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Table 1 The SINS classification according to Fisher et al. [[4]]

From: Reliability of the Spinal Instability Neoplastic Score (SINS) among radiation oncologists: an assessment of instability secondary to spinal metastases

  Score
Location  
 Junctional (occiput-C2, C7-T2, T11-L1, L5-S1) 3
 Mobile spine (C3-C6, L2-L4) 2
 Semirigid (T3-T10) 1
 Rigid (S2-S5) 0
Pain *  
 Yes 3
 Occasional pain but not mechanical 1
 Pain-free lesion 0
Bone lesion  
 Lytic 2
 Mixed (lytic/blastic) 1
 Blastic 0
Radiographic spinal alignment  
 Subluxation/translation present 4
 De novo deformity (kyphosis/scoliosis) 2
 Normal alignment 0
Vertebral body collapse  
  > 50% collapse 3
  < 50% collapse 2
 No collapse with > 50% body involved 1
 None of the above 0
Posterolateral involvement of spinal elements  
 Bilateral 3
 Unilateral 1
 None of the above 0
  1. *Pain improvement with recumbency and/or pain with movement/loading of spine.
  2. Facet, pedicle, or costovertebral joint fracture or replacement with tumor.