The Inpatient Metastatic Spine Score

OBJECTIVES: The low historical accuracy rate (25%) of Medical Oncology prognosis for inpatients with spinal metastatic disease presents several challenges. This study examines the prognostic accuracy of the Inpatient Metastatic Spine Score for inpatients prospectively considered for enrollment on the Spine Patient Optimal Radiosurgery Treatment for Symptomatic MEtastatic Neoplasms (SPORTSMEN) multicenter phase II randomized controlled trial. METHODS: From May 2025 to February 2026, inpatients at a single center were prospectively considered for SPORTSMEN inclusion. Prognosis was assessed per the Inpatient Metastatic Spine Score; scores of 0 to 3 were recommended for stereotactic body radiation therapy (and potential SPORTSMEN enrollment) due to a predicted positive prognosis (3+ mo before death/hospice). Scores 4 to 7 were deemed SPORTSMEN-ineligible due to predicted negative prognosis (<3 mo before death/hospice). Scores were correlated with actual patient prognosis. The Fisher test was used for statistical analysis. RESULTS: Twenty-five inpatients were evaluated. 7/11 (64%) with scores from 0 to 3 had a positive prognosis, while 3/14 (21%) with scores from 4 to 7 had a positive prognosis; this difference was statistically significant (P=0.0486). The accuracy of the Inpatient Metastatic Spine Score (7/11 positive + 11/14 negative=18/25 patients=72%) was significantly greater than the historical rate of Medical Oncology prognosis (P=0.0351). CONCLUSIONS: The accuracy of the Inpatient Metastatic Spine Score for prospectively assessing the prognosis of inpatients with spine metastases for a randomized controlled trial was 72%, significantly superior to that historically provided by Medical Oncology prognosis. These findings strongly support that the prognosis of inpatients with spinal metastases may be most accurately determined by the Inpatient Metastatic Spine Score.