Location | ㅤ |
Junctional (O-C2; C7-T2; TII-LI; L5-SI) | 3 |
Mobile spine (C3-6; L2-4) | 2 |
Semirigid (T3-10) | 1 |
Rigid (S2-S5) | 0 |
Vertebral body collapse | ㅤ |
>50% collapse | 3 |
<50% collapse | 2 |
No collapse with >50% body involved | 1 |
None of the above | 0 |
Mechanical pain | ㅤ |
Yes | 3 |
No | 2 |
Pain free lesion | 1 |
Posterolateral involvement | ㅤ |
Bilateral | 3 |
Unilateral | 1 |
None of the above | 0 |
Bone lesion | ㅤ |
Lytic | 2 |
Mixed (lytic/blastic) | 1 |
Blastic | 0 |
Radiographic spinal alignment | ㅤ |
Subluxation/translation present | 4 |
Deformity (kyphosis/scoliosis) | 2 |
Normal6 | 0 |
Score (Total = 0-18) | 1-6 | 7-12 | 13-18 |
Clinical categories | Stable | Potentially unstable | Unstable |
Binary scale | Stable | Current or potentially unstable = possible surgical intervention | ㅤ |
- Higher more unstable
- Mnemonic: PAL PVL:
- Post-lateral involvement
- Alignment
- Location
- Pain
- Vertebral collapse
- Lesion: Lytic/Blastic
- Lytic or sclerotic
- Osteoblastic/sclerotic metastases
- T1: hypointense
- T2: hypointense
- Mixed sclerotic and lytic extradural bone lesions
- T1: hypointense
- T2: hypo- and/or hyperintense
- Lytic extradural bone lesions
- T1: intermediate to hypointense
- T2: hyper- or isointense
- T1 C+ (Gd): enhancement usually present
- Most spinal metastases are lytic, and plain radiographs may not reveal changes until up to half of the VB is affected
- Lytic
- Lung
- Thyroid
- Renal
- Sclerotic
- breast 60%
- Prostate 90%
- Spinal instability
- The SOSG has defined spinal instability:
- Loss of spinal integrity as a result of a neoplastic process that is associated with movement-related pain, symptomatic or progressive deformity, and/or neural compromise under physiological stresses
- Instability pain must be distinguished from biologic pain.
- Instability pain: severe movement-related pain that is characteristic of the specific spinal level involved.
- Biologic pain: presents in the evenings and mornings and readily responds to steroids and radiation
- All patients with clear manifestations of cervical, thoracic, or lumbar mechanical instability require a surgical stabilization because mechanical pain does not improve with steroids and radiation does not restore spinal stability
- Level if instability
- C1/2
- Patients with C2 fractures with normal spinal alignment or minimal subluxation often heal without surgical intervention.
- These patients may be placed in a hard cervical collar during and for 6 weeks after radiotherapy, with a 95% chance of fracture healing [37].
- Patients with fracture subluxations >5 mm or >3.5 mm subluxation and 11-degree angulation between C1 and C2 with movement-related neck pain require instrumented spine fixation
- Subaxial cervical spine
- instability is manifested by pain with flexion and extension that often corresponds to dynamic instability of the spine on imaging and tumor extension into the joint
- Thoracic spine
- Instability seen on pain with extension
- Due to patient straightens an unstable kyphosis.
- Lumbar spine
- Instability seen as mechanical radiculopathy
- manifested with severe radicular pain upon standing.
- Tumour infiltration of the lumbar vertebral body and the corresponding joint result in the inability of the vertebra to support biologic axial loads, leading to collapse of the neural foramen when standing and compression of the exiting nerve root
- SINS limitation
- SINS do not take into account (these factors can affect stability)
- Disease that is contiguous or multi-level,
- Previous spine surgery
- previous radiation
Made with Bullet