A novel classification system for spinal instability in neoplastic disease

An evidence-based approach and expert consensus from the spine oncology study group

Charles G. Fisher, Christian P. Dipaola, Timothy C. Ryken, Mark H. Bilsky, Christopher I. Shaffrey, Sigurd H. Berven, James S. Harrop, Michael G. Fehlings, Stefano Boriani, Dean Chou, Meic H. Schmidt, David W. Polly, Roberto Biagini, Shane Burch, Mark B. Dekutoski, Aruna Ganju, Peter C. Gerszten, Ziya L. Gokaslan, Michael W. Groff, Norbert J. Liebsch & 13 others Ehud Mendel, Scott H. Okuno, Shreyaskumar Patel, Laurence D. Rhines, Peter S. Rose, Daniel Sciubba, Narayan Sundaresan, Katsuro Tomita, Peter P. Varga, Luiz R. Vialle, Frank D. Vrionis, Yoshiya Yamada, Daryl R. Fourney

Research output: Contribution to journalArticle

Abstract

Study Design: Systematic review and modified Delphi technique. Objective: To use an evidence-based medicine process using the best available literature and expert opinion consensus to develop a comprehensive classification system to diagnose neoplastic spinal instability. Summary Of Background Data: Spinal instability is poorly defined in the literature and presently there is a lack of guidelines available to aid in defining the degree of spinal instability in the setting of neoplastic spinal disease. The concept of spinal instability remains important in the clinical decision-making process for patients with spine tumors. Methods: We have integrated the evidence provided by systematic reviews through a modified Delphi technique to generate a consensus of best evidence and expert opinion to develop a classification system to define neoplastic spinal instability. Results: A comprehensive classification system based on patient symptoms and radiographic criteria of the spine was developed to aid in predicting spine stability of neoplastic lesions. The classification system includes global spinal location of the tumor, type and presence of pain, bone lesion quality, spinal alignment, extent of vertebral body collapse, and posterolateral spinal element involvement. Qualitative scores were assigned based on relative importance of particular factors gleaned from the literature and refined by expert consensus. Conclusion: The Spine Instability Neoplastic Score is a comprehensive classification system with content validity that can guide clinicians in identifying when patients with neoplastic disease of the spine may benefit from surgical consultation. It can also aid surgeons in assessing the key components of spinal instability due to neoplasia and may become a prognostic tool for surgical decision-making when put in context with other key elements such as neurologic symptoms, extent of disease, prognosis, patient health factors, oncologic subtype, and radiosensitivity of the tumor.

Original languageEnglish (US)
JournalSpine
Volume35
Issue number22
DOIs
StatePublished - Oct 15 2010

Fingerprint

Consensus
Spine
Delphi Technique
Expert Testimony
Neoplasms
Spinal Diseases
Evidence-Based Medicine
Radiation Tolerance
Neurologic Manifestations
Decision Making
Referral and Consultation
Guidelines
Bone and Bones
Pain
Health

Keywords

  • instability
  • spinal metastasis
  • spine oncology
  • tumor

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

A novel classification system for spinal instability in neoplastic disease : An evidence-based approach and expert consensus from the spine oncology study group. / Fisher, Charles G.; Dipaola, Christian P.; Ryken, Timothy C.; Bilsky, Mark H.; Shaffrey, Christopher I.; Berven, Sigurd H.; Harrop, James S.; Fehlings, Michael G.; Boriani, Stefano; Chou, Dean; Schmidt, Meic H.; Polly, David W.; Biagini, Roberto; Burch, Shane; Dekutoski, Mark B.; Ganju, Aruna; Gerszten, Peter C.; Gokaslan, Ziya L.; Groff, Michael W.; Liebsch, Norbert J.; Mendel, Ehud; Okuno, Scott H.; Patel, Shreyaskumar; Rhines, Laurence D.; Rose, Peter S.; Sciubba, Daniel; Sundaresan, Narayan; Tomita, Katsuro; Varga, Peter P.; Vialle, Luiz R.; Vrionis, Frank D.; Yamada, Yoshiya; Fourney, Daryl R.

In: Spine, Vol. 35, No. 22, 15.10.2010.

