title: The Spinal Instability Neoplastic Score: Impact on Oncologic Decision-Making.
abstract: METHODS
  Systematic literature review.
  
  
  OBJECTIVE
  To address the following questions in a systematic literature review: 1. How is spinal neoplastic instability defined or classified in the literature before and after the introduction of the Spinal Instability Neoplastic Score (SINS)? 2. How has SINS affected daily clinical practice? 3. Can SINS be used as a prognostic tool?
  
  
  BACKGROUND
  Spinal neoplastic-related instability was defined in 2010 and simultaneously SINS was introduced as a novel tool with criteria agreed upon by expert consensus to assess the degree of spinal stability.
  
  
  METHODS
  PubMed, Embase, and clinical trial databases were searched with the key words "spinal neoplasm," "spinal instability," "spinal instability neoplastic score," and synonyms. Studies describing spinal neoplastic-related instability were eligible for inclusion. Primary outcomes included studies describing and/or defining neoplastic-related instability, SINS, and studies using SINS as a prognostic factor.
  
  
  RESULTS
  The search identified 1414 articles, of which 51 met the inclusion criteria. No precise definition or validated assessment tool was used specific to spinal neoplastic-related instability prior to the introduction of SINS. Since the publication of SINS in 2010, the vast majority of the literature regarding spinal instability has used SINS to assess or describe instability. Twelve studies specifically investigated the prognostic value of SINS in patients who underwent radiotherapy or surgery.
  
  
  CONCLUSIONS
  No consensus could be determined regarding the definition, assessment, or reporting of neoplastic-related instability before introduction of SINS. Defining spinal neoplastic-related instability and the introduction of SINS have led to improved uniform reporting within the spinal neoplastic literature. Currently, the prognostic value of SINS is controversial.
  
  
  METHODS
  N/A.
authors.affiliation: Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Versteeg
authors.affiliation: Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Jorrit-Jan
authors.initials: JJ
authors.lastname: Verlaan
authors.affiliation: Department of Radiation Oncology, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada.
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.affiliation: The Department of Neurosurgery and Orthopedics at The Ohio State University, Columbus, OH.
authors.forename: Ehud
authors.initials: E
authors.lastname: Mendel
authors.affiliation: The Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals, Nottingham, UK.
authors.forename: Nasir A
authors.initials: NA
authors.lastname: Quraishi
authors.affiliation: Division of Neurosurgery, University of Saskatchewan and Royal University Hospital, Saskatoon, SK, Canada.
authors.forename: Daryl R
authors.initials: DR
authors.lastname: Fourney
authors.affiliation: Division of Spine, Department of Orthopaedics, University of British Columbia, Vancouver General Hospital, and the Combined Neurosurgical and Orthopaedic Spine Program at Vancouver Coastal Health, Vancouver, BC, Canada.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
mesh_terms: D000066491:Clinical Decision-Making; D006801:Humans; D007593:Joint Instability / Q000473:pathology / Q000503:physiopathology; D011379:Prognosis; D013125:Spinal Neoplasms / Q000473:pathology / Q000503:physiopathology*; D013131:Spine / Q000473:pathology / Q000503:physiopathology*