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A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group.

Publication ,  Journal Article
Fisher, CG; DiPaola, CP; Ryken, TC; Bilsky, MH; Shaffrey, CI; Berven, SH; Harrop, JS; Fehlings, MG; Boriani, S; Chou, D; Schmidt, MH; Burch, S ...
Published in: Spine (Phila Pa 1976)
October 15, 2010

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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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

October 15, 2010

Volume

35

Issue

22

Start / End Page

E1221 / E1229

Location

United States

Related Subject Headings

  • Surveys and Questionnaires
  • Spinal Neoplasms
  • Orthopedics
  • Middle Aged
  • Male
  • Joint Instability
  • International Agencies
  • Humans
  • Female
  • Evidence-Based Medicine
 

Citation

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Fisher, C. G., DiPaola, C. P., Ryken, T. C., Bilsky, M. H., Shaffrey, C. I., Berven, S. H., … Fourney, D. R. (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 (Phila Pa 1976), 35(22), E1221–E1229. https://doi.org/10.1097/BRS.0b013e3181e16ae2
Fisher, Charles G., Christian P. DiPaola, Timothy C. Ryken, Mark H. Bilsky, Christopher I. Shaffrey, Sigurd H. Berven, James S. Harrop, et al. “A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group.Spine (Phila Pa 1976) 35, no. 22 (October 15, 2010): E1221–29. https://doi.org/10.1097/BRS.0b013e3181e16ae2.
Fisher CG, DiPaola CP, Ryken TC, Bilsky MH, Shaffrey CI, Berven SH, et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010 Oct 15;35(22):E1221–9.
Fisher, Charles G., et al. “A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group.Spine (Phila Pa 1976), vol. 35, no. 22, Oct. 2010, pp. E1221–29. Pubmed, doi:10.1097/BRS.0b013e3181e16ae2.
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 DM, Sundaresan N, Tomita K, Varga PP, Vialle LR, Vrionis FD, Yamada Y, Fourney DR. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 2010 Oct 15;35(22):E1221–E1229.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

October 15, 2010

Volume

35

Issue

22

Start / End Page

E1221 / E1229

Location

United States

Related Subject Headings

  • Surveys and Questionnaires
  • Spinal Neoplasms
  • Orthopedics
  • Middle Aged
  • Male
  • Joint Instability
  • International Agencies
  • Humans
  • Female
  • Evidence-Based Medicine