Calculators · Orthopaedics · Score
Spinal Instability Neoplastic Score (SINS)
Also called SINS
Six-item score of mechanical instability from spinal metastases, to decide when to ask for a surgical opinion.
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Formula and scoring
Location 0–3 + pain 0/1/3 + bone lesion 0–2 + alignment 0/2/4 + collapse 0–3 + posterolateral 0/1/3. Total 0–18.
Exam and ward pearls
- SINS measures mechanical stability only; neurological deficit and cord compression are assessed separately.
- Junctional segments score highest (3); the rigid sacrum (S2–S5) scores 0.
When not to rely on it
- Built by systematic review plus expert (Delphi) consensus; it guides referral and does not tell you which operation to do.
Source
- Fisher CG, DiPaola CP, Ryken TC, 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 (Phila Pa 1976). 2010;35(22):E1221-9. doi:10.1097/BRS.0b013e3181e16ae2 · PMID 20562730
- Serratrice N, Faddoul J, Tarabay B, et al. Ten years after SINS: role of surgery and radiotherapy in the management of patients with vertebral metastases. Front Oncol. 2022;12:802595 (Table 1). doi:10.3389/fonc.2022.802595 · PMID 35155240
Formula and cut-offs checked against these sources on 8 Nov 2026. Educational tool for clinicians; it does not replace clinical judgement.