Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
World Neurosurg. 2020 May;137:e564-e569. doi: 10.1016/j.wneu.2020.02.038. Epub 2020 Feb 14.
Most patients with spinal tumors suffer no symptoms or have mild symptoms, but about 14% of patients have refractory pain caused by mechanical instability, or symptoms of spinal cord damage caused by epidural spinal cord compression. The Spinal Instability Neoplastic Score (SINS) and Kostuik classification are commonly used to evaluate spinal stability, and help to make a more detailed operation plan. The objectives of this study are to evaluate the reliability and reproducibility of the SINS and Kostuik classification, and to explore their clinical application value.
All 80 patients with spinal tumors were enrolled. Six spine surgeons who have certain clinical experience were selected. Patients were scored according to the SINS scoring system and classification was determined according to the Kostuik system. We used Fleiss and Cohen κ values to check the coefficient consistency for multifactors. We used Cohen κ value to check the interobserver reliability and intraobserver reproducibility. After 12 weeks, we repeated the analysis.
The interobserver reliability and intraobserver reproducibility of the SINS scoring system were near perfect with values of 0.831 and 0.874, respectively. The interobserver reliability and intraobserver reproducibility of the Kostuik classification system were moderate with values of 0.505 and 0.595, respectively.
Compared with the Kostuik classification system, the SINS scoring system has better interobserver reliability and intraobserver reproducibility, which can be widely used in clinical practice and has great significance in the decision-making of spinal tumor treatment. Although the Kostuik classification system is often used in clinical practice, it shows inferior reliability and reproducibility in our study.
大多数脊柱肿瘤患者无明显症状或仅有轻微症状，但约 14%的患者存在机械失稳引起的难治性疼痛，或硬膜外脊髓压迫引起的脊髓损伤症状。脊柱失稳肿瘤评分（SINS）和 Kostuik 分类常用于评估脊柱稳定性，有助于制定更详细的手术计划。本研究旨在评估 SINS 和 Kostuik 分类的可靠性和可重复性，并探讨其临床应用价值。
纳入 80 例脊柱肿瘤患者，选择 6 名具有一定临床经验的脊柱外科医生，按照 SINS 评分系统对患者进行评分，并根据 Kostuik 系统进行分类。采用 Fleiss 和 Cohen κ 值检验多因素的系数一致性，采用 Cohen κ 值检验观察者间可靠性和观察者内可重复性。12 周后重复分析。
SINS 评分系统的观察者间可靠性和观察者内可重复性接近完美，值分别为 0.831 和 0.874。Kostuik 分类系统的观察者间可靠性和观察者内可重复性为中度，值分别为 0.505 和 0.595。
与 Kostuik 分类系统相比，SINS 评分系统具有更好的观察者间可靠性和观察者内可重复性，可广泛应用于临床实践，对脊柱肿瘤治疗决策具有重要意义。尽管 Kostuik 分类系统在临床实践中经常使用，但在本研究中其可靠性和可重复性较差。
