A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group.
Fisher CG, DiPaola CP, Ryken TC, et al. Spine 2010 · PMID 20562730 · doi:10.1097/brs.0b013e3181e16ae2
- Question
- How can spinal instability caused by tumour be graded consistently to guide surgical referral?
- Design
- Systematic review plus Delphi expert consensus by the Spine Oncology Study Group.
- Patients
- Patients with spinal neoplastic disease, mainly metastases.
- Intervention
- Spinal Instability Neoplastic Score (location, pain, bone lesion type, alignment, vertebral body collapse, posterolateral involvement)
- Comparison
- Not applicable (classification)
- Primary outcome
- Classification into stable, potentially unstable and unstable categories
- Key result
- Combines six clinical and radiological components into a weighted score that classes lesions as stable, potentially unstable or unstable, with the higher categories prompting a spinal surgical opinion.
- Limitations
- Consensus-derived; the intermediate category is heterogeneous and the score does not by itself determine treatment.
- Impact on practice
- Widely used in UK MSCC pathways and endorsed in NICE guidance to identify patients needing spinal surgical opinion.