ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2022
Georg schmorl prize of the German spine society (DWG) 2021: Spinal Instability Spondylodiscitis Score (SISS)-a novel classification system for spinal instability in spontaneous spondylodiscitis.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
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Who cites it
24 citing papers in PubMed, 29 citations in OpenAlex.
- Recommendations of the International Consensus Meeting (ICM) 2025 on Spinal Infections: Part B Tubercular Spondylodiscitis.Global spine journal · 2026Article
- Recommendations of the International Consensus Meeting (ICM) 2025 on Spinal Infections: Part A Pyogenic Spondylodiscitis.Global spine journal · 2026Article
- Comparison of Hospital Mortality and Risk Factors in Conservative and Surgical Treatment of Pyogenic Vertebral Osteomyelitis: A Nationwide Analysis of 49,951 Cases in Germany.Global spine journal · 2026Article
- The Modified Spinal Instability Spondylodiscitis Score (mSISS): Adaptation and Validation of a Novel Classification System for Spinal Instability in Spondylodiscitis.Global spine journal · 2026Article
- Infectious Spondylodiscitis of Bacterial Causes in Adults: Epidemiology, Pathophysiology, Diagnostic and Treatment Challenges.Microorganisms · 2026Review
- MRI spondylodiscitis severity index: A novel scoring system based on contrast-enhanced MRI of the spine for predicting the clinical course and severity of pyogenic spondylodiscitis.Skeletal radiology · 2026Article
- Prediction and risk factors for one year mortality in patients after surgery for pyogenic spondylodiscitis.Neurosurgical review · 2026Article
- Risk factors for revision surgery due to construct failure after instrumented treatment of pyogenic spondylodiscitis.Brain & spine · 2026Article
- Progress in diagnosis and treatment of primary spondylodiscitis: a systematic literature review.EFORT open reviews · 2025Article
- Challenges and limitations of the existing scoring systems for postoperative outcomes in thoracolumbar pyogenic spondylitis: a multicenter retrospective cohort study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- [Spondylitis and spondylodiscitis].Radiologie (Heidelberg, Germany) · 2025Review
- What Is Worse: A Comparison of Solitary Versus Multifocal Pyogenic Spondylodiscitis Using a Nationwide Analysis of Readmission Rates and Risk Factors.Journal of clinical medicine · 2025Article
- Risk Factors for Delayed Diagnosis of Pyogenic Spondylitis: A Cross-Sectional Study with Prospective Case Series.Spine surgery and related research · 2025Article
- Diagnostic Accuracy of Pre-Biopsy MRI and CT Features for Predicting Vertebral Biopsy Yield in Suspected Vertebral Discitis Osteomyelitis: A Retrospective Single-Center Study.Diagnostics (Basel, Switzerland) · 2025Article
- Surgical treatment of unstable spondylodiscitis with posterior instrumentation and bioactive glass (BAG-S53P4): surgical technique and results at medium-term follow-up.Journal of spine surgery (Hong Kong) · 2025Article
- Percutaneous pedicle screw fixation in the surgical treatment of monosegmental pyogenic spondylodiscitis.Journal of orthopaedic surgery and research · 2025Article
- Evaluation of the SITE score for de-novo spinal infection patients in clinical practice - A case-based approach.Brain & spine · 2025Article
- Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations.Brain & spine · 2025Article
- Article
- Peripherally inserted central venous catheter in outpatient antibiotic spinal infection treatment is safe, effective and leads to significant reduction in healthcare expenses.Neurosurgical review · 2024Article
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Authors and funding
7 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeEven though spinal infections are associated with high mortality and morbidity, their therapy remains challenging due to a lack of established classification systems and widely accepted guidelines for surgical treatment. This study's aim therefore was to propose a comprehensive classification system for spinal instability based on the Spinal Instability Neoplastic Score (SINS) aiding spine surgeons in choosing optimal treatment for spontaneous spondylodiscitis.
methodsPatients who were treated for spontaneous spondylodiscitis and received computed tomography (CT) imaging were included retrospectively. The Spinal Instability Spondylodiscitis Score (SISS) was developed by expert consensus. SINS and SISS were scored in CT-images by four readers. Intraclass correlation coefficients (ICCs) and Fleiss' Kappa were calculated to determine interrater reliabilities. Predictive validity was analyzed by cross-tabulation analysis.
resultsA total of 127 patients were included, 94 (74.0%) of which were treated surgically. Mean SINS was 8.3 ± 3.2, mean SISS 8.1 ± 2.4. ICCs were 0.961 (95%-CI: 0.949-0.971) for total SINS and 0.960 (95%-CI: 0.946-0.970) for total SISS. SINS yielded false positive and negative rates of 12.5% and 67.6%, SISS of 15.2% and 40.0%, respectively.
conclusionWe show high reliability and validity of the newly developed SISS in detecting unstable spinal lesions in spontaneous spondylodiscitis. Therefore, we recommend its use in evaluating treatment choices based on spinal biomechanics. It is, however, important to note that stability is merely one of multiple components in making surgical treatment decisions.
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