Utility of the Spinal Instability Score in Patients with Spinal Metastases and the Impact on Clinical Outcome

Research Square (Research Square)(2023)

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摘要
Abstract Objective Spinal metastases may cause spinal instability. The Spinal Instability Neoplastic Score (SINS) was developed to assess spinal neoplastic-related instability. Aim of this study was to determine the utility of SINS in predicting progression of a pathologic fracture due to spinal metastases. Methods A retrospective analysis of patients with a pathologic fracture due to a spinal metastases between January 2018 and December 2018 was performed. We selected patients with a minimum follow-up of 12 months and analysed them according to the SINS criteria. The primary endpoint was the progression of vertebral body fracture following radiotherapy. Results 332 Patients were identified. Median age was 68 SD +/- 10,3. 38% were Female. Median follow-up was 26 months (range 12–29). 30, 283 and 19 Patients presented with low (0–6), moderate (7–12) and high (13–18) SINS, respectively. Fracture progression following radiotherapy was seen in 9 (30%), 84 (30%) and 8 (42%) in cases with low, moderate, or high SINS (P = 0.522), respectively. During follow-up, 25% of patients with low SINS showed a progression to moderate SINS without neurological deficits. In the originally moderate group, 17% had progression with neurological deficits needing surgery. None had functional recovery postoperatively. 83% of the progression cases in the moderate group did not develop neurological deficits and 4 underwent surgery for pain management. 63% of all progressions in the high group developed neurological deficits, however none of them recover postoperatively (P < 0.001). Conclusion SINS is a very useful tool for assess stability of a pathologic fracture due to spinal metastases after radiotherapy for spinal metastases. Moderate or high SINS are associated with a high risk of fracture progression as well as risk for neurological deterioration, therefore surgical instrumentation in these groups may be advised prior to radiotherapy.
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spinal instability score,spinal metastases
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