SINS Spinal Instability Neoplastic Score

{
  "applicability": {
    "use_for": "Mechanical-instability assessment of a spinal segment involved by neoplastic disease.",
    "scoring_unit": "Calculate a separate score for every involved spinal lesion or segment; do not collapse multiple lesions into one patient-level sum.",
    "modalities_and_inputs": [
      "CT_or_radiographs_for_osseous_morphology_and_alignment",
      "MRI_for_neural_and_soft_tissue_context",
      "clinical_history_for_mechanical_pain"
    ]
  },
  "feature_groups": [
    {
      "id": "location",
      "options": [
        {
          "finding": "junctional_C0-C2_C7-T2_T11-L1_L5-S1",
          "points": 3
        },
        {
          "finding": "mobile_C3-C6_L2-L4",
          "points": 2
        },
        {
          "finding": "semirigid_T3-T10",
          "points": 1
        },
        {
          "finding": "rigid_S2-S5",
          "points": 0
        }
      ]
    },
    {
      "id": "pain",
      "clinical_input_required": true,
      "options": [
        {
          "finding": "mechanical_pain_with_movement_upright_posture_or_loading_relieved_by_recumbency",
          "points": 3
        },
        {
          "finding": "occasional_or_biologic_pain_without_mechanical_characteristics",
          "points": 1
        },
        {
          "finding": "pain_free_lesion",
          "points": 0
        }
      ]
    },
    {
      "id": "bone_lesion",
      "options": [
        {
          "finding": "lytic",
          "points": 2
        },
        {
          "finding": "mixed_lytic_and_blastic",
          "points": 1
        },
        {
          "finding": "blastic",
          "points": 0
        }
      ]
    },
    {
      "id": "alignment",
      "options": [
        {
          "finding": "subluxation_or_translation",
          "points": 4
        },
        {
          "finding": "de_novo_kyphosis_or_scoliosis_without_translation",
          "points": 2
        },
        {
          "finding": "normal_alignment",
          "points": 0
        }
      ]
    },
    {
      "id": "vertebral_body_collapse",
      "options": [
        {
          "finding": ">50_percent_collapse",
          "points": 3
        },
        {
          "finding": "<50_percent_collapse",
          "points": 2
        },
        {
          "finding": "no_collapse_but_>50_percent_body_involved",
          "points": 1
        },
        {
          "finding": "no_collapse_and_<=50_percent_body_involved",
          "points": 0
        }
      ]
    },
    {
      "id": "posterolateral_involvement",
      "structures": [
        "pedicles",
        "facets",
        "costovertebral_joints"
      ],
      "options": [
        {
          "finding": "bilateral_involvement",
          "points": 3
        },
        {
          "finding": "unilateral_involvement",
          "points": 1
        },
        {
          "finding": "no_involvement",
          "points": 0
        }
      ]
    }
  ],
  "calculation": {
    "formula": "location + pain + bone_lesion + alignment + vertebral_body_collapse + posterolateral_involvement",
    "range": "0-18",
    "all_six_components_required_for_total": true
  },
  "score_map": [
    {
      "outcome_code": "0-6",
      "score": "0-6",
      "interpretation": "stable",
      "referral_for_stability_evaluation": "not_generally_required_by_SINS_alone"
    },
    {
      "outcome_code": "7-12",
      "score": "7-12",
      "interpretation": "potentially_unstable",
      "referral_for_stability_evaluation": "recommended"
    },
    {
      "outcome_code": "13-18",
      "score": "13-18",
      "interpretation": "unstable",
      "referral_for_stability_evaluation": "recommended"
    }
  ],
  "output_contract": [
    "lesion_or_segment_scored",
    "six_component_findings",
    "six_component_points",
    "exact_total",
    "stability_category",
    "missing_clinical_input_warning"
  ],
  "missing_input_behavior": [
    "Do not infer mechanical pain from CT or MRI; request or report the missing clinical history.",
    "Do not calculate a definitive total when any component is unavailable; return the known components and identify what is missing."
  ],
  "limitations": [
    "SINS is a referral and communication tool, not a standalone treatment prescription or an overall oncologic-prognosis score.",
    "Neurologic deficit, high-grade epidural cord compression, multilevel disease, prior surgery or radiotherapy, diffuse bone involvement, poor bone quality, body weight, activity and systemic status require separate assessment.",
    "A score of 7 or more supports spine-surgical evaluation; it does not mandate a particular operation."
  ],
  "source_locator": "Fisher et al., Spine 2010;35:E1221-E1229, PMID 20562730, six-component SINS; Fourney et al., JCO 2011, PMID 21709187, 0-6/7-12/13-18 validation; Hussain et al., Clin Orthop Relat Res 2019, PMC6907315, component definitions, per-lesion rule and limitations."
}