MDCalc

Spinal Instability Neoplastic Scale (SINS) Score

Evaluates the degree of spinal instability in patients with spinal tumors.

  • Use in patients with metastatic or primary spinal tumors to assess the risk of spinal instability.
  • When dealing with multiple spinal lesions, remember that stability scores should not be summed; instead, each lesion must be scored separately.

Spine location

Presence of mechanical pain

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

Bone lesion quality

Radiographic spinal alignment 

Vertebral body collapse

Posterolateral involvement of spinal elements

Facet, pedicle, or CV joint fracture or replacement with tumor

Result:

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Management
  • Total scores range from 0 to 18, with higher scores indicating greater instability.
    • A score of 7-12 suggests indeterminate stability; consultation with a spine surgeon is recommended.
    • A score ≥13 indicates the likely need for surgical intervention; surgical consultation is recommended.
  • This tool should not be used in isolation to make decisions about spine surgery; clinical judgment and other diagnostic tools must be integrated into the decision-making process.
  • Additional factors such as other spinal diseases, previous spinal surgeries, and overall patient health should be considered, as these may also contribute to instability and influence the decision on surgical intervention.