Interobserver agreement for the spine instability neoplastic score varies according to the experience of the evaluator

OBJECTIVES: To evaluate the interobserver agreement for the Neoplastic Spine Instability Score (SINS) among spine surgeons with or without experience in vertebral metastasis treatment and physicians in other specialties. METHODS: Case descriptions were produced based on the medical records of 40 patients with vertebral metastases. The descriptions were then published online. Physicians were invited to evaluate the descriptions by answering questions according to the Neoplastic Spine Instability Score (SINS). The agreement among physicians was calculated using the kappa coefficient. RESULTS: Seventeen physicians agreed to participate: three highly experienced spine surgeons, seven less-experienced spine surgeons, three surgeons of other specialties, and four general practitioners (n = 17). The agreement for the final SINS score among all participants was fair, and it varied according to the SINS component. The agreement was substantial for the spine location only. The agreement was higher among experienced surgeons. The agreement was nearly perfect for spinal location among the spine surgeons who were highly experienced in vertebral metastases. CONCLUSIONS: This study demonstrates that the experience of the evaluator has an impact on SINS scale classification. The interobserver agreement was only fair among physicians who were not spine surgeons and among spine surgeons who were not experienced in the treatment of vertebral metastases, which may limit the use of the SINS scale for the screening of unstable lesions by less-experienced evaluators.

Intramedullary lipoma of the cervical and thoracic spinal cord

We report the case of a patient with quadriparesis due to a cervicothoracic intramedullary lipoma unassociated with spinal dysraphism. Intraspinal lipomas are usually associated with spinal dysraphism but in rare cases this association does not exist. Once the symptoms develop surgery does not usually result in any improvement in the neurological symptoms. Early Magnetic Resonance Imaging in patients with symptoms is recommended so that the tumour may he removed before permanent neurological deficit develops

Enfermedad metastásica de la columna vertebral: fisiopatología de las metástasis vertebrales (segunda parte)

Presentamos en este capítulo una actualización de los conocimientos acerca de los mecanismos que rigen la producción de metástasis en la columna vertebral