{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:59:59Z","timestamp":1785513599254,"version":"3.56.0"},"reference-count":30,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,4,27]],"date-time":"2022-04-27T00:00:00Z","timestamp":1651017600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Research Foundation","award":["491454339"],"award-info":[{"award-number":["491454339"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Adequate assessment of spinal instability using the spinal instability neoplastic score (SINS) frequently guides surgical therapy in spinal epidural osseous metastases and subsequently influences neurological outcome. However, how to surgically manage \u2018impending instability\u2019 at SINS 7\u201312 most appropriately remains uncertain. This study aimed to evaluate the necessity of spinal instrumentation in patients with SINS 7\u201312 with regards to neurological outcome. Methods: We screened 683 patients with spinal epidural metastases treated at our interdisciplinary spine center. The preoperative SINS was assessed to determine spinal instability and neurological status was defined using the Frankel score. Patients were dichotomized according to being treated by instrumentation surgery and neurological outcomes were compared. Additionally, a subgroup analysis of groups with SINS of 7\u20139 and 10\u201312 was performed. Results: Of 331 patients with a SINS of 7\u201312, 76.1% underwent spinal instrumentation. Neurological outcome did not differ significantly between instrumented and non-instrumented patients (p = 0.612). Spinal instrumentation was performed more frequently in SINS 10\u201312 than in SINS 7\u20139 (p &lt; 0.001). The subgroup analysis showed no significant differences in neurological outcome between instrumented and non-instrumented patients in either SINS 7\u20139 (p = 0.278) or SINS 10\u201312 (p = 0.577). Complications occurred more frequently in instrumented than in non-instrumented patients (p = 0.016). Conclusions: Our data suggest that a SINS of 7\u201312 alone might not warrant the increased surgical risks of additional spinal instrumentation.<\/jats:p>","DOI":"10.3390\/cancers14092193","type":"journal-article","created":{"date-parts":[[2022,4,27]],"date-time":"2022-04-27T13:40:57Z","timestamp":1651066857000},"page":"2193","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Impact of Spinal Instrumentation on Neurological Outcome in Patients with Intermediate Spinal Instability Neoplastic Score (SINS)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0788-4681","authenticated-orcid":false,"given":"Moritz","family":"Lenschow","sequence":"first","affiliation":[{"name":"Center for Neurosurgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Lenz","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9873-1711","authenticated-orcid":false,"given":"Niklas","family":"von Spreckelsen","sequence":"additional","affiliation":[{"name":"Center for Neurosurgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Ossmann","sequence":"additional","affiliation":[{"name":"Center for Neurosurgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Ke\u00dfling","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lukas","family":"Nadjiri","sequence":"additional","affiliation":[{"name":"Department of Radiooncology and Cyberknife Center, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9545-3990","authenticated-orcid":false,"given":"Sergej","family":"Telentschak","sequence":"additional","affiliation":[{"name":"Center for Neurosurgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7069-6291","authenticated-orcid":false,"given":"Kourosh","family":"Zarghooni","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kn\u00f6ll","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Perrech","sequence":"additional","affiliation":[{"name":"Center for Neurosurgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eren","family":"Celik","sequence":"additional","affiliation":[{"name":"Department of Radiooncology and Cyberknife Center, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1392-3990","authenticated-orcid":false,"given":"Max","family":"Scheyerer","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7527-6990","authenticated-orcid":false,"given":"Volker","family":"Neuschmelting","sequence":"additional","affiliation":[{"name":"Center for Neurosurgery, University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1097\/BRS.0b013e3181e16ae2","article-title":"A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus from the Spine Oncology Study Group","volume":"35","author":"Fisher","year":"2010","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/BRS.0000000000001822","article-title":"The Spinal Instability Neoplastic Score: Impact on Oncologic Decision-Making","volume":"41","author":"Versteeg","year":"2016","journal-title":"Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"337","DOI":"10.4055\/cios20014","article-title":"Treatment Strategy for Impending Instability in Spinal Metastases","volume":"12","author":"Kim","year":"2020","journal-title":"Clin. Orthop. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.clineuro.2014.04.025","article-title":"Perioperative Complication and Surgical Outcome in Patients with Spine Metastases: Retrospective 200-Case Series in a Single Institute","volume":"122","author":"Lee","year":"2014","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1016\/j.wneu.2019.05.067","article-title":"SINS Score and Stability: Evaluating the Need for Stabilization within the Uncertain Category","volume":"128","author":"Pennington","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.spinee.2017.07.008","article-title":"Patient-Reported Outcomes after Surgical Stabilization of Spinal Tumors: Symptom-Based Validation of the Spinal Instability Neoplastic Score (SINS) and Surgery","volume":"18","author":"Hussain","year":"2018","journal-title":"Spine J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1634\/theoncologist.2015-0266","article-title":"The Effect of Introducing the Spinal Instability Neoplastic Score in Routine Clinical Practice for Patients with Spinal Metastases","volume":"21","author":"Versteeg","year":"2016","journal-title":"Oncologist"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1002\/1097-0142(194811)1:4<634::AID-CNCR2820010410>3.0.CO;2-L","article-title":"The Use of the Nitrogen Mustards in the Palliative Treatment of Carcinoma with Particular Reference to Bronchogenic Carcinoma","volume":"1","author":"Karnofsky","year":"1948","journal-title":"Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"324","DOI":"10.3171\/2010.3.SPINE09459","article-title":"Reliability Analysis of the Epidural Spinal Cord Compression Scale","volume":"13","author":"Bilsky","year":"2010","journal-title":"J. Neurosurg. Spine"},{"key":"ref_10","first-page":"179","article-title":"The Value of Postural Reduction in the Initial Management of Closed Injuries of the Spine with Paraplegia and Tetraplegia","volume":"7","author":"Frankel","year":"1969","journal-title":"Paraplegia"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Versteeg, A.L., Sahgal, A., Laufer, I., Rhines, L.D., Sciubba, D.M., Schuster, J.M., Weber, M.H., Lazary, A., Boriani, S., and Bettegowda, C. (2021). Correlation between the Spinal Instability Neoplastic Score (SINS) and Patient Reported Outcomes. Glob. Spine J.","DOI":"10.1177\/21925682211033591"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1111\/os.12551","article-title":"Patient Characteristics Following Surgery for Spinal Metastases: A Multicenter Retrospective Study","volume":"11","author":"Yang","year":"2019","journal-title":"Orthop. