Is a Revised Tokuhashi Scoring System Useful in Preoperative Evaluation of Metastatic Spinal Tumor Prognosis?

Abstract

Objective: The aim of this study was to evaluate the consistency between revised prognostic score derived from the Tokuhashi scoring system (TSS) and the actual patient survival period after surgical treatment at our institution. Methods: From 1998 to 2005, surgically treated 44 patients with metastatic spine tumors were reviewed retrospectively at our institution. Among these 44 patients, 32 had died, 2 were alive at the time of the last follow-up evaluation, and 10 were lost to the follow-up. Only 32 patients who died after surgery have been investigated in this study. Preoperatively, patients were staged serveral standard diagnostic modalities, such as, plain radiographs, computed tomography, magnetic resonance imaging and etc. Each patient was evaluated using the TSS and placed in one of three groups depending upon this evaluation. Results: The actual mean (±SD) survival period was 6.6 months (±1.14) for the first group (predicted survival periods in revised TSS, less than 6 months), 15.1 months (± 5.38) for the second group (predicted survival periods in revised TSS, 6 months or more) and 37.5 months (±8.70) for the third group (predictied survival period in revised TSS, 1 year or more). The survival periods for these groups were significantly different (p=0.0006). Applying the TSS for evaluation of prognosis of metastatic spinal tumors was found to be very reliable results with a statistically significance. Of six parameters measured in the TSS, Extraspinal bone metastases, metastases to the major internal organs, the primary tumor site contributed to predicting the survival periods. Conclusions: This study has revealed that the revised prognostic score resulting from the TSS predicts actual survival periods remarkably well. Hence, we thought that the revised TSS could be useful and reliable tool in prognosis of metastic spinal tumors.