Clinical calculator summary
Original 2010 Spinal Instability Neoplastic Score
Clinical calculator summary
Original 2010 Spinal Instability Neoplastic Score
A six-component lesion-level classification of neoplastic spinal instability.
Evidence-based context for fast calculator use
- Purpose:
- Standardize communication and identify lesions warranting specialist assessment without prescribing treatment.
- Population:
- Patients with neoplastic disease involving the spine in the original Spine Oncology Study Group framework.
- Factors:
- Location, Mechanical pain, Bone-lesion quality, Alignment, Vertebral-body collapse, Posterolateral involvement
- Reference:
- Fisher et al. Spine. 2010;35(22):E1221-E1229.
SINS (Spinal Instability)
Clinical Context & Background
Original 2010 SINS = location + mechanical pain + bone-lesion quality + radiographic alignment + vertebral-body collapse + posterolateral-element involvement (range 0-18).Reference Data
| SINS total | Original classification | Interpretation |
|---|---|---|
| 0-6 | Stable | No instability-based referral indicated by SINS alone |
| 7-12 | Potentially unstable | Spine-specialist evaluation supported |
| 13-18 | Unstable | Spine-specialist evaluation supported |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- Use for lesion-level assessment of possible neoplastic spinal instability using clinical pain characterization and appropriate imaging.
- Have a clinician select every source-defined component deliberately; the tool does not infer radiographic findings.
How To Interpret
- Totals 0-6 are Stable, 7-12 Potentially unstable, and 13-18 Unstable.
- Scores 7-18 support spine-specialist evaluation, but the score alone does not determine surgery or another treatment.
What To Do Next
- Integrate SINS with neurologic examination, epidural spinal cord compression, tumor biology, radiosensitivity, systemic disease, prognosis, performance status, patient goals, and specialist judgment.
- Urgent neurologic symptoms or suspected cord compression require urgent assessment regardless of SINS.
Limitations
- Does not measure neurologic compromise, epidural spinal cord compression, tumor histology, systemic prognosis, operative candidacy, or treatment benefit.
- Not validated for traumatic or degenerative spinal instability.
- The source collapse categories are retained as categorical imaging judgments; the calculator does not infer an exact 50% boundary.
- Interobserver variability is greatest for several imaging components, so appropriate imaging expertise matters.
Validated Population
Neoplastic spinal lesions assessed within the original Spine Oncology Study Group framework.
Referral boundary
A total of 6 is Stable; a total of 7 is Potentially unstable and supports spine-specialist evaluation.
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed SINS cases passed through visible production controls at scores 0, 8, and 18 across all classification bands.
- No unexpected N/A, literal undefined value, stale control, or browser-console error was observed.
Case-level evidence is retained in validation/browser-revalidation/sins-spinal-instability-neoplastic-score-2026-08-03.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
- Overall browser status: failed-console. medium: Production emitted minified React error #418 during route loads/reloads used by this run.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/sins-spinal-instability-neoplastic-score.json.
: Full validation test
- 1,524/1,524 independent category-combination, exact-total-boundary, malformed-input, trace, UI, reset, immutability, card, download, catalog, and no-panel-inheritance checks passed.
- No registered master panel calculates SINS; no panel receives inherited SINS verification.
: Calculation and input-contract correction
- Removed six favorable/pre-scored defaults and arbitrary-value summation; every source-defined component is now required and missing, extra, coercive, or unsupported categories are rejected.
- Restored exact Stable 0-6, Potentially unstable 7-12, and Unstable 13-18 mapping, with complete contribution trace and referral wording that does not prescribe surgery or stabilization.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
Related Tools
Frequently Asked Questions
Does a SINS of 7 require surgery?
No. Scores 7-18 support spine-specialist evaluation, but SINS alone does not prescribe surgery or stabilization.
Does SINS assess spinal cord compression?
No. Epidural spinal cord compression and neurologic compromise require separate urgent clinical and imaging assessment.
What are the original SINS categories?
Stable is 0-6, Potentially unstable is 7-12, and Unstable is 13-18.
Evidence-based oncology decision support. Verify with clinical guidelines.