Spinal Instability Neoplastic Score (SINS): Reliability Among Spine Fellows and Resident Physicians in Orthopedic Surgery and Neurosurgery

Abstract

Study Design:Reliability analysis.Objectives:The Spinal Instability Neoplastic Score (SINS) was developed for assessing patients with spinal neoplasia. It identifies patients who may benefit from surgical consultation or intervention. It also acts as a prognostic tool for surgical decision making. Reliability of SINS has been established for spine surgeons, radiologists, and radiation oncologists, but not yet among spine surgery trainees. The purpose of our study is to determine the reliability of SINS among spine residents and fellows, and its role as an educational tool.Methods:Twenty-three residents and 2 spine fellows independently scored 30 de-identified spine tumor cases on 2 occasions, at least 6 weeks apart. Intraclass correlation coefficient (ICC) measured interobserver and intraobserver agreement for total SINS scores. Fleiss’s kappa and Cohen’s kappa analysis evaluated interobserver and intraobserver agreement of 6 component subscores (location, pain, bone lesion quality, spinal alignment, vertebral body collapse, and posterolateral involvement of spinal elements).Results:Total SINS scores showed near perfect interobserver (0.990) and intraobserver (0.907) agreement. Fleiss’s kappa statistics revealed near perfect agreement for location; substantial for pain; moderate for alignment, vertebral body collapse, and posterolateral involvement; and fair for bone quality (0.948, 0.739, 0.427, 0.550, 0.435, and 0.382). Cohen’s kappa statistics revealed near perfect agreement for location and pain, substantial for alignment and vertebral body collapse, and moderate for bone quality and posterolateral involvement (0.954, 0.814, 0.610, 0.671, 0.576, and 0.561, respectively).Conclusions:The SINS is a reliable and valuable educational tool for spine fellows and residents learning to judge spinal instability.

Resection of giant invasive thoracic schwannoma

“…Only instable lesions need spinal instrumentation. The lesion of our patient is considered stable, moreover some amount of infiltration is tolerable in the semi rigid spine (from Th3 to Th10) more than in the junctional or on the mobile spine, and that is the first criteria of stability evaluation in "The spinal instability neoplastic score (SINS)" adopted by some spine surgeons (3,6). Total removal of the tumor is the only factor related to long term outcome (2,4), in case where it is not possible, a decompression of neural structures is the priority, but a repeat surgery might be necessary (2).…”

Current surgical strategies for treating spinal tumors: Results of a questionnaire survey among members of the German Spine Society (DWG)

“…Recommendations that involve the mentioned techniques are based on frameworks/algorithms [14,15] that cover the question for stability (e.g. SINS [16,17]) of metastastic lesions, accompanying neurological deteriotation by epidural tumor involvement (i.e. ESCC grading scale [18]), radioresponsiveness based on the underlying tumor histology and the idividual life expectancy.…”

Kompresi Medulla Spinalis akibat Metastasis

“…Panjabi dan White mendefinisikan instabilitas spinal sebagai kondisi hilangnya kemampuan tulang belakang mempertahankan hubungan antar vertebra dalam menahan beban fisiologis. 10 Spinal Instability Neoplastic Score (SINS) merupakan salah satu stratifikasi yang biasa digunakan untuk membantu klinisi menentukan adanya instabilitas tulang. 7 Tujuan utama operasi pada metastasis tulang belakang adalah stabilisasi tulang, mengangkat massa tumor penyebab kompresi, mengurangi nyeri, dan mempertahankan fungsi neurologis.…”