The Spine Instability Neoplastic Score (SINS) is a comprehensive classification system with content validity that can guide clinicians in identifying when patients with neoplastic disease of the spine may benefit from surgical consultation. It can also aid surgeons in assessing the key components of spinal instability due to neoplasia and may become a prognostic tool for surgical decision-making when put in context with other key elements such as neurologic symptoms, extent of disease, prognosis, patient health factors, oncologic subtype, and radiosensitivity of the tumor.


1. Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, 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:E1221-9.
2. Fourney DR, Frangou EM, Ryken TC, DiPaola CP, Shaffrey CI, Berven SH, et al. Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol 2011; 29:3072-3077.


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Select risk items

Location in spine:

[pain improvement with recumbency and/or pain with movement/loading of spine]

Bone lesion:

Radiographic spinal aligment:

Vertebral body collapse:

Posterolateral involvement of spinal elements:
[facet, pedicle, or costovertebral joint fracture or replacement with tumor]