Classification system for Spine Instability Neoplastic Score (SINS)

Component scores for clinical and radiographic findings		Score
Spine location
Junctional (occiput-C2, C7-T2, T11-L1, L5-S1)		3
Mobile spine (C3-C6, L2-L4)		2
Semi-rigid (T3-T10)		1
Rigid (S2-S5)		0
Pain relief with recumbence (lying down) or pain with movement/loading of the spine
Yes		3
No (occasional pain but not mechanical)		1
Pain-free lesion		0
Bone lesion quality
Lytic		2
Mixed lytic/blastic		1
Blastic		0
Radiographic spinal alignment
Subluxation/translation present		4
De novo deformity (kyphosis/scoliosis)		2
Normal alignment		0
Vertebral body collapse
>50% collapse		3
<50% collapse		2
No collapse with >50% body involved		1
None of the above		0
Posterolateral involvement of spinal elements (facet, pedicle, or costovertebral joint fracture or replacement with tumor)
Bilateral		3
Unilateral		1
None of the above		0
The SINS score is generated by adding all of the scores from the six individual components (minimal score is 0, maximal score is 18)
Score	Classification	Action
0 to 6	Stable spine
7 to 12	Indeterminant	Possible impending instability, warrants surgical consultation
13 to 18	Instability	Warrants surgical consultation

Graphic 80396 Version 3.0