinal instability.

The Role of Prognostic Scoring Systems in Assessing Surgical Candidacy for Patients With Vertebral Metastasis: A Narrative Review

The Spinal Instability Neoplastic Score is reviewed, which examines for impending spinal instability in patients with vertebral metastases and represents a novel approach compared with hitherto scoring systems.

Reliability of the spinal instability neoplastic scale among radiologists: an assessment of instability secondary to spinal metastases.

SINS is a reliable tool for radiologists rating tumor-related spinal instability and accurately discriminates between stable and potentially unstable or unstable lesions and, therefore, can guide the need for surgical consultation.

Spine Instability Neoplastic Score: agreement across different medical and surgical specialties.

Is the Spinal Instability Neoplastic Score Accurate and Reliable in Predicting Vertebral Compression Fractures for Spinal Metastasis? A Systematic Review and Qualitative Analysis

The SINS system may be accurate and reliable in predicting the occurrence of post-radiotherapy VCFs for spinal metastasis, but some components seem to be substantially weak and need to be revised.

Intra- and interobserver reliability of the Spinal Instability Neoplastic Score system for instability in spine metastases: a systematic review and meta-analysis.

Meta-analysis of the available literature suggests Spinal Instability Neoplastic Score to have good intraobserver and interobserver reliability, giving it the potential to be a valuable guide to the management of patients with spinal metastases.

Incorporating the Spine Instability Neoplastic Score into a Treatment Strategy for Spinal Metastasis: LMNOP

LMNOP is the first systematic approach to spinal metastasis that incorporates SINS, and is easy to remember, it addresses clinical factors not directly addressed by other systems, and it is adaptable to changes in technology.



Instability and impending instability of the thoracolumbar spine in patients with spinal metastases: a systematic review.

Metastatic disease commonly occurs in the spine and incidence is likely to increase secondary to improved survival rates in many cancer patients. Despite published research on instability in patients

Diagnosis and Management of a Metastatic Tumor in the Atlantoaxial Spine

The experience of a large multidisciplinary tertiary referral oncology center in diagnosing and managing metastatic disease of the atlantoaxial spine in the era of magnetic resonance imaging is reviewed to establish treatment parameters.

Metastatic Disease of the Spine

New data documenting the benefit of surgical decompression using improved techniques such as anterior approaches have amplified the role of the spine surgeon in the care of these patients.

An evaluation of spinal deformity in metastatic breast cancer.

Understanding the natural history of metastatic spinal deformity, instability and spinal canal compromise can be recognized and treated early, before the onset of progressive deformity and neurologic sequelae.

A Revised Scoring System for Preoperative Evaluation of Metastatic Spine Tumor Prognosis

The consistency rate between the predicted prognosis from the criteria of the total scores and the actual survival period was high in patients within each score range and a similar result was also observed in both the surgical procedure group and conservative treatmentgroup.

Surgical Strategy for Spinal Metastases

A new surgical strategy for spinal metastases based on the prognostic scoring system is proposed and provides appropriate guidelines for treatment in all patients with spinal metastased patients.

Metastatic disease in long bones: A proposed scoring system for diagnosing impending pathologic fractures. 1989.

  • H. Mirels
  • Medicine
    Clinical orthopaedics and related research
  • 2003
A weighted scoring system is proposed to quantify the risk of sustaining a pathologic fracture through a metastatic lesion in a long bone and it is suggested that all metastatic lesions in long bones be evaluated prior to irradiation.

Spinal Stabilization of Vertebral Column Tumors

An analysis of indications, techniques, results of stabilization and decompression of 100 consecutive spinal tumour cases was carried out and acrylic cement was used both anteriorly and posteriorly together with implant stabilization.

Methods of Surgical Stabilization for Metastatic Disease of the Spine

The present scope of such surgical procedures is reviewed along with identification of the most reliable selection factors for surgical candidates in order to improve functional outcome from surgical treatment of metastatic disease of the spine.