SINS — Spinal Instability Neoplastic Score
Assesses spinal instability due to neoplastic disease. Guides spine surgery referral. Score 0–18.
Score interpretation
SINS 0–6. Likely stable spine. Surgery unlikely to be required.
→ Systemic oncological therapy (radiation, systemic treatment). Monitor clinically. Consider spine team opinion if symptomatic.
SINS 7–12. Potentially unstable — spine surgery consultation recommended.
→ Refer to spine surgery team for evaluation. Avoid heavy loading activities. May benefit from surgical stabilisation before systemic treatment.
SINS 13–18. Unstable spine — surgical stabilisation indicated.
→ Urgent spine surgery consultation. Restrict activities pending surgical assessment. Do NOT commence radiation without surgical stabilisation if unstable.
Interpretation bands for the SINS. Apply clinical judgement and local guidance.
References
- Fisher CG 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. 2010;35(22):E1221-E1229.
Related
Curated clinical cross-links plus same-class fallbacks.
- Tranexamic Acid (ICU/Trauma/Surgical) · Antifibrinolytic
- Protamine Sulphate (Heparin Reversal) · Heparin Reversal / Cardiac Surgery
- Zoledronic Acid · Bisphosphonate (IV)
- Denosumab · RANK Ligand Inhibitor (Anti-resorptive)
- Zoledronic Acid · IV Bisphosphonate
- Cefuroxime · Second-Generation Cephalosporin — Respiratory / Surgical Prophylaxis
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.