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SINS (Spinal Instability)

Clinical Context & Background

The Spinal Instability Neoplastic Score (SINS) assesses spinal stability in patients with neoplastic disease. It guides referrals to spine surgeons. A score ≥ 13 indicates instability requiring surgical consultation, while 7-12 is indeterminate.
Primary Source EvidenceFisher CG, DiPaola CP, Ryken TC, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010;35(22):E1221-E1229.
Formula Logic
Sum of 6 radiographic and clinical factors.

Reference Data

SINS ScoreClassificationRecommendation
0 - 6StableRadiation / Observation
7 - 12Indeterminate (Impending)Surgical Consultation
13 - 18UnstableSurgical Stabilization Required

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