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Clinical-Radiological Heterogeneity Within Intermediate Spinal Instability Neoplastic Scores (7-12): Factors
Kamil Krystkiewicz1, Magdalena Julita Orzechowska2, Aleksander Kowal1
1Department of Neurosurgery and Neurooncology, Copernicus Memorial Hospital in Łódź, Łódź, Poland.
World Neurosurgery
|July 8, 2026
Summary
The intermediate Spinal Instability Neoplastic Score (SINS) category is a heterogeneous group in surgical spine oncology. Clinical factors, not just SINS scores, guide stabilization decisions for spinal metastases.
Area of Science:
- Spine oncology
- Neurosurgery
- Orthopedic surgery
Background:
- Spinal metastases present a complex challenge in surgical oncology.
- The Spinal Instability Neoplastic Score (SINS) aids in treatment decisions.
- The intermediate SINS category (7-12) requires careful interpretation in clinical practice.
Purpose of the Study:
- To operationalize the intermediate SINS category in a real-world surgical spine oncology setting.
- To identify preoperative factors predicting instrumented stabilization for spinal metastases.
- To evaluate the utility of SINS in guiding surgical intervention.
Main Methods:
- Retrospective analysis of adult patients with spinal metastases undergoing surgery (2020-2025).
- Assessment of SINS and epidural spinal cord compression (ESCC) using clinical and imaging data.
- Comparison of intermediate SINS cases based on instrumentation status; multivariable and ROC analyses.
Main Results:
- Of 103 patients with complete SINS data, 78 fell into the intermediate category.
- 78% of intermediate SINS cases received instrumented stabilization; 22% received decompression alone.
- Symptom duration >14 days, Frankel grade E, and ECOG 0-II were associated with stabilization; ≥3 metastases were associated with lower likelihood of instrumentation.
Conclusions:
- The intermediate SINS category is clinically heterogeneous, representing a 'gray zone'.
- Surgical stabilization decisions integrate clinical and radiological assessments, not solely relying on SINS.
- Avoidance of rigid SINS cutoffs is supported by institutional practice.
