# SINS — Spinal Instability Neoplastic Score

> Scores six components (one clinical, five radiographic) to grade the mechanical instability of a neoplastic spinal segment and prompt surgical referral.

**Situação:** vigente · **Órgão:** Coluna · **Órgão emissor:** Spine Oncology Study Group · **Versão:** 2010 · **Ano:** 2010

## Procedência e vigência
- Família: léxico
- Tipo de lógica: score
- Modalidade: CT, MRI
- Fonte primária: Fisher CG, DiPaola CP, Ryken TC, et al.; review by Hussain I, Barzilai O, et al.. A novel classification system for spinal instability in neoplastic disease (SINS), reproduced in Classifications in Brief (2010) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6907315/
- Última verificação: 2026-07-24
- Última checagem: 2026-07-24

## Lógica de decisão
Score every involved segment separately. Preserve the clinical pain input, return all six component scores, and treat the total as an instability-referral aid rather than an automatic procedure selector.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 0-6 | Stable (0-6) | Total SINS of 0-6 after scoring all six elements for one involved lesion or spinal segment: location, mechanical pain, bone-lesion quality, alignment, vertebral-body collapse, and posterolateral-element involvement. Every lesion is scored separately when multiple levels are involved. | The SINS referral interpretation is stable; referral specifically for evaluation of neoplastic spinal instability is not generally required by this score alone. Neurologic deficit, epidural compression and other urgent clinical findings remain separate assessments and can supersede the score. | Stable SINS category. This is a qualitative mechanical-stability classification, not a calibrated probability of fracture, neurologic deterioration, survival or treatment response. | Fisher et al., Spine 2010, PMID 20562730, six-component construction; Fourney et al., JCO 2011, PMID 21709187, validated 0-6 stable band; Hussain et al., PMC6907315, Description and Interpretation sections, including separate scoring for each lesion. | ✓ |
| 7-12 | Potentially unstable (7-12) | Total SINS of 7-12 after the same complete six-component, per-lesion calculation. The validated label is potentially unstable (also described as indeterminate stability), not a specific operative diagnosis. | Refer for spine-surgical or spine-oncology evaluation of possible mechanical instability. The score does not choose between observation, bracing, cement augmentation, fixation, radiotherapy or another treatment; that decision requires neurologic, oncologic and systemic context. | Potentially unstable category with greater concern for tumor-related mechanical instability than 0-6. The band does not provide a patient-specific event probability and contains clinically heterogeneous component combinations. | Fourney et al., JCO 2011, PMID 21709187, 7-12 potentially unstable category; Hussain et al., PMC6907315, Interpretation and Limitations: scores 7-18 warrant referral, while SINS does not itself provide treatment recommendations. | ✓ |
| 13-18 | Unstable (13-18) | Total SINS of 13-18 after the complete six-component, per-lesion calculation. High totals can reflect junctional location, mechanical pain, lytic destruction, translation or deformity, collapse, and bilateral posterolateral-element involvement in different combinations. | Refer promptly for specialist evaluation of mechanical instability. SINS identifies an unstable category but does not prescribe a specific operation or override neurologic compression, tumor biology, prognosis, prior treatment, bone quality, systemic fitness or patient goals. | Unstable SINS category and the highest qualitative concern for neoplastic mechanical instability. It is not a calibrated individual probability of collapse, neurologic injury, mortality or benefit from surgery. | Fourney et al., JCO 2011, PMID 21709187, 13-18 unstable category; Fisher et al., Spine 2010, PMID 20562730, use in surgical-consultation decisions; Hussain et al., PMC6907315, Interpretation and Limitations. | ✓ |

### Citações por categoria
- **0-6**: Fisher CG, DiPaola CP, Ryken TC, et al.; review by Hussain I, Barzilai O, et al.. A novel classification system for spinal instability in neoplastic disease (SINS), reproduced in Classifications in Brief (2010) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6907315/ · Fisher et al., Spine 2010, PMID 20562730, six-component construction; Fourney et al., JCO 2011, PMID 21709187, validated 0-6 stable band; Hussain et al., PMC6907315, Description and Interpretation sections, including separate scoring for each lesion.
- **7-12**: Fisher CG, DiPaola CP, Ryken TC, et al.; review by Hussain I, Barzilai O, et al.. A novel classification system for spinal instability in neoplastic disease (SINS), reproduced in Classifications in Brief (2010) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6907315/ · Fourney et al., JCO 2011, PMID 21709187, 7-12 potentially unstable category; Hussain et al., PMC6907315, Interpretation and Limitations: scores 7-18 warrant referral, while SINS does not itself provide treatment recommendations.
- **13-18**: Fisher CG, DiPaola CP, Ryken TC, et al.; review by Hussain I, Barzilai O, et al.. A novel classification system for spinal instability in neoplastic disease (SINS), reproduced in Classifications in Brief (2010) — https://pmc.ncbi.nlm.nih.gov/articles/PMC6907315/ · Fourney et al., JCO 2011, PMID 21709187, 13-18 unstable category; Fisher et al., Spine 2010, PMID 20562730, use in surgical-consultation decisions; Hussain et al., PMC6907315, Interpretation and Limitations.

## Referências cruzadas
- _fronteira compartilhada_ → [Bilsky ESCC — Epidural spinal cord compression (ESCC / Bilsky) scale](https://radcommons.laudos.ai/systems/bilsky-escc.md) — SINS addresses instability; the ESCC scale addresses epidural cord compression in the same metastatic spine assessment.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2010-10-01 | published | Spinal Instability Neoplastic Score published in Spine. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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