The Spine Instability Neoplastic Score: an independent reliability and reproducibility analysis

Spine J. 2014 Aug 1;14(8):1466-9. doi: 10.1016/j.spinee.2013.08.044. Epub 2013 Oct 3.


Background: Metastatic vertebral instability has not yet been clearly defined in the literature; there still exists a paucity of reliable criteria to assess the risk of vertebral collapse.

Purpose: We performed an independent interobserver and intraobserver agreement evaluation of the Spine Instability Neoplastic Score (SINS) and correlated the score with selected clinical cases and the treatment they received.

Study design: Independent reliability study for the newly created SINS.

Patient sample: Thirty patients who underwent either radiotherapy alone or surgery followed by radiotherapy were randomly selected from the orthopedic surgery and radiotherapy department's databases.

Outcome measures: Patients were rated and classified for spinal stability using SINS. Intraclass correlation coefficient (ICC) and Fleiss's kappa measures were occupied for reliability analysis.

Methods: Patients who underwent either radiotherapy alone or surgery followed by radiotherapy were randomly selected and classified for spinal stability using the SINS by orthopedic surgeons and nonorthopedic oncology specialists. ICC and Fleiss's kappa were calculated for inter- and intraobserver agreement. A comparative analysis of SINS and the actual management was also conducted.

Results: Interobserver ICC reliability for the SINS was 0.79; κ values for location, pain, bone quality, alignment, vertebral body collapse, and posterolateral involvement were 0.81, 0.58, 0.21, 0.45, 0.42, and 0.29 respectively. Intraobserver ICC for the SINS scores was 0.96; ICC values for the same components were 0.98, 0.98, 0.87, 0.88, 0.92, and 0.86, respectively. Potentially unstable lesions (SINS score≥7) were operated on in 62.5%.

Conclusions: SINS seem to be a reproducible tool that could be used equally by multiple specialists to estimate metastatic vertebral stability; however, prospective clinical validation is still pending.

Keywords: Impending fractures; Observer agreement; Reliability analysis; Spinal Instability Neoplastic Score; Spinal instability; Spinal metastasis.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Fractures, Spontaneous / diagnostic imaging
  • Fractures, Spontaneous / etiology*
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Orthopedics
  • Radiography
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Assessment
  • Spinal Fractures / diagnostic imaging
  • Spinal Fractures / etiology*
  • Spinal Neoplasms / complications
  • Spinal Neoplasms / diagnostic imaging
  • Spinal Neoplasms / secondary*