Can We Extrapolate SINS Score to Evaluate Instability in Spinal Tuberculosis?

Abstract

Prospective Observational Study. To assess the feasibility of utilizing SINS score, originally suggested for neoplastic conditions, to assess structural instability in spinal tuberculosis. Patients with an established diagnosis of spinal tuberculosis were included in the study. Based on SINS scoring, patients classified as those with "indeterminate stability" were managed with or without surgery based on other parameters including neurological status, severity of pain, medical comorbidities, etc. Eighty [39 males, 41 females] patients prospectively evaluated with mean age 46.74 ± 17.3 years. Classification done into stable [n = 7], indeterminate [n = 45] and unstable [n = 28] groups based on SINS scoring. All the patients in unstable group were treated with surgical stabilization whereas none in the stable group required surgical stabilization. In the indeterminate group, 26 patients underwent surgical stabilization, while 19 treated non-operatively. Major determinants predisposing to surgical intervention in "indeterminate group" were pain [14 of 26 patients] and neurological status [11 of 26 patients]. Mean follow-up 38.5 ± 22.61 months with minimum follow-up being 24 months. Preoperative VAS score for pain improved from median of 9/10 to 1/10 following surgery [P < .0001]. In the non-operative group, the improvement was from median score of 6/10 to 1/10 [P < .0001]. Preoperative ODI improved in non-operative and operative group from median of 42% and 70%, respectively to 10% and 12%, respectively in the postoperative period [P < .0001 for both groups]. SINS scoring can be a helpful tool in surgical decision-making even in spinal tuberculosis. Further refinement of the score can be done with a larger, multicenter study.