Fig. 1

Scoring bone damage and instability - spectrum of findings. a) Focal lytic lesions > 5 mm in diameter located at the left sacrum (white arrows). In this case the MSBDS was 2 (1 + 1). b) Single focal lytic lesion > 5 mm in the vertebral body (white arrow) with no vertebral collapse. The smaller focal lytic lesion (green line) is < 5 mm (no points in the MSBDS). In this case the MSBDS was 1. c) Large lytic lesion at the junctional spine (L5-S1) with collapse/involvement > 50%, posterolateral (facet, pedicle) involvement and more than 2/3 of bone diameter. In this case the MSBDS was 11 (3 + 3 + 2 + 3): the lesion was considered “high-risk” and immediate surgical or radiation oncologist consultation was warranted. In this case, there was also a possible spinal canal involvement. d) Lytic lesion > 5 mm (white arrow) at the junctional spine (thoraci spine) with collapse/involvement < 50%, and a small (small white arrow) focal lesion at the right rib cage. In this case the MSBDS was 6 (3 + 2 + 1): the lesion was considered “Medium risk:” 5–10 with medium risk of pathologic fracture. e) Large lytic lesion at the junctional spine (thoracic spine) with collapse/involvement > 50%, posterolateral (facet, pedicle) involvement and more than 2/3 of bone diameter. In this case the MSBDS was 11 (3 + 3 + 2 + 3): the lesion was considered “high-risk” and immediate surgical or radiation oncologist consultation was warranted. In this case, there is spinal canal involvement. f) Lytic lesion at the left femoral neck (white arrow). This lesion alone warrants 5 points in the MSBDS putting the patients in “medium risk” group