Score every involved segment separately. Preserve the clinical pain input, return all six component scores, and treat the total as an instability-referral aid rather than an automatic procedure selector.
{
"applicability": {
"use_for": "Mechanical-instability assessment of a spinal segment involved by neoplastic disease.",
"scoring_unit": "Calculate a separate score for every involved spinal lesion or segment; do not collapse multiple lesions into one patient-level sum.",
"modalities_and_inputs": [
"CT_or_radiographs_for_osseous_morphology_and_alignment",
"MRI_for_neural_and_soft_tissue_context",
"clinical_history_for_mechanical_pain"
]
},
"feature_groups": [
{
"id": "location",
"options": [
{
"finding": "junctional_C0-C2_C7-T2_T11-L1_L5-S1",
"points": 3
},
{
"finding": "mobile_C3-C6_L2-L4",
"points": 2
},
{
"finding": "semirigid_T3-T10",
"points": 1
},
{
"finding": "rigid_S2-S5",
"points": 0
}
]
},
{
"id": "pain",
"clinical_input_required": true,
"options": [
{
"finding": "mechanical_pain_with_movement_upright_posture_or_loading_relieved_by_recumbency",
"points": 3
},
{
"finding": "occasional_or_biologic_pain_without_mechanical_characteristics",
"points": 1
},
{
"finding": "pain_free_lesion",
"points": 0
}
]
},
{
"id": "bone_lesion",
"options": [
{
"finding": "lytic",
"points": 2
},
{
"finding": "mixed_lytic_and_blastic",
"points": 1
},
{
"finding": "blastic",
"points": 0
}
]
},
{
"id": "alignment",
"options": [
{
"finding": "subluxation_or_translation",
"points": 4
},
{
"finding": "de_novo_kyphosis_or_scoliosis_without_translation",
"points": 2
},
{
"finding": "normal_alignment",
"points": 0
}
]
},
{
"id": "vertebral_body_collapse",
"options": [
{
"finding": ">50_percent_collapse",
"points": 3
},
{
"finding": "<50_percent_collapse",
"points": 2
},
{
"finding": "no_collapse_but_>50_percent_body_involved",
"points": 1
},
{
"finding": "no_collapse_and_<=50_percent_body_involved",
"points": 0
}
]
},
{
"id": "posterolateral_involvement",
"structures": [
"pedicles",
"facets",
"costovertebral_joints"
],
"options": [
{
"finding": "bilateral_involvement",
"points": 3
},
{
"finding": "unilateral_involvement",
"points": 1
},
{
"finding": "no_involvement",
"points": 0
}
]
}
],
"calculation": {
"formula": "location + pain + bone_lesion + alignment + vertebral_body_collapse + posterolateral_involvement",
"range": "0-18",
"all_six_components_required_for_total": true
},
"score_map": [
{
"outcome_code": "0-6",
"score": "0-6",
"interpretation": "stable",
"referral_for_stability_evaluation": "not_generally_required_by_SINS_alone"
},
{
"outcome_code": "7-12",
"score": "7-12",
"interpretation": "potentially_unstable",
"referral_for_stability_evaluation": "recommended"
},
{
"outcome_code": "13-18",
"score": "13-18",
"interpretation": "unstable",
"referral_for_stability_evaluation": "recommended"
}
],
"output_contract": [
"lesion_or_segment_scored",
"six_component_findings",
"six_component_points",
"exact_total",
"stability_category",
"missing_clinical_input_warning"
],
"missing_input_behavior": [
"Do not infer mechanical pain from CT or MRI; request or report the missing clinical history.",
"Do not calculate a definitive total when any component is unavailable; return the known components and identify what is missing."
],
"limitations": [
"SINS is a referral and communication tool, not a standalone treatment prescription or an overall oncologic-prognosis score.",
"Neurologic deficit, high-grade epidural cord compression, multilevel disease, prior surgery or radiotherapy, diffuse bone involvement, poor bone quality, body weight, activity and systemic status require separate assessment.",
"A score of 7 or more supports spine-surgical evaluation; it does not mandate a particular operation."
],
"source_locator": "Fisher et al., Spine 2010;35:E1221-E1229, PMID 20562730, six-component SINS; Fourney et al., JCO 2011, PMID 21709187, 0-6/7-12/13-18 validation; Hussain et al., Clin Orthop Relat Res 2019, PMC6907315, component definitions, per-lesion rule and limitations."
}