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.3747\/co.25.3835","article-title":"Impact of the Spinal Instability Neoplastic Score on Surgical Referral Patterns and Outcomes","volume":"25","author":"Dosani","year":"2018","journal-title":"Curr. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jocn.2017.04.004","article-title":"Contemporary Spinal Oncology Treatment Paradigms and Outcomes for Metastatic Tumors to the Spine: A Systematic Review of Breast, Prostate, Renal, and Lung Metastases","volume":"41","author":"Yao","year":"2017","journal-title":"J. Clin. Neurosci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.jos.2018.10.003","article-title":"Clinical Outcomes and Significant Factors in the Survival Rate after Decompression Surgery for Patients Who Were Non-Ambulatory Due to Spinal Metastases","volume":"24","author":"Tateiwa","year":"2019","journal-title":"J. Orthop. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E503","DOI":"10.1097\/BRS.0000000000001273","article-title":"Predictors of 30-and 90-Day Survival Following Surgical Intervention for Spinal Metastases","volume":"41","author":"Schoenfeld","year":"2016","journal-title":"Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"432","DOI":"10.3171\/2018.9.SPINE18147","article-title":"Spinal Instability Neoplastic Score Component Validation Using Patient-Reported Outcomes","volume":"30","author":"Hussain","year":"2019","journal-title":"J. Neurosurg. Spine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/S0140-6736(05)66954-1","article-title":"Direct Decompressive Surgical Resection in the Treatment of Spinal Cord Compression Caused by Metastatic Cancer: A Randomised Trial","volume":"366","author":"Patchell","year":"2005","journal-title":"Lancet"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1055\/s-0034-1375560","article-title":"Incorporating the Spine Instability Neoplastic Score into a Treatment Strategy for Spinal Metastasis: LMNOP","volume":"4","author":"Ivanishvili","year":"2014","journal-title":"Glob. Spine J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"E6","DOI":"10.3171\/2021.2.FOCUS201098","article-title":"An Analysis of Tumor-Related Potential Spinal Column Instability (Spine Instability Neoplastic Scores 7-12) Eventually Requiring Surgery with a 1-Year Follow-Up","volume":"50","author":"Vargas","year":"2021","journal-title":"Neurosurg. Focus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2127","DOI":"10.1007\/s00520-019-05015-5","article-title":"Outcomes of Surgical Treatments of Spinal Metastases: A Prospective Study","volume":"28","author":"Bouthors","year":"2020","journal-title":"Support. Care Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.1016\/j.spinee.2013.10.028","article-title":"The incidence and patterns of hardware failure after separation surgery in patients with spinal metastatic tumors","volume":"14","author":"Amankulor","year":"2014","journal-title":"Spine J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/j.wneu.2018.01.176","article-title":"The Potential of Minimally Invasive Surgery to Treat Metastatic Spinal Disease versus Open Surgery: A Systematic Review and Meta-Analysis","volume":"112","author":"Lu","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"7988","DOI":"10.1038\/s41598-021-87121-1","article-title":"Comprehensive Surgical Treatment Strategy for Spinal Metastases","volume":"11","author":"Wagner","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1200\/JCO.2015.61.9338","article-title":"Survival and clinical outcomes in surgically treated patients with metastatic epidural spinal cord compression: Results of the prospective multicenter AOSpine study","volume":"34","author":"Fehlings","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"456","DOI":"10.3171\/2019.8.SPINE19583","article-title":"Instrumented surgical treatment for metastatic spinal tumors: Is fusion necessary?","volume":"32","author":"Park","year":"2019","journal-title":"J. Neurosurg. Spine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"527","DOI":"10.3171\/2020.12.SPINE201741","article-title":"Are Spine Metastasis Survival Scoring Systems Outdated and Do They Underestimate Life Expectancy? Caution in Surgical Recommendation Guidance","volume":"35","author":"Tabourel","year":"2021","journal-title":"J. Neurosurg. Spine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1634\/theoncologist.2012-0293","article-title":"The NOMS Framework: Approach to the Treatment of Spinal Metastatic Tumors","volume":"18","author":"Laufer","year":"2013","journal-title":"Oncologist"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1227\/NEU.0000000000000907","article-title":"Prediction of Quality of Life and Survival after Surgery for Symptomatic Spinal Metastases: A Multicenter Cohort Study to Determine Suitability for Surgical Treatment","volume":"77","author":"Choi","year":"2015","journal-title":"Neurosurgery"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1093\/neuros\/nyz472","article-title":"Metastatic spine disease: Should patients with short life expectancy be denied surgical care? An international retrospective cohort study","volume":"87","author":"Dea","year":"2020","journal-title":"Neurosurgery"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/9\/2193\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:02:25Z","timestamp":1760137345000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/9\/2193"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,27]]},"references-count":30,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["cancers14092193"],"URL":"https:\/\/doi.org\/10.3390\/cancers14092193","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,27]]}}}