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Study Design: This was a retrospective cohort study. Purpose: We evaluated the predictive value of the Spinal Instability Neoplastic Score (SINS) system for spinal adverse events (SAEs) in patients with single spinal metastatic tumor. Overview of Literature: The SINS system was developed to assess spinal instability in patients with single metastatic spinal tumor. However, the system's potential predictive value for SAEs has been partially studied. Methods: This system was applied to a retrospective cohort of 78 patients with single spinal metastatic tumors. The patients underwent surgical treatment and were postoperatively followed up for at least 2 years or until death. The attribution of each score and total SINS to SAE (vertebral compression fracture [VCF] and spinal cord compression [SCC]) occurrence was assessed using the Cox proportional hazards model. Results: SAEs occurred on average 7 months after diagnosis of spinal metastasis. The mean survival rate post diagnosis was 43 months. Multivariate analysis using the Cox proportional hazards model revealed that the pain (p =0.029) and spinal alignment (p =0.001) scores were significantly related to VCF occurrence, whereas the pain (p =0.008) and posterolateral involvement (p =0.009) scores were related to SCC occurrence. Conclusions: Among the components of the SINS system, while pain and spinal alignment showed a significant association with VCF occurrence, pain and posterolateral involvement showed association with SCC occurrence. [ABSTRACT FROM AUTHOR]