Preliminary establishment of a spinal stability scoring system for multiple myeloma

Table 1 Basic characteristics of the experts

Content		n (%)
Gender
	Males	11 (73)
	Females	4 (27)
Age (yr)
	31-40	6 (40)
	41-50	3 (20)
	≥ 50	6 (40)
Engaged in medical care time (yr)
	≤ 10	3 (20)
	11-20	5 (33)
	> 20	7 (47)
Educational background
	Bachelor‘s degree	4 (27)
	Master’s degree	4 (27)
	doctorate	7 (46)
Professional titles
	Attending	5 (33)
	Associate chief of doctor	4 (27)
	Chief of doctor	6 (40)

Table 2 The expert scores from the second round of the consultations

First-level indices	Second-level indices	mean ± SD	CV%
Location	Junctional	4.87 ± 0.34	0.07
	Mobile	4.47 ± 0.50	0.11
	Semirigid	3.53 ± 0.62	0.17
	Rigid	3.07 ± 0.44	0.14
	Lesion-free	2.47 ± 0.81	0.33
Level of pain	Recalcitrant pain in the corresponding zone (not relieved after chemotherapy) VAS > 7	4.80 ± 0.40	0.08
	Moderate pain in the corresponding zone (not relieved after chemotherapy) VAS 4-7	4.47 ± 0.49	0.11
	Mild pain in the corresponding zone (VAS = 3 after chemotherapy)	3.67 ± 0.48	0.13
	Mild pain during activity (VAS ≤ 2 after chemotherapy) no rest pain	3.20 ± 0.40	0.12
	No pain during activity after chemotherapy	2.67 ± 0.94	0.35
Number of segments	> 3	4.93 ± 0.25	0.05
	3	4.87 ± 0.56	0.11
	2	4.67 ± 0.79	0.17
	1	3.80 ± 0.99	0.26
	No change in morphology	2.73 ± 0.10	0.36
physiological curvature
Lateral radiograph	Physiological curvature of the lesion is abnormal	4.67 ± 0.47	0.10
	Physiological curvature of the lesion is normal	3.00 ± 0.52	0.17
Front radiograph	Scoliosis/rotation	4.80 ± 0.40	0.08
	No scoliosis/rotation	3.00 ± 0.52	0.17
Comorbidities	Spondylolisthesis ( 1 degree)	4.87 ± 0.34	0.07
	Shift/dislocation (0-1degree)	4.53 ± 0.62	0.14
	Herniated disk	3.93 ± 0.44	0.11
	Bone spurs	3.13 ± 0.50	0.16
	Bony fusion	2.80 ± 0.54	0.19
Neurological function	Frankel A	5.00 ± 0.00	0.00
	Frankel B	4.87 ± 0.34	0.07
	Frankel C	4.73 ± 0.44	0.09
	Frankel D	4.07 ± 0.25	0.06
	Frankel E	2.87 ± 0.34	0.12

VAS: Visual analog scale.

Table 3 The location score and its secondary index score

Location	Score
Junctional	4
Occipitocervical region (C1-C2)
Cervicothoracic region (C7-T2)
Thoracolumbar region (T11-L1)
Lumbosacral region (L5-S1)
Mobile	3
Cervical vertebra (C3-C7)
Lumbar vertebra (L2-L4)
Semirigid (T3-T10)	2
Rigid (S2-S5)	1
Lesion-free	0

Table 4 The pain score and its secondary index score

Pain	Score
Intractable pain (not alleviated by bed rest/chemotherapy, VAS > 7)	4
Moderate pain (not alleviated by bed rest/chemotherapy, VAS 4-7)	3
Mild pain (After bed rest/chemotherapy, VAS = 3)	2
Slight pain after activity (VAS ≤ 2) no pain when resting	1
No pain during physical activity after chemotherapy	0

VAS: Visual analog scale.

Table 5 The number of segments score and its secondary index score

Number of segments	Score
> 3	4
3	3
2	2
1	1
No change in morphology	0

Table 6 The physiological curvature score and its secondary index score

Physiological curvature	Score
Lateral radiograph
Physiological curvature of the lesion is abnormal	2
Physiological curvature of the lesion is normal	0
Front radiograph
Scoliosis/rotation	2
No scoliosis/rotation	0

Table 7 The comorbidities score and its secondary index score

Comorbidities	Score
Spondylolisthesis (> 1 degree)	4
Shift/dislocation (0-1 degree)	3
Herniated disk	2
Bone spurs	1
Bony fusion	0

Table 8 The neurological function score and its secondary index score

Neurological function (according to the Frankel classification)	Score
Frankel A	4
Frankel B	3
Frankel C	2
Frankel D	1
Frankel E	0

Table 9 Results of the multiple myeloma spinal stability scoring system and Spinal Instability Neoplastic Score by R-R paired chi-square test

	SINS					McNemar-Bowker	P value
MM		Stable	Potentially unstable	Unstable	Total	38.105	0.000
	Stable	5	37	3	45
	Potentially unstable	1	21	3	25
	Unstable	0	1	1	2
	Total	6	59	7	72

SINS: Spinal Instability Neoplastic Score; MM: Multiple myeloma.