{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:02:20Z","timestamp":1756771340418,"version":"3.44.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T00:00:00Z","timestamp":1744156800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T00:00:00Z","timestamp":1744156800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100012314","name":"Shinshu University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100012314","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Aims<\/jats:title>\n            <jats:p>To investigate the characteristics of spinal adverse events after non-operative treatment for spinal metastases with intermediate instability and to discuss clinical considerations when selecting non-operative treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This study included 56 patients with spinal metastases who had Spinal Instability Neoplastic Scores (SINS) of 7\u201312 and who underwent radiotherapy and intensive rehabilitation without a bed rest period as initial treatment between 2020 and 2023. We evaluated progression of paralysis and changes in spinal alignment before treatment, within 1 month, 1 to 6 months, and more than 6 months after treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Paralysis progressed within 1 month after treatment in 7 of 56 patients (12.5%). Pre-treatment paralysis and SINS\u2009\u2265\u200911 were significantly associated with progression of paralysis. Alignment changes occurred in 18 of 56 patients (32.1%), with a similar incidence in patients with SINS\u2009\u2265\u200911 and \u2264\u200910. Fifteen of 44 patients (34.1%) without pre-treatment paralysis had alignment changes, but 1 patient (2.3%) experienced progression of paralysis due to increased instability within 1 month. All 3 patients whose paralysis progressed despite no evidence of malignant spinal cord compression before or after treatment had SINS\u2009\u2265\u200911 and showed vertebral height reduction and kyphosis progression within 1 month.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Patients with pre-treatment paralysis and SINS\u2009\u2265\u200911 can progress to paralysis early; therefore, careful observation and imaging examinations are recommended early after treatment. If spinal alignment worsens, the treatment plan should be reconsidered, including restrictions of activity and surgical treatment.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00586-025-08817-w","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T21:14:22Z","timestamp":1744146862000},"page":"3505-3512","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical considerations for non-operative treatment of spinal metastases with intermediate instability"],"prefix":"10.1007","volume":"34","author":[{"given":"Atsushi","family":"Tanaka","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masanori","family":"Okamoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munehisa","family":"Kito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiichiro","family":"Koiwai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshinori","family":"Tsukahara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Oba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keiji","family":"Matsumori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hirokazu","family":"Ideta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaoru","family":"Aoki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Takazawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasunari","family":"Fujinaga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Horiuchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,4,9]]},"reference":[{"key":"8817_CR1","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1634\/theoncologist.2015-0266","volume":"21","author":"AL Versteeg","year":"2016","unstructured":"Versteeg AL, van der Velden JM, Verkooijen HM et al (2016) The effect of introducing the spinal instability neoplastic score in routine clinical practice for patients with spinal metastases. 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