Research output: Contribution to journalArticle

Fisher, CG, Dipaola, CP, Ryken, TC, Bilsky, MH, Shaffrey, CI, Berven, SH, Harrop, JS, Fehlings, MG, Boriani, S, Chou, D, Schmidt, MH, Polly, DW, Biagini, R, Burch, S, Dekutoski, MB, Ganju, A, Gerszten, PC, Gokaslan, ZL, Groff, MW, Liebsch, NJ, Mendel, E, Okuno, SH, Patel, S, Rhines, LD, Rose, PS, Sciubba, D, Sundaresan, N, Tomita, K, Varga, PP, Vialle, LR, Vrionis, FD, Yamada, Y & Fourney, DR 2010, 'A novel classification system for spinal instability in neoplastic disease: An evidence-based approach and expert consensus from the spine oncology study group', Spine, vol. 35, no. 22. https://doi.org/10.1097/BRS.0b013e3181e16ae2
Fisher, Charles G. ; Dipaola, Christian P. ; Ryken, Timothy C. ; Bilsky, Mark H. ; Shaffrey, Christopher I. ; Berven, Sigurd H. ; Harrop, James S. ; Fehlings, Michael G. ; Boriani, Stefano ; Chou, Dean ; Schmidt, Meic H. ; Polly, David W. ; Biagini, Roberto ; Burch, Shane ; Dekutoski, Mark B. ; Ganju, Aruna ; Gerszten, Peter C. ; Gokaslan, Ziya L. ; Groff, Michael W. ; Liebsch, Norbert J. ; Mendel, Ehud ; Okuno, Scott H. ; Patel, Shreyaskumar ; Rhines, Laurence D. ; Rose, Peter S. ; Sciubba, Daniel ; Sundaresan, Narayan ; Tomita, Katsuro ; Varga, Peter P. ; Vialle, Luiz R. ; Vrionis, Frank D. ; Yamada, Yoshiya ; Fourney, Daryl R. / A novel classification system for spinal instability in neoplastic disease : An evidence-based approach and expert consensus from the spine oncology study group. In: Spine. 2010 ; Vol. 35, No. 22.
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abstract = "Study Design: Systematic review and modified Delphi technique. Objective: To use an evidence-based medicine process using the best available literature and expert opinion consensus to develop a comprehensive classification system to diagnose neoplastic spinal instability. Summary Of Background Data: Spinal instability is poorly defined in the literature and presently there is a lack of guidelines available to aid in defining the degree of spinal instability in the setting of neoplastic spinal disease. The concept of spinal instability remains important in the clinical decision-making process for patients with spine tumors. Methods: We have integrated the evidence provided by systematic reviews through a modified Delphi technique to generate a consensus of best evidence and expert opinion to develop a classification system to define neoplastic spinal instability. Results: A comprehensive classification system based on patient symptoms and radiographic criteria of the spine was developed to aid in predicting spine stability of neoplastic lesions. The classification system includes global spinal location of the tumor, type and presence of pain, bone lesion quality, spinal alignment, extent of vertebral body collapse, and posterolateral spinal element involvement. Qualitative scores were assigned based on relative importance of particular factors gleaned from the literature and refined by expert consensus. Conclusion: The Spine Instability Neoplastic Score is a comprehensive classification system with content validity that can guide clinicians in identifying when patients with neoplastic disease of the spine may benefit from surgical consultation. It can also aid surgeons in assessing the key components of spinal instability due to neoplasia and may become a prognostic tool for surgical decision-making when put in context with other key elements such as neurologic symptoms, extent of disease, prognosis, patient health factors, oncologic subtype, and radiosensitivity of the tumor.",
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T1 - A novel classification system for spinal instability in neoplastic disease

T2 - An evidence-based approach and expert consensus from the spine oncology study group

AU - Fisher, Charles G.

AU - Dipaola, Christian P.

AU - Ryken, Timothy C.

AU - Bilsky, Mark H.

AU - Shaffrey, Christopher I.

AU - Berven, Sigurd H.

AU - Harrop, James S.

AU - Fehlings, Michael G.

AU - Boriani, Stefano

AU - Chou, Dean

AU - Schmidt, Meic H.

AU - Polly, David W.

AU - Biagini, Roberto

AU - Burch, Shane

AU - Dekutoski, Mark B.

AU - Ganju, Aruna

AU - Gerszten, Peter C.

AU - Gokaslan, Ziya L.

AU - Groff, Michael W.

AU - Liebsch, Norbert J.

AU - Mendel, Ehud

AU - Okuno, Scott H.

AU - Patel, Shreyaskumar

AU - Rhines, Laurence D.

AU - Rose, Peter S.

AU - Sciubba, Daniel

AU - Sundaresan, Narayan

AU - Tomita, Katsuro

AU - Varga, Peter P.

AU - Vialle, Luiz R.

AU - Vrionis, Frank D.

AU - Yamada, Yoshiya

AU - Fourney, Daryl R.

PY - 2010/10/15

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N2 - Study Design: Systematic review and modified Delphi technique. Objective: To use an evidence-based medicine process using the best available literature and expert opinion consensus to develop a comprehensive classification system to diagnose neoplastic spinal instability. Summary Of Background Data: Spinal instability is poorly defined in the literature and presently there is a lack of guidelines available to aid in defining the degree of spinal instability in the setting of neoplastic spinal disease. The concept of spinal instability remains important in the clinical decision-making process for patients with spine tumors. Methods: We have integrated the evidence provided by systematic reviews through a modified Delphi technique to generate a consensus of best evidence and expert opinion to develop a classification system to define neoplastic spinal instability. Results: A comprehensive classification system based on patient symptoms and radiographic criteria of the spine was developed to aid in predicting spine stability of neoplastic lesions. The classification system includes global spinal location of the tumor, type and presence of pain, bone lesion quality, spinal alignment, extent of vertebral body collapse, and posterolateral spinal element involvement. Qualitative scores were assigned based on relative importance of particular factors gleaned from the literature and refined by expert consensus. Conclusion: The Spine Instability Neoplastic Score is a comprehensive classification system with content validity that can guide clinicians in identifying when patients with neoplastic disease of the spine may benefit from surgical consultation. It can also aid surgeons in assessing the key components of spinal instability due to neoplasia and may become a prognostic tool for surgical decision-making when put in context with other key elements such as neurologic symptoms, extent of disease, prognosis, patient health factors, oncologic subtype, and radiosensitivity of the tumor.

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KW - spine oncology

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