Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, 525 East 68th St, Box 99, New York, NY 10065, USA.
Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
Spine J. 2018 Feb;18(2):261-267. doi: 10.1016/j.spinee.2017.07.008. Epub 2017 Jul 13.
Neoplastic spinal instability is movement-related pain or neurologic compromise under physiologic loads with the Spinal Instability Neoplastic Score (SINS) developed to facilitate diagnosis. There is a paucity of evidence that mechanical instability correlates with patient-reported symptoms and that surgical stabilization significantly improves these patient-reported outcomes (PROs).
The objective of this study was to determine if SINS correlates with patient-reported preoperative pain and disability, and if surgical stabilization significantly improves PRO.
A single-institution prospective cohort study was carried out.
A total of 131 patients who underwent stabilization for metastatic spinal tumor treatment between July 2014 and August 2016 were included.
Preoperative baseline and mean difference in perioperative PROs as assessed by the Brief Pain Inventory (BPI) and MD Anderson Symptom Inventory (MDASI) were the outcome measures.
The SINS was analyzed as a continuous, ordinal, and categorical variable (Stable: 0-6, Indeterminate: 7-12, Unstable: 13-18). Statistical analysis was performed using Spearman rank coefficient (rho), the Kruskal-Wallis test, and an extension of the Cochran-Armitage trend test. The SINS and association between the mean differences in post- and preoperative PRO scores was analyzed using the Wilcoxon signed-rank test.
There was a statistically significant positive correlation between increasing SINS and severity of preoperative pain with BPI average pain (rho=0.20; p=.03) and MDASI pain (rho=0.19; p=.03). Increasing SINS correlated with severity of preoperative disability with BPI walking (rho=0.19; p=.04), MDASI activity (rho=0.24; p=.006), and MDASI walking (rho=0.20; p=.03). Similar associations were noted when SINS was analyzed as an ordinal categorical variable. Stabilization significantly improved nearly all PRO measures for patients with indeterminate and unstable SINS. Significant correlations persisted when controlling for neurologic status and were not affected based on the technique of surgical stabilization used.
Patient-related outcome-based validation of SINS confirms this scoring system for diagnosing neoplastic spinal instability and provides surgeons with a tool to determine which patients will benefit from stabilization. Surgical stabilization of cancer patients with SINS consistent with mechanical instability provides significant reduction in pain and improves patient mobility independent of neurologic status and stabilization technique.
肿瘤性脊柱不稳定是指在生理负荷下与脊柱不稳定肿瘤评分（SINS）相关的运动相关性疼痛或神经功能障碍，该评分有助于诊断。目前，缺乏证据表明机械不稳定与患者报告的症状相关，且手术稳定显著改善这些患者报告的结局（PRO）。
本研究旨在确定 SINS 是否与患者术前疼痛和残疾相关，以及手术稳定是否显著改善 PRO。
进行了一项单机构前瞻性队列研究。
纳入了 2014 年 7 月至 2016 年 8 月期间因转移性脊柱肿瘤治疗而接受稳定治疗的 131 例患者。
使用简短疼痛量表（BPI）和 MD 安德森症状量表（MDASI）评估术前基线和围手术期 PRO 的平均差异，作为结局测量。
分析 SINS 作为连续、有序和分类变量（稳定：0-6，不确定：7-12，不稳定：13-18）。使用 Spearman 秩相关系数（rho）、Kruskal-Wallis 检验和 Cochran-Armitage 趋势检验的扩展来进行统计分析。使用 Wilcoxon 符号秩检验分析 SINS 与术前和术后 PRO 评分平均差异之间的关联。
SINS 逐渐增加与 BPI 平均疼痛（rho=0.20；p=.03）和 MDASI 疼痛（rho=0.19；p=.03）的术前疼痛严重程度呈统计学显著正相关。SINS 逐渐增加与 BPI 行走（rho=0.19；p=.04）、MDASI 活动（rho=0.24；p=.006）和 MDASI 行走（rho=0.20；p=.03）的术前残疾严重程度相关。当 SINS 被分析为有序分类变量时，也观察到类似的关联。对于 SINS 不确定和不稳定的患者，稳定显著改善了几乎所有 PRO 测量。当控制神经状态时，相关性仍然存在，且不受所使用的手术稳定技术的影响。
基于患者相关结局的 SINS 验证证实了该评分系统用于诊断肿瘤性脊柱不稳定，并为外科医生提供了一种工具，以确定哪些患者将从稳定中受益。对于 SINS 一致的机械不稳定的癌症患者进行手术稳定可显著减轻疼痛并改善患者活动能力，独立于神经状态和稳定技术。
