• Laurens Bollen, Karlijn Groenen, and Willem Pondaag.
• *Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands†Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopedic Research Laboratory, Nijmegen, The Netherlands‡Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands§Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands¶Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands||Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands.
• Spine. 2017 Aug 15; 42 (16): E956-E962.

Study DesignRetrospective cohort study.ObjectiveTo determine the predictive value of the Spinal Instability Neoplastic Score (SINS) in a cohort of patients treated with radiotherapy for spinal bone metastases.Summary Of Background DataAssessment of spinal stability in metastatic disease is challenging and is mostly done by relying on clinical experience, in the absence of validated guidelines or an established predetermined set of risk factors. The SINS provides clinicians with a tool to assess tumor-related spinal instability.MethodsA total of 110 patients were included in this retrospective study. Time to event was calculated as the difference between start of radiotherapy and date of occurrence of an adverse event or last follow-up, with death being considered a competing event. A competing risk analysis was performed to estimate the effect of the SINS on the cumulative incidence of the occurrence of an adverse event.ResultsSixteen patients (15%) experienced an adverse event during follow-up. The cumulative incidence for the occurrence of an adverse event at 6 and 12 months was 11.8% (95% confidence interval 5.1%-24.0%) and 14.5% (95% confidence interval 6.9%-22.2%), respectively. Competing risk analysis showed that the final SINS classification was not significantly associated with the cumulative incidence of an adverse event within the studied population.ConclusionThe clinical applicability of the SINS as a tool to assess spinal instability seems limited.Level Of Evidence3.

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