Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Education and Research, New Delhi, Delhi, India.
Department of Neurosurgery, Rajiv Gandhi Cancer Institute and Research Center, New Delhi, Delhi, India.
World Neurosurg. 2024 Sep;189:e745-e752. doi: 10.1016/j.wneu.2024.06.159. Epub 2024 Jul 2.
A significant dilemma exists for the surgical plan of spinal metastases with a spinal instability neoplastic score (SINS) of 7-12. Our aim is to trim down this range of "potential instability" and find a virtual cut-off value for instrumentation.
We performed a retrospective study on 60 patients who underwent surgical intervention for vertebral metastasis. They were segregated into 'instrumented' and "noninstrumented" groups. The primary endpoint of the study was to see whether surgical stabilization was done.
Although univariate analysis showed the overall SINS score, involvement of posterior elements, and mechanical pain to be the factors that significantly affected our decision making in favor of stabilization, only the SINS score was found to be statistically significant on multivariate analysis. On plotting the proportion of patients undergoing stabilization at each SINS score we found the curves to crossover between SINS 8 and 9, ran almost parallel to each other at values 9 and 10 and then seemed to diverge from each other significantly at values above 10. Taking SINS 9 as the cut-off value above which instrumentation is advised, the receiver operating characteristic curve had a sensitivity of 67.57% (95% confidence interval 50.21% to 81.99%) and specificity of 73.91% (95% confidence interval 51.59% to 89.77%). The area under the curve was 0.79 (0.67-0.91).
SINS 9-10 seems to be the actual ambiguous subset in the wider subgroup of the 'potentially unstable' category SINS 7-12, like a 'Matryoshka doll'. A SINS value of 9 can be seen as a cut-off value for instrumentation.
对于 SINS 评分为 7-12 的脊柱转移瘤患者的手术计划存在一个重大难题。我们的目的是缩小这个“潜在不稳定”范围，并找到一个用于器械固定的虚拟截止值。
我们对 60 名因脊柱转移而行手术干预的患者进行了回顾性研究。将他们分为“器械固定”和“非器械固定”两组。本研究的主要终点是观察是否进行了手术稳定。
尽管单因素分析显示总体 SINS 评分、后柱受累和机械性疼痛是影响我们支持稳定决策的因素，但多因素分析仅发现 SINS 评分具有统计学意义。在绘制每个 SINS 评分下接受稳定治疗的患者比例的曲线时，我们发现 SINS 8 和 9 之间的曲线交叉，SINS 9 和 10 之间的曲线几乎平行，然后在 SINS 值大于 10 时似乎明显发散。以 SINS 9 作为建议器械固定的截止值，ROC 曲线的敏感性为 67.57%（95%置信区间 50.21%至 81.99%），特异性为 73.91%（95%置信区间 51.59%至 89.77%）。曲线下面积为 0.79（0.67-0.91）。
SINS 9-10 似乎是 SINS 7-12 这个“潜在不稳定”更广泛亚组中真正的模糊亚组，就像一个“俄罗斯套娃”。SINS 值为 9 可以作为器械固定的截止值。
