SINS

Spine Instability Neoplastic Score

Location

  • 3 points: Junctional (C0-C2, C7-T2, T11-L1, L5-S1)
  • 2 points: Mobile spine (C3-C6, L2-L4)
  • 1 point: Semi-rigid (T3-T10)
  • 0 points: Rigid (S2-S5)

    • Pain relief with recumbency and/or pain with movement/loading of the spine

  • 3 points: Yes
  • 1 point: No (occasional pain but not mechanical)
  • 0 points: Pain free lesion

    • Bone lesion

  • 2 points: Lytic
  • 1 point: Mixed (lytic/blastic)
  • 0 points: Blastic

    • Radiographic spinal alignment

  • 4 points: Subluxation / translation present
  • 2 points: De novo deformity (kyphosis / scoliosis)
  • 0 points: Normal alignment

    • Vertebral body collapse

  • 3 points: >50% collapse
  • 2 points: <50% collapse
  • 1 point: No collapse with >50% body involved
  • 0 points: None of the above

    • Posterolateral involvement of the spinal elements (facet, pedicle or costovertebral joint fracture or replacement with tumor)

  • 3 points: Bilateral
  • 1 point: Unilateral
  • 0 points: None of the above

    • Interpretation

  • sum score 0-6: stable
  • sum score 7-12: indeterminate (possibly impending) instability
  • sum score 13-18: instability

    • SINS scores of 7 to 18 warrant surgical consultation.

    Reference

    Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine 2010; 35:E1221-9.