Abstract
The objective of the different types of treatments for a spinal metastasis is to provide the best oncological and functional result with the least aggressive side effects. Initially created in 2010 to help clinicians in the management of vertebral metastases, the Spine Instability Neoplastic Score (SINS) has quickly found its place in the decision making and the treatment of patients with metastatic spinal disease. Here we conduct a review of the literature describing the different changes that occurred with the SINS score in the last ten years. After a brief presentation of the spinal metastases’ distribution, with or without spinal cord compression, we present the utility of SINS in the radiological diagnosis and extension of the disease, in addition to its limits, especially for scores ranging between 7 and 12. We take this opportunity to expose the latest advances in surgery and radiotherapy concerning spinal metastases, as well as in palliative care and pain control. We also discuss the reliability of SINS amongst radiologists, radiation oncologists, spine surgeons and spine surgery trainees. Finally, we will present the new SINS-derived predictive scores, biomarkers and artificial intelligence algorithms that allow a multidisciplinary approach for the management of spinal metastases.
Highlights
The Spine Instability Neoplastic Score (SINS) introduced by the Spine Oncology Study Group (SOSG), quickly established itself as a reliable and predictive tool for clinicians allowing them to decide whether patients with spinal neoplastic disease of the spine would benefit from surgical intervention [9, 10]
We describe the evolution of our practice over the past ten years, and we provide the latest updates in the management of vertebral metastases
SINS served as the basis for the development of new scores as the treatment strategy algorithm of Paton et al [85] (LMNOP), that evaluates the number of spinal Levels involved, the Location of disease in the spine (L), Mechanical instability (M), Neurology (N), Oncology (O), Patient fitness, Prognosis and response to Prior therapy (P)
Summary
The spine is the most common site of bone metastases in general and skeletal metastases in particular, with a prevalence of 30-70% and 20-40% in cancer patients respectively [1, 2].spinal metastases are a concerning health issue as well as an economic burden [3, 4], despite the fact that the management of these patients has considerably evolved both in terms of surgery and radiotherapy (RT) [5,6,7,8]. The Spine Instability Neoplastic Score (SINS) introduced by the Spine Oncology Study Group (SOSG), quickly established itself as a reliable and predictive tool for clinicians allowing them to decide whether patients with spinal neoplastic disease of the spine would benefit from surgical intervention [9, 10] It assesses and scores 6 variables (Table 1): location of the lesion, characteristics of pain, type of bony lesion, radiographic spinal alignment, degree of vertebral body destruction, and involvement of posterolateral spinal elements. The mean survival was 12.3 months [24] At this point, treating such patients with metastatic epidural spinal cord compression remains a challenge, and a multidisciplinary approach is highly recommended. Screening for brain disease extension is very important [32], especially that postoperative complications are increased in case of brain metastases
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