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Is the Spinal Instability Neoplastic Score Accurate and Reliable in Predicting Vertebral Compression Fractures for Spinal Metastasis? A Systematic Review and Qualitative Analysis

Journal of Korean Neurosurgical Society 2021년 64권 1호 p.4 ~ 12
이창현, 홍재택, 이선호, 이성, 손문준, 김성환, 정천기,
소속 상세정보
이창현 ( Lee Chang-Hyun ) - Seoul National University College of Medicine Seoul National University Hospital Department of Neurosurgery
홍재택 ( Hong Jae-Taek ) - Catholic University Eunpyeong St. Mary’s Hospital Department of Neurosurgery
이선호 ( Lee Sun-Ho ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Neurosurgery
이성 ( Yi Seong ) - Yonsei University College of Medicine Severance Hospital Department of Neurosurgery
손문준 ( Sohn Moon-Jun ) - Inje University Ilsan Paik Hospital Department of Neurosurgery
김성환 ( Kim Sung-Hwan ) - Catholic University College of Medicine St. Vincent’s Hospital Department of Radiation Oncology
정천기 ( Chung Chun-Kee ) - Seoul National University College of Medicine Seoul National University Hospital Department of Neurosurgery

Abstract


Spinal metastases can present with varying degrees of mechanical instability. The Spinal Instability Neoplastic Score (SINS) was developed as a tool to assess spinal neoplastic-related instability while helping to guide referrals among oncology specialists. Some previous papers suggested that the SINS was accurate and reliable, while others disagreed with this opinion. We performed a systematic review regarding the SINS to evaluate its accuracy and precision in predicting vertebral compression fractures (VCFs). The 21 included studies investigated a total of 2118 patients. Thirteen studies dealt with the accuracy of SINS to predict post-radiotherapy VCFs, and eight dealt with the precision. Among 13 studies, 11 agreed that the SINS categories showed statistically significant accuracy in predicting VCF. Among eight studies, body collapse was effective for predicting VCFs in six studies, and alignment and bone lesion in two studies. Location has no statistical significance in predicting VCFs in any of the eight studies. The precision of SINS categories was substantial to excellent in six of eight studies. Among the six components of the SINS, the majority of the included studies reported that location showed near perfect agreement; body collapse, alignment, and posterolateral involvement showed moderate agreement; and bone lesion showed fair agreement. Bone lesion showed significant accuracy in predicting VCFs in half of eight studies, but displayed fair reliability in five of seven studies. Although location was indicated as having near perfect reliability, the component showed no accuracy for predicting VCFs in any of the studies and deleting or modifying the item needs to be considered. The SINS system may be accurate and reliable in predicting the occurrence of post-radiotherapy VCFs for spinal metastasis. Some components seem to be substantially weak and need to be revised.

키워드

Spine; Metastasis; Spinal neoplastic instability score; Fractures, Compression; Radiotherapy

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