Published online Oct 26, 2021. doi: 10.12998/wjcc.v9.i30.9023
Peer-review started: March 12, 2021
First decision: July 16, 2021
Revised: July 26, 2021
Accepted: September 16, 2021
Article in press: September 16, 2021
Published online: October 26, 2021
In the evaluation of patients with spinal tumors, spinal stability assessment is very important, and it often guides our decisions in the selection of surgical or conservative treatment. At present, the most commonly used clinical spinal tumor stability evaluation system is the spinal instability neoplastic score (SINS) system.
Although multiple myeloma (MM) can also be evaluated by the SINS scoring system, we found that patients with MM have their own characteristics; almost all of them have osteolytic destruction, and most cases involve multiple segments of the spine. To evaluate the spinal stability of patients with MM more accurately in the clinic, we referred to the SINS scoring system to establish a scoring system that could evaluate the spinal stability of MM.
The objective of the study was to evaluate the clinical applicability of the MM stability score by comparing it with the SINS system. The MM spinal stability score system will be used to evaluate clinical MM patients. Through the evaluation of spinal stability, corresponding intervention measures should be given in time to improve the quality of life of the patients and improve their prognosis.
The current literature on multiple myeloma and spinal stability was systematically reviewed before the study began to determine the best clinical and imaging evidence of spinal stability and to establish a framework for MM spine stability assessments. The spine stability scoring system of multiple myeloma was established by the Delphi method. The MM scoring system and SINS scoring system were used to analyze the same group of data, and the consistency of the two scoring systems was tested.
After integrating the information from the expert consultation questionnaire, we established the initial scoring system for MM spine stability and used the scoring system to assess a series of representative clinical cases. The scoring system consisted of the following six components: "Location", "Pain", "Number of segments", "Physiological curvature", "Comorbidities", and "Neurological function". The MM spinal stability scoring system was created by calculating the scores of the six separate components. The minimum value was “0”, and the maximum value was “24”. A score of “0–10” indicated “spine stability”, a score of “11–17” indicated “potential instability”, and a score of “18–24” indicated “spine instability”. Patients with a score of “11–24” need an intervention such as surgery. We selected some typical cases to be evaluated with the MM spinal scoring system and SINS system, and the results were compared. We found that most of the "potentially unstable" patients in the MM score were rated as "stable" in the SINS score.
The authors established the initial scoring system for MM spine stability. The authors believe that the MM spinal stability scoring system is more suitable for MM patients than the SINS scoring system.
In the future, the authors will further optimize the MM spine stability scoring system. The authors prepared clinical trials for prospective studies to analyze the advantages and disadvantages of the MM spinal stability scoring system.