Division of Neurosurgery, Halifax Infirmary, 1796 Summer Street, Room 3814, Halifax, Nova Scotia, B3H 3A7, Canada.
Spinal Cord. 2020 Aug;58(8):892-899. doi: 10.1038/s41393-020-0432-8. Epub 2020 Feb 11.
A retrospective study.
This study assessed the clinical utility of the Spinal Instability Neoplastic Score (SINS) in relation to the surgical treatment of spinal epidural metastasis and factors important for surgical decision-making. These factors include epidural spinal cord compression (ESCC), patient prognosis and neurologic status.
Queen Elizabeth II Health Sciences Centre, Halifax, Canada.
We identified 285 patients with spinal metastatic disease. Data were extracted through a retrospective review. SINS and ESCC were scored based on CT and MRI, respectively.
Patients were grouped into stable (35%), potentially unstable (52%), and unstable (13%) groups. The overall incidence of metastatic spinal deformity was 9%. Surgical interventions were performed in 21% of patients, including decompression and instrumented fusion (70%), decompression alone (17%), percutaneous vertebral augmentation (9%), and instrumented vertebral augmentation (5%). The use of spinal instrumentation was significantly associated with unstable SINS (p = 0.005). Grade 3 ESCC was also significantly associated with unstable SINS (p < 0.001). Kaplan-Meier analysis revealed that SINS was not a predictor of survival (p = 0.98). In the radiotherapy-alone group, a significant proportion of patients with potentially unstable SINS (30%) progressed into unstable SINS category at an average 364 ± 244 days (p < 0.001).
This study demonstrated that more severe categories of SINS were associated with higher degrees of ESCC, and surgical interventions were more often utilized in this group with more frequent placement of spinal instrumentation. Although SINS did not predict patient prognosis, it correlates with the progression of metastatic instability in patients treated with radiotherapy.
回顾性研究。
本研究评估了脊柱不稳定肿瘤评分（SINS）在脊柱硬膜外转移的外科治疗中的临床实用性，以及对手术决策重要的因素。这些因素包括硬膜外脊髓压迫（ESCC）、患者预后和神经状态。
加拿大哈利法克斯伊丽莎白二世女王健康科学中心。
我们确定了 285 例患有脊柱转移疾病的患者。通过回顾性研究提取数据。SINS 和 ESCC 分别基于 CT 和 MRI 进行评分。
患者分为稳定（35%）、潜在不稳定（52%）和不稳定（13%）组。转移性脊柱畸形的总发生率为 9%。21%的患者接受了手术干预，包括减压和器械融合（70%）、单纯减压（17%）、经皮椎体增强（9%）和器械椎体增强（5%）。脊柱器械的使用与不稳定的 SINS 显著相关（p=0.005）。ESCC 分级 3 也与不稳定的 SINS 显著相关（p<0.001）。Kaplan-Meier 分析显示 SINS 不是生存的预测因素（p=0.98）。在单独放疗组中，具有潜在不稳定 SINS 的患者中有相当大的比例（30%）在平均 364±244 天内进展为不稳定 SINS 类别（p<0.001）。
本研究表明，SINS 的严重程度与更严重的 ESCC 相关，在这组患者中，手术干预更为常见，脊柱器械的使用更为频繁。尽管 SINS 不能预测患者的预后，但它与接受放疗的患者转移性不稳定的进展相关。
