Pithwa Yogesh Kishorkant, Sinha Roy Vikrant
FNB Spine Surgery, HOSMAT Hospital and Sattvik Spine & Scoliosis Center, Bengaluru, Karnataka, India.
Global Spine J. 2023 Jun;13(5):1305-1310. doi: 10.1177/21925682211030876. Epub 2021 Jul 14.
Prospective Observational Study.
To assess the feasibility of utilizing SINS score, originally suggested for neoplastic conditions, to assess structural instability in spinal tuberculosis.
Patients with an established diagnosis of spinal tuberculosis were included in the study. Based on SINS scoring, patients classified as those with "indeterminate stability" were managed with or without surgery based on other parameters including neurological status, severity of pain, medical comorbidities, etc.
Eighty [39 males, 41 females] patients prospectively evaluated with mean age 46.74 ± 17.3 years. Classification done into stable [n = 7], indeterminate [n = 45] and unstable [n = 28] groups based on SINS scoring. All the patients in unstable group were treated with surgical stabilization whereas none in the stable group required surgical stabilization. In the indeterminate group, 26 patients underwent surgical stabilization, while 19 treated non-operatively. Major determinants predisposing to surgical intervention in "indeterminate group" were pain [14 of 26 patients] and neurological status [11 of 26 patients]. Mean follow-up 38.5 ± 22.61 months with minimum follow-up being 24 months. Preoperative VAS score for pain improved from median of 9/10 to 1/10 following surgery [ < .0001]. In the non-operative group, the improvement was from median score of 6/10 to 1/10 [ < .0001]. Preoperative ODI improved in non-operative and operative group from median of 42% and 70%, respectively to 10% and 12%, respectively in the postoperative period [ < .0001 for both groups].
SINS scoring can be a helpful tool in surgical decision-making even in spinal tuberculosis. Further refinement of the score can be done with a larger, multicenter study.
前瞻性观察性研究。
评估最初用于肿瘤疾病的SINS评分在评估脊柱结核结构不稳定方面的可行性。
确诊为脊柱结核的患者纳入本研究。根据SINS评分，将分类为“稳定性不确定”的患者根据包括神经状态、疼痛严重程度、内科合并症等其他参数决定是否进行手术治疗。
前瞻性评估了80例患者[39例男性，41例女性]，平均年龄46.74±17.3岁。根据SINS评分分为稳定组[n = 7]、不确定组[n = 45]和不稳定组[n = 28]。不稳定组的所有患者均接受手术稳定治疗，而稳定组中无一例需要手术稳定治疗。在不确定组中，26例患者接受了手术稳定治疗，19例接受非手术治疗。“不确定组”手术干预的主要决定因素是疼痛[26例患者中的14例]和神经状态[26例患者中的11例]。平均随访38.5±22.61个月，最短随访时间为24个月。术后疼痛的术前视觉模拟评分（VAS）从中位数9/10改善至1/10[<.0001]。在非手术组中，改善情况是从中位数6/10至1/10[<.0001]。术前脊柱功能障碍指数（ODI）在非手术组和手术组中分别从中位数42%和70%改善至术后的10%和12%[两组均<.0001]。
即使在脊柱结核中，SINS评分也可作为手术决策的有用工具。通过更大规模的多中心研究可对该评分进行进一步完善。
