A systematic review of the spinal instability neoplastic score and its relationship with peri-interventional patient-centered measures: The clinical impact of spinal instability
Bibliographic record
Abstract
BACKGROUND: The spinal instability neoplastic score (SINS) provides a standardized assessment of spinal stability in patients with metastatic spine disease. Although intended to assist clinical decision-making, the relationships between SINS and patient-centered measures, such as pain intensity, functional status, and health-related quality of life (HRQoL), remain undefined. METHODS: This systematic review followed PRISMA guidelines. A comprehensive literature search was performed across PubMed, Scopus, Embase, and Web of Science databases using keywords related to SINS and spinal metastases. Studies assessing the relationships between SINS and pain intensity scores, functional status, and HRQoL were included. Data on study characteristics, type of interventions, and patient-centered measures were extracted. Risk of bias was assessed using the Newcastle-Ottawa Scale. A meta-analysis was not feasible due to significant treatment, outcome, and population heterogeneity. RESULTS: Thirteen studies (n = 1823; mean age 63.0 ± 12.5 years) were included. Five of six studies reported a significant association between higher baseline SINS scores and pain intensity, most commonly using the Visual Analog Scale and Numeric Rating, while 1 of 2 studies identified a predictive value of SINS for posttreatment pain. Nine studies evaluated peri-interventional functional status using 6 different tools; significant correlations with baseline SINS were identified for MD Anderson Symptom Inventory and Spine Oncology Study Group Outcomes Questionnaire 2.0, while no relationships were identified for the Barthel Index, Eastern Cooperative Oncology Group score, or Frankel scale. Further, stable postradiotherapy SINS was associated a higher baseline Karnofsky Performance Status (KPS). Three studies assessed HRQoL using either the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, the 36-Item Short Form Survey, or the EuroQol Five-Dimension Scale; 2 of these studies reported that higher SINS values were associated with lower baseline physical functioning. Of 13 studies, 12 were of moderate methodological quality. CONCLUSIONS: SINS demonstrated correlations with peri-interventional pain intensity, functional status, and HRQoL. Pretreatment correlations were generally more consistent. However, in radiotherapy-treated cohorts, stable posttreatment SINS was associated with higher baseline KPS, suggesting a potential predictive relationship between these measures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.065 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.012 | 0.011 |
| Bibliometrics | 0.013 | 0.014 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".