Is Dr. Hussain available to speak on the next talk, Correlation of the Spinal Instability, Neoplastic Score, Individual Components with Patient-Reported Outcomes Following Surgery? Thanks again for having me. This is work that I've done with my sister training program at Morristown Kettering. So our disclosures. So neoplastic spinal instability is defined as movement-related pain, deformity, or neurologic compromise under physiologic loads as a result of a neoplastic process. SINS was developed by the Spinal Oncology Study Group in order to better define which patients are at risk and is composed of six different categories with cumulative scores of 0 to 6 considered stable, 7 to 12 considered indeterminate, and 13 to 18 considered unstable. We've previously published results that show that cumulative SINS correlates with preoperative disability and response to stabilization surgery. However, to provide a more granular assessment of the scoring system, our current studies seek to determine how SINS, each of these SINS components correlates with preoperative patient-reported outcomes and response to stabilization surgery. And furthermore, since most patients who are evaluated using SINS fall into the indeterminate category, we want to better delineate the heterogeneity of this group in order to better understand instability. To this end, we performed a prospective cohort study of 131 patients with metastatic spine tumors that were stabilized via open or percutaneous approaches. We collected 10 patient-reported outcome measures for pain and disability using the Brief Pain Inventory and the MD Anderson Symptom Inventory, which are both patient-reported outcome measures that have been validated specifically within the cancer population. And we performed various statistical analyses, including the Spearman Rank Coefficient and Wilcoxon Sine Rank Test. Looking first at metastatic location, we were able to show that there were a number of significant correlations with preoperative disability involving activity and walking measures, and that there were a couple of these that still maintained significance when evaluating improvement in postoperative symptoms following stabilization. When looking at mechanical pain, we were able to show that the vast majority of our measures correlated with preoperative disability, and that, again, there were a couple of measures that still maintained significance when evaluating these patients after stabilization surgery. When evaluating the other measures, specifically bone lesion, alignment, and vertebral body collapse, we were able to show various associations with preoperative disability and improvements in various functions after stabilization surgery. Ironically, since bone lesion was, we were able to show that blastic lesions rather than lytic lesions conferred more significant benefit from stabilization surgery, and we were also able to show that posterior element pathology did not correlate with any of our patient-reported outcome measures. When looking at the indeterminate group, we stratified these patients based on low scores, 7 to 9, versus high scores, 10 to 12, and when evaluating their improvement in postoperative symptoms following stabilization surgery, there was a clear difference between the groups with almost the patients who scored 10 or higher improving in almost all aspects of our patient-reported outcome measures, suggesting that these patients are more closely aligned with unstable patients rather than indeterminate or stable patients. In conclusion, we found that the presence of mechanical pain in a metastatic location had the strongest correlation with preoperative disability and improvement after stabilization surgery, that among patients with indeterminate SINs, patients with higher scores experienced improvement in a larger number of patient-reported outcome scores, suggesting that this group really does include distinct populations, and that further analyses are required to better elucidate SINs component numerical scoring based on the degree of correlation with these patient-reported outcome scores, for example, that patients with the presence of mechanical pain or junctional location metastatic tumors may be given a higher number score than what's currently been assigned to them. I'd like to acknowledge my mentors, Mark Bilsky and Elia Lauffer, and that's all. Thank you.

Spinal Instability Neoplastic Score

patient-reported outcomes

neoplastic spinal instability

metastatic spine tumors

correlation coefficients