Ten Years After SINS: Role of Surgery and Radiotherapy in the Management of Patients With Vertebral Metastases

Abstract

The objective of the different types of treatments for a spinal metastasis is to provide the best oncological and functional result with the least aggressive side effects. Initially created in 2010 to help clinicians in the management of vertebral metastases, the Spine Instability Neoplastic Score (SINS) has quickly found its place in the decision making and the treatment of patients with metastatic spinal disease. Here we conduct a review of the literature describing the different changes that occurred with the SINS score in the last ten years. After a brief presentation of the spinal metastases’ distribution, with or without spinal cord compression, we present the utility of SINS in the radiological diagnosis and extension of the disease, in addition to its limits, especially for scores ranging between 7 and 12. We take this opportunity to expose the latest advances in surgery and radiotherapy concerning spinal metastases, as well as in palliative care and pain control. We also discuss the reliability of SINS amongst radiologists, radiation oncologists, spine surgeons and spine surgery trainees. Finally, we will present the new SINS-derived predictive scores, biomarkers and artificial intelligence algorithms that allow a multidisciplinary approach for the management of spinal metastases.

Vertebral body collapse after radiotherapy for spinal metastases

“…There was one patient who had paralysis during the study period. The patient also had severe pain who cannot get out of bed with instability of the spine as measured by spine instability neoplastic score (6). The surgery was performed (laminecomy and spine stabilization) for the patient.…”

“…These spinal skeletal-related events (SREs) drastically reduce patients' activities of daily living (ADL) and quality of life (QOL) (1)(2)(3). If the patient has symptoms of VBC and/or SREs, radiotherapy (RT) and surgery would be preferred to chemotherapy because of their direct local effect such as shrinkage of the tumor, decompression with the removal of lamina or pedicle, and removal of the compressing tumor (4)(5)(6). In patients with paralysis, decompression and fixation are the first treatment choices (6)(7)(8)(9).…”

“…If the patient has symptoms of VBC and/or SREs, radiotherapy (RT) and surgery would be preferred to chemotherapy because of their direct local effect such as shrinkage of the tumor, decompression with the removal of lamina or pedicle, and removal of the compressing tumor (4)(5)(6). In patients with paralysis, decompression and fixation are the first treatment choices (6)(7)(8)(9). However, conservative treatment using orthoses is often preferred in patients without paralysis (10).…”

Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression—A New Integrative Flowchart for Patient Management

“…It assesses and scores six variables, namely the location of the lesion, characteristics of pain, type of bony lesion, radiographic spinal alignment, degree of vertebral body destruction, and involvement of posterolateral spinal elements [ 56 ]. The scores for each variable are added, resulting in a final score ranging from 0 to 18 [ 55 , 56 ].…”

“…It assesses and scores six variables, namely the location of the lesion, characteristics of pain, type of bony lesion, radiographic spinal alignment, degree of vertebral body destruction, and involvement of posterolateral spinal elements [ 56 ]. The scores for each variable are added, resulting in a final score ranging from 0 to 18 [ 55 , 56 ]. Stability is defined by a score of 0 to 6, possibly impending instability is determined by a score of 7 to 12, while instability is coined by a score of 13 to 18 [ 55 , 56 ].…”