Clinical tools for oncology professionals

Spinal Instability Neoplastic Score (SINS)

The SINS score assesses tumour related instability of the vertebral column. It is used identify patients with spinal neoplastic disease that may require neurosurgical consultation. It can also be used by neurosurgical teams to score key components of spinal instability

Select the patient's score for each component of the SINS score below.

Tumour location

Occiput-C2, C7-T2, T11-L1, L5-S1
3 points
Mobile spine:
C3-C6, L2-L4
2 points
1 points
0 points


Mechanical pain:
Improves with recumbency or pain with movement or spinal loading
3 points
Occasional pain but not mechanical
1 points
Painless lesion 0 points

Bone lesion type

Lytic 2 points
Mixed 1 points
Blastic 0 points

Radiographic spinal alignment

Subluxation/translation 4 points
De novo deformity
Kyphosis/ scoliosis
2 points
Normal alignment 0 points

Vertebral body collapse

>50% collapse 3 points
<50% collapse 2 points
No collapse but with >50% vertebral body involved 1 points
None of the above 0 points

Posterior spinal element involvement

Bilateral 3 points
Unilateral 1 points
None of the above 0 points

SINS score: Spinal Instability Neoplastic Score

0-6: Stable

7-12: Potentially unstable

13-18: Unstable

A SINS score of 7-18 is an indication for neurosurgical referral to assess spinal stability and need for neurosurgical intervention 1 .

Spinal stability is an important component of decision making in spinal oncology patients. Other factors include neurology, tumour histology, prognosis, patient comorbidities and patient choice. The SINS score was developed by incorporating the best available literature and expert opinion consensus to create a classification system for diagnosing spinal neoplastic instability. The SINS score has been validated in a cohort of 30 patients with spinal tumours and achieved a sensitivity and specificity of 96% and 80% respectively for potentially unstable lesions 2 .


1) 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. 2010;35(22):E1221-9. doi:10.1097/BRS.0b013e3181e16ae2

2) Fourney DR, Frangou EM, Ryken TC, et al. Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29(22):3072-3077. doi:10.1200/JCO.2010.34.3897