Table 4.
Spine Instability Neoplastic Scale (SINS).
| Location within the spine | Points |
|---|---|
| Junctional (C0-C2, C7-T2, T11-L2, L5-S1) | 3 |
| Mobile spine (C3-C6, L2-L4) | 2 |
| Semi-rigid (T3-T10) | 1 |
| Rigid (S2-S5) | 0 |
| Pain relief with recumbence and pain with movement or loading of the spine | |
| Yes | 3 |
| No (occasional pain but not mechanical) | 1 |
| Pain-free lesion | 0 |
| Bone lesion quality | |
| Lytic | 2 |
| Mixed lytic or blastic | 1 |
| Blastic | 0 |
| Radiographic spinal alignment | |
| Subluxation or translation | 4 |
| De-novo deformity (kyphosis or scoliosis) | 2 |
| Normal alignment | 0 |
| Vertebral body collapse | |
| >50% collapse | 3 |
| <50% collapse | 2 |
| No collapse with 50% body involvement | 1 |
| None of the above | 0 |
| Postero-lateral involvement of spinal elements (facet, pedicle, costo-vertebral joint fracture or replacement with tumor) | |
| Unilateral | 3 |
| Bilateral | 1 |
| None of the above | 0 |
A score of 0–6 is classified as a stable spine, and no action is needed. A score of 7–12 receives a classification of indeterminate, and indicates potential instability, which warrants surgical consultation. A score of 13–18 indicates spinal instability that warrants surgical consultation.