2023 Volume 14 Issue 2 Pages 82-87
Introduction: The spinal instability neoplastic score (SINS) is a classification system used to diagnose neoplastic spinal instability. Several reports have also described its use as a screening tool to identify patients at risk of skeletal-related events. We investigated the efficacy of SINS to detect the risk of neurological deficit in patients with spinal metastases by assessing spinal metastatic instability before the onset of myelopathy.
Methods: We performed surgery on 81 patients with cervical or thoracic lesions classified as metastatic spine disease between 2004 and 2019. In this cohort, spinal instability was assessed in 29/81 patients before the occurrence of myelopathy. Spinal instability was evaluated by SINS with computed tomography (CT) performed within 6 months of the neurological deficit. We defined patients with a score of 7 or higher as at-risk patients.
Results: CT was performed at an average of 72 days before the onset of neurological deficits. The SINS were 2 no-metastases cases, 4 of less than 7 (stability), 15 of 7-12 (indeterminate instability), and 8 of 13-18 (instability). We were unable to detect 21% (6/29) patients at risk of SINS.
Conclusions: We may not be able to detect approximately 20% at-risk patients with neurological deficits by SINS before myelopathy presents.
