Article
Utility of the spinal instability score in patients with spinal metastases – a single-centre study with 332 patients
Die Nützlichkeit des „Spinal Instability Score“ für Patienten mit Wirbelkörpermetastasen – eine monozentrische Studie mit 332 Patienten
Search Medline for
Authors
Published: | June 4, 2021 |
---|
Outline
Text
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, 44% 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 recovered 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.