Ten Years After SINS: Role of Surgery and Radiotherapy in the Management of Patients With Vertebral Metastases

The objective of the different types of treatments for a spinal metastasis is to provide the best oncological and functional result with the least aggressive side effects. Initially created in 2010 to help clinicians in the management of vertebral metastases, the Spine Instability Neoplastic Score (SINS) has quickly found its place in the decision making and the treatment of patients with metastatic spinal disease. Here we conduct a review of the literature describing the different changes that occurred with the SINS score in the last ten years. After a brief presentation of the spinal metastases' distribution, with or without spinal cord compression, we present the utility of SINS in the radiological diagnosis and extension of the disease, in addition to its limits, especially for scores ranging between 7 and 12. We take this opportunity to expose the latest advances in surgery and radiotherapy concerning spinal metastases, as well as in palliative care and pain control. We also discuss the reliability of SINS amongst radiologists, radiation oncologists, spine surgeons and spine surgery trainees. Finally, we will present the new SINS-derived predictive scores, biomarkers and artificial intelligence algorithms that allow a multidisciplinary approach for the management of spinal metastases.

Automated summary

The objective of treatments for spinal metastasis is to achieve the best oncological and functional outcomes while minimizing side effects. The Spine Instability Neoplastic Score (SINS) has been widely used in the management of vertebral metastases over the past ten years. This review discusses the changes that have occurred with the SINS score and its utility in diagnosing and assessing the extent of spinal metastases. The reliability of SINS among different medical professionals is also examined, along with the latest advancements in surgery, radiotherapy, palliative care, and pain control for spinal metastases.