Kim, Hyoungmin 1 ; Lee, Choon-Ki 1 ; Yeom, Jin S. 1 ; Lee, Jae Hyup 1 ; Lee, Suk- Joong 2 ; Chang, Bong-Soon 1
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1 The Predictive Value of the Spinal Instability Neoplastic Score (SINS) System for Adverse Events of Pathologic Fracture and Spinal Cord Compression in Patients with Single Spinal Metas tasis. Kim, Hyoungmin 1 ; Lee, Choon-Ki 1 ; Yeom, Jin S. 1 ; Lee, Jae Hyup 1 ; Lee, Suk- Joong 2 ; Chang, Bong-Soon 1 1. Department of Orthopedic Surgery, College of Medicine, Seoul National University, Jongno-gu, Seoul, Korea, Republic of. 2. Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Pusan, Korea, Republic of.
2 The Predictive Value of the SINS System Presenter: Bong-Soon Chang MD, PhD No Financial Relationships Co-Authors: Kim, Hyoungmin No Financial Relationships Lee, Choon-Ki No Financial Relationships Yeom, Jin S. (d) Medtronic Lee, Jae Hyup (c) BioApha Lee, Suk- Joong No Financial Relationships EuroSpine Liverpool, 2013 Authors Disclosure Information a. Grants/Research Support b. Consultant c. Stock/Shareholder d. Speakers Bureau e. Other Financial Support
3 Concept of Spinal Instability Classic but, Poorly defined yet Widely accepted Harrington 1986 JBJS Wise et al 1999 Spine Bilsky et al 2006 Hematol Oncol Clin North Am instability with tumor ( injury from high energy trauma) Failed systemic reviews to define spinal instability with tumor Weber MH et al 2011 Int J Oncol Fehlings et al in press Spine
4 SINS: spinal neoplastic instability score Spinal Oncology Study Group Delphi technique 2010, Spine 2011, J Clin Oncology Spinal Neoplastic Instability neoplastic process loss of spinal integrity under physiologic loads movement related pain, symptomatic or progressive deformity neural compromise
5 Purpose Validation of SINS system for prediction of spinal events requiring surgical intervention SINS system Spinal cord compression? Pathologic fracture?
6 Materials & Methods A consecutive series of 78 patients with a single spinal metastasis diagnosed with MRI in 2007 and 2008 Why single spinal metastasis? Simplified model To exclude confounding effects from multisegmenal disease Survival analysis with Cox-regression analysis End point 1: Spinal cord compression End point 2: Pathologic fracture Variable: scores of each item in SINS system
7 Results Urogenital 10pts, 12.8% Breast 20pts, 25.6% Breast Lung GI Urogenital Spinal metastasis confirmed with MRI in 1411 pts GI 25pts 32.2% Lung 18pts, 23.1% Endocrine Extremity Single spinal metastasis: 78pts Known cancer patients with spine lesion: 68pts Initial presentation with malignancy of unknown origin in spine : 10pts (their diagnosis was confirmed wit biopsy) Male 39 pts, Female 39 pts / Age: 55 ± 13 yrs Survival period after diagnosis of spinal metastasis: 43 ± 60 mos Spinal events at 8±14 months after Dx of cancer Spinal cord compression: 11 cases / Pathologic fracture: 17 cases Treatment CTx+RTx: 30 cases / CTx alone : 26 cases / RTx alone : 20 cases / None : 2 cases
8 Resutls Spinal events at 8±14 months after Dx of cancer Spinal cord compression: 11 cases Pathologic fracture: 17 cases Treatment CTx+RTx: 30 cases CTx alone : 26 cases RTx alone : 20 cases None : 2 cases
9 Pain * cord compression Results Posterior involve * cord compression P=0.008 P=0.002 Pain * fracture Alignment * fracture Location * fracture P=0.009 P=0.008 P=0.036
10 Spinal events according to Tx Treatment option spinal cord compression B SE Wald df Sig. Exp(B) CTx CTx+RTx none RTx Treatment option pathologic fracture B SE Wald df Sig. Exp(B) CTx CTx+RTx none RTx
11 SINS regarding Solitary Spinal Metastasis Thoracic > mobile > junctional? Pathologic Fracture Spinal Cord Compression
12 References Fourney, D. R., E. M. Frangou, et al. (2011). "Spinal instability neoplastic sc ore: an analysis of reliability and validity from the spine oncology study g roup." J Clin Oncol 29(22): Fisher, C. G., C. P. DiPaola, et al. (2010). "A novel classification system for s pinal instability in neoplastic disease: an evidence-based approach and ex pert consensus from the Spine Oncology Study Group." Spine (Phila Pa 1 976) 35(22): E Fourney, D. R. and Z. L. Gokaslan (2003). "Spinal instability and deformity due to neoplastic conditions." Neurosurgical Focus 14(1): e8. Jackson, R. J. and Z. L. Gokaslan (1999). "Occipitocervicothoracic fixation f or spinal instability in patients with neoplastic processes." Journal of Neur osurgery 91(1 Suppl):
J Korean Soc Spine Surg 2018 Jun;25(2): Originally published online June 30, 2018;
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