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Spine J. 2016 May;16(5):591-9. doi: 10.1016/j.spinee.2015.10.006. Epub 2015 Oct 22.

Spine Instability Neoplastic Score: agreement across different medical and surgical specialties.

Author information

1
Department of Radiology, Valencian Oncology Institute Foundation, C/ Beltrán Báguena, 19, 46009 Valencia, Spain; Research Institute in Health Services Foundation, C/ San Vicente,112, 3, 46007 Valencia, Spain; Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain. Electronic address: aranae@uv.es.
2
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Scientific Department, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain.
3
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; CIBER Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS. Ctra. Colmenar Km. 9.1, 28034 Madrid, Spain.
4
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Department of Radiology, Hospital Regional Universitario Carlos Haya, Avda Carlos Haya s/n, 29010 Málaga, Spain.
5
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, CPI Building (8E), F access, 1st floor, Cami de Vera, s/n, 46022 Valencia, Spain.
6
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; CIBER Epidemiology and Public Health (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS. Ctra. Colmenar Km. 9.1, 28034 Madrid, Spain; Barts and the London School of Medicine & Dentistry, Queen Mary University of London, Mile End Road, London E1 4NS, UK.
7
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; CIBER Epidemiology and Public Health (CIBERESP), Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS. Ctra. Colmenar Km. 9.1, 28034 Madrid, Spain.
8
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario la Princesa, Madrid, Spain.
9
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain.
10
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
11
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Central de Asturias, Asturias, Spain.
12
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain.
13
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
14
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario y Politécnico La Fe, Valencia, Spain.
15
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Vall d'Hebron, Barcelona, Spain.
16
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Nacional de Parapléjicos, Toledo, Spain.
17
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain.
18
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Instituto Oncológico Xanit, Benalmádena, Málaga, Spain.
19
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Reina Sofía, Córdoba, Spain.
20
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; OSATEK. Hospital de Galdakao, Vizcaya, Spain.
21
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Consorcio hospitalario Provincial de Castellón, Castellón, Spain.
22
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain.
23
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Puerta del Mar, Cádiz, Spain.
24
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Clínico Universitario de Valencia, Valencia, Spain.
25
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital General Universitario Gregorio Marañón, Madrid, Spain.
26
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain.
27
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario la Paz, Madrid, Spain; HM Universitario Sanchinarro, Madrid, Spain.
28
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Intermutual de Levante, San Antonio de Benagéber, Valencia, Spain.
29
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Clinic de Barcelona, Barcelona, Spain.
30
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital de Manacor, Manacor, Islas Baleares, Spain.
31
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Arnau de Vilanova, Valencia, Spain.
32
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
33
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; HM Universitario Sanchinarro, Madrid, Spain.
34
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Marqués de Valdecilla, Santander, Spain.
35
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
36
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Donostia, Donostia, Spain.
37
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Clínica Oncosur, Córdoba, Spain.
38
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Clínica Oncosur, Granada, Spain.
39
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
40
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Doctor Peset, Valencia, Spain.
41
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Duran i Reynals, l'Hospitalet de Llobregat, Barcelona, Spain.
42
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital POVISA, Vigo, Spain.
43
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario de Salamanca, Salamanca, Spain.
44
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Regional Universitario Carlos Haya, Málaga, Spain.
45
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Virgen del Rocío, Sevilla, Spain.
46
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario de Canarias, Islas Canarias, Spain.
47
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Clínica Jerez, Jerez de la Frontera, Spain.
48
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Virgen de las Nieves, Granada, Spain.
49
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain.
50
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital 9 de Octubre, Valencia, Spain.
51
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
52
Spanish Back Pain Research Network, Kovacs Foundation, Paseo de Mallorca 36, 07012 Palma de Mallorca, Spain; Complejo Hospitalario de Navarra, Navarra, Spain.

Abstract

BACKGROUND CONTEXT:

Spinal instability is an acknowledged complication of spinal metastases; in spite of recent suggested criteria, it is not clearly defined in the literature.

PURPOSE:

This study aimed to assess intra and interobserver agreement when using the Spine Instability Neoplastic Score (SINS) by all physicians involved in its management.

STUDY DESIGN:

Independent multicenter reliability study for the recently created SINS, undertaken with a panel of medical oncologists, neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists, was carried out.

PATIENT SAMPLE:

Ninety patients with biopsy-proven spinal metastases and magnetic resonance imaging, reviewed at the multidisciplinary tumor board of our institution, were included.

OUTCOME MEASURES:

Intraclass correlation coefficient (ICC) was used for SINS score agreement. Fleiss kappa statistic was used to assess agreement on the location of the most affected vertebral level; agreement on the SINS category ("stable," "potentially stable," or "unstable"); and overall agreement with the classification established by tumor board.

METHODS:

Clinical data and imaging were provided to 83 specialists in 44 hospitals across 14 Spanish regions. No assessment criteria were pre-established. Each clinician assessed the SINS score twice, with a minimum 6-week interval. Clinicians were blinded to assessments made by other specialists and to their own previous assessment. Subgroup analyses were performed by clinicians' specialty, experience (≤7, 8-13, ≥14 years), and hospital category (four levels according to size and complexity). This study was supported by Kovacs Foundation.

RESULTS:

Intra and interobserver agreement on the location of the most affected levels was "almost perfect" (κ>0.94). Intra-observer agreement on the SINS score was "excellent" (ICC=0.77), whereas interobserver agreement was "moderate" (ICC=0.55). Intra-observer agreement in SINS category was "substantial" (k=0.61), whereas interobserver agreement was "moderate" (k=0.42). Overall agreement with the tumor board classification was "substantial" (κ=0.61). Results were similar across specialties, years of experience, and hospital category.

CONCLUSIONS:

Agreement on the assessment of metastatic spine instability is moderate. The SINS can help improve communication among clinicians in oncology care.

KEYWORDS:

Medical specialty; Observer agreement; Reliability analysis; Spinal instability; Spinal metastases; Spine Instability Neoplastic Score

PMID:
26471708
DOI:
10.1016/j.spinee.2015.10.006
[Indexed for MEDLINE]

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