Abstract
Objective : The aim of this study is to assess the intra- and interobserver concordance of SINS, Harrington, Tokuhashi and Tomita scores among general orthopedic surgeons and spine surgeons with experience above 5 and 10 years in the evaluation of patients with spinal metastasis. Methods : Twenty cases of patients with metastatic lesion of the spine were presented to 10 examiners and the scores aforementioned have been applied. After six weeks, the cases were reintroduced in a different order and data were analyzed. Results : The intraobserver reliability showed better agreement in SINS score among examiners with less experience and Harrington and Tomita scores among those who had more than 10-year experience. The interobserver reliability of the examiners of the group with over 10-year experience showed higher precision when using these scores, especially Harrington and Tomita. The SINS score was the choice for daily practice and was able to modify the management more often. Conclusions : This study demonstrated that the use of predictive scores of instability, Harrington, and prognosis, Tomita, had a higher intra- and interobserver reliability particularly among spine surgeons with experience above 10 years.
Highlights
The spine is the most common site of metastatic disease.[1,2] Patients with cancer present spinal metastases in 70% of cases and up to 10% develop spinal cord compression.[2,3] The ratio of these lesions to primary tumors is 40:1 and skeletal dissemination should be considered in the differential diagnosis of a patient with a spinal cord lesion.[1,4,5]Metastatic involvement of the spine is more common in primary tumors of the breast, lung, kidney, thyroid gland, and the prostate, in that order, according to Papastefanou et al.[6]
We retrospectively evaluated the medical records of 20 patients with metastatic lesions in the spine treated at the Spine Clinic of Hospital São Paulo, of the Universidade Federal de São Paulo (UNIFESP) Department of Orthopedics, Escola Paulista de Medicina
After six weeks the cases were reviewed again in a different order, to eliminate any memory bias, with a restatement of the scores presented in the tables below and a self-assessment questionnaire consisting of three questions: (1) Do you use these scores routinely in treating patients with vertebral tumors? (2) If you do not use them, what is your method of choice for daily practice? and (3) If the treatment indicated by the score is different from yours, which classification system would change your conduct? The responses were stored, for the calculation of intra- and interobserver reproducibility
Summary
The spine is the most common site of metastatic disease.[1,2] Patients with cancer present spinal metastases in 70% of cases and up to 10% develop spinal cord compression.[2,3] The ratio of these lesions to primary tumors is 40:1 and skeletal dissemination should be considered in the differential diagnosis of a patient with a spinal cord lesion.[1,4,5]. The involvement of the spine is a common problem and its incidence is increasing because the methods of detection, screening, and treatment of primary cancer are allowing patients with active disease to live longer.[6,8]. This study attempts to evaluate the intra- and interobserver concordances in the SINS,[8] Harrington,[13] Tokuhashi et al.,[10] and Tomita et al.[14] scores between general orthopedic surgeons and spine surgeons with more than 5 and 10 years of experience in the evaluation of patients with vertebral metastasis
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