Departments of1Neurosurgery.
4School of Medicine, University of California, San Francisco, California.
Neurosurg Focus. 2021 May;50(5):E6. doi: 10.3171/2021.2.FOCUS201098.
Within the Spine Instability Neoplastic Score (SINS) classification, tumor-related potential spinal instability (SINS 7-12) may not have a clear treatment approach. The authors aimed to examine the proportion of patients in this indeterminate zone who later required surgical stabilization after initial nonoperative management. By studying this patient population, they sought to determine if a clear SINS cutoff existed whereby the spine is potentially unstable due to a lesion and would be more likely to require stabilization.
Records from patients treated at the University of California, San Francisco, for metastatic spine disease from 2005 to 2019 were retrospectively reviewed. Seventy-five patients with tumor-related potential spinal instability (SINS 7-12) who were initially treated nonoperatively were included. All patients had at least a 1-year follow-up with complete medical records. A univariate chi-square test and Student t-test were used to compare categorical and continuous outcomes, respectively, between patients who ultimately underwent surgery and those who did not. A backward likelihood multivariate binary logistic regression model was used to investigate the relationship between clinical characteristics and surgical intervention. Recursive partitioning analysis (RPA) and single-variable logistic regression were performed as a function of SINS.
Seventy-five patients with a total of 292 spinal metastatic sites were included in this study; 26 (34.7%) patients underwent surgical intervention, and 49 (65.3%) did not. There was no difference in age, sex, comorbidities, or lesion location between the groups. However, there were more patients with a SINS of 12 in the surgery group (55.2%) than in the no surgery group (44.8%) (p = 0.003). On multivariate analysis, SINS > 11 (OR 8.09, CI 1.96-33.4, p = 0.004) and Karnofsky Performance Scale (KPS) score < 60 (OR 0.94, CI 0.89-0.98, p = 0.008) were associated with an increased risk of surgery. KPS score was not correlated with SINS (p = 0.4). RPA by each spinal lesion identified an optimal cutoff value of SINS > 10, which were associated with an increased risk of surgical intervention. Patients with a surgical intervention had a higher incidence of complications on multivariable analysis (OR 2.96, CI 1.01-8.71, p = 0.048).
Patients with a mean SINS of 11 or greater may be at increased risk of mechanical instability requiring surgery after initial nonoperative management. RPA showed that patients with a KPS score of 60 or lower and a SINS of greater than 10 had increased surgery rates.
在脊柱不稳定性肿瘤评分（SINS）分类中，与肿瘤相关的潜在脊柱不稳定（SINS 7-12）可能没有明确的治疗方法。作者旨在检查最初接受非手术治疗后，处于这一不确定区域的患者中，有多少人后来需要手术稳定。通过研究这一患者群体，他们试图确定是否存在明确的 SINS 临界值，脊柱因病变而存在潜在不稳定性，更有可能需要稳定。
回顾性分析了 2005 年至 2019 年在加利福尼亚大学旧金山分校接受转移性脊柱疾病治疗的患者记录。纳入了 75 例 SINS 7-12 肿瘤相关性潜在脊柱不稳定患者，这些患者最初接受非手术治疗。所有患者均至少随访 1 年，且病历完整。采用单变量卡方检验和学生 t 检验分别比较了手术组和非手术组之间的分类和连续结果。采用向后似然二元逻辑回归模型研究临床特征与手术干预之间的关系。递归分区分析（RPA）和单变量逻辑回归作为 SINS 的函数进行。
本研究共纳入 75 例患者，共 292 个脊柱转移部位；26 例（34.7%）患者接受手术治疗，49 例（65.3%）未接受手术治疗。两组患者的年龄、性别、合并症或病变部位无差异。然而，手术组的 SINS 为 12 的患者比例（55.2%）高于非手术组（44.8%）（p = 0.003）。多变量分析显示，SINS＞11（OR 8.09，CI 1.96-33.4，p = 0.004）和 Karnofsky 表现量表（KPS）评分＜60（OR 0.94，CI 0.89-0.98，p = 0.008）与手术风险增加相关。KPS 评分与 SINS 无相关性（p = 0.4）。对每个脊柱病变的 RPA 确定了 SINS＞10 的最佳临界值，与手术干预风险增加相关。多变量分析显示，接受手术治疗的患者并发症发生率较高（OR 2.96，CI 1.01-8.71，p = 0.048）。
SINS 平均值为 11 或更高的患者，在初始非手术治疗后可能存在更高的机械不稳定风险，需要手术治疗。RPA 显示，KPS 评分低于 60 分和 SINS 大于 10 的患者手术率增加。
