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- Title
Correlation of the Spinal Instability Neoplastic Score (SINS) Individual Components and Indeterminate Subgroup Designation With Patient-Reported Outcomes Following Instrumented Surgical Stabilization.
- Authors
Hussain, Ibrahim; Barzilai, Ori; Reiner, Anne; DiStefano, Natalie; McLaughlin, Lily; Ogilvie, Shahiba; Bilsky, Mark; Laufer, Ilya
- Abstract
Introduction: The Spinal Instability Neoplastic Score (SINS) was developed to facilitate the diagnosis of instability in patients with spine tumors. It is comprised of six categories and cumulative scores are denoted as stable (0-6), indeterminate (7-12), or unstable (13-18). We have previously demonstrated that SINS correlates with pre-operative patient reported outcomes (PRO) and response to stabilization, with higher scores experiencing greater relief after surgery. However, there is a paucity of data demonstrating the extent to which each component contributes to PRO. Furthermore, treatment decisions for "indeterminate" SINS requires further elucidation. The objectives of our study were to determine how each SINS component correlates with pre- and post-operative PRO and to study the heterogeneity of the "indeterminate" group in order to further delineate instability. Material and Methods: SINS and PRO (10 pain, walking, and activity related items from the Brief Pain Inventory (BPI) and MD Anderson Symptom Inventory (MDASI)) were prospectively collected from 131 patients undergoing instrumented stabilization surgery for metastatic spinal disease. Association between individual SINS components with pre-operative symptom burden and symptom change after surgery was analyzed using Spearman Rank Correlation Coefficient (ρ). Correlation between SINS component scores and magnitude of pain relief was analyzed using the Kruskal Wallis test. Pre-operative SINS and association with pre-operative PRO scores were compared for two SINS categories within the indeterminate group (7-9 vs. 10-12) using the Wilcoxon two-sample test. The mean differences in post- and pre-operative PRO scores for these subgroups were compared using the Wilcoxon signed rank test. P-values less than or equal to 0.05 were considered statistically significant. Results: SINS metastatic location component significantly correlated with all pre-operative functional disability measures, including BPI activity (ρ = 0.27; P = 0.002) and MDASI walking (ρ = 0.33; P = 0.0002). Patients with higher location scores experienced a larger improvement in walking ability after surgery (BPI P = 0.04, MDASI P = 0.02). 8 out of 10 pre-operative PRO items significantly correlated with SINS mechanical pain component, including MDASI pain (ρ = 0.34; P < 0.0001) and activity (ρ = 0.31; P = 0.0003). This component also significantly correlated with improvement in BPI worst pain (ρ = -0.26; P = 0.01) and MDASI pain (ρ = -0.28; P = 0.04) following surgery. There was a significant association between lower SINS bone lesion quality component scores and improvement in BPI worst pain (P = 0.05) postoperatively, with sclerotic tumors (score = 0) experiencing greater relief compared to patients with lytic (score = 2) tumors. Following surgical stabilization, patients with low indeterminate SINS (7-9) demonstrated significant decreases in 3 out of 10 PRO, whereas those with high indeterminate SINS (10-12) demonstrated significant decreases in 8/10 PRO, including MDASI spine pain (-2.4; P = 0.001) and BPI activity (-2.4; P < 0.0001), and MDASI activity (-2.0; P = 0.0006). Conclusion: The presence of mechanical pain followed by metastatic location correlated most strongly with pre-operative functional disability measures and improvement in PRO following surgical stabilization to a statistically significant degree. Blastic rather than lytic bone lesions demonstrated a significantly stronger association with symptomatic pain improvement following stabilization. Patients with SINS 10-12 demonstrated markedly improved PRO nearly across the board compared to SINS 7-9 with stabilization surgery, suggesting that this group includes distinct populations.
- Publication
Global Spine Journal, 2018, Vol 8, p83S
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/2192568218771030