Abstract
Purpose
The revised Tokuhashi score has been widely used to evaluate indications for surgery and predict survival in patients with metastatic spinal disease. Our aim was to analyse the actual survival time of patients treated for metastatic spinal cord compression (MSCC) in comparison with the predicted survival based on the revised Tokuhashi score. This would thereby allow us to determine the overall predictive value of this scoring system.
Methods
This study was a semi-prospective clinical study of all patients with MSCC presenting to our unit over 8 years—data from October 2003 to December 2009 were collected retrospectively and from December 2009, all data collected prospectively to October 2011. Patients were divided into three groups—Group 1 (Tokuhashi score 0–8, n = 84), Group 2 (Tokuhashi score 9–11, n = 83) and Group 3 (Tokuhashi score 12–15, n = 34). Data collected included demographic data, primary tumour histology, surgery type and complications, neurological outcome (Frankel grade) and survival.
Results
A total of 233 patients with MSCC were managed surgically in our unit during this time. Out of these complete data were available on 201 patients for analysis. Mean age of patients was 61 years (range 18–86; 127 M, 74 F). The primary tumour type was Breast (n = 29, 15 %), Haematological (n = 28, 14 %), Renal (n = 26, 13 %), Prostate (n = 26, 13 %), Lung (n = 23, 11 %), Gastro-intestinal (n = 11, 5 %), Sarcoma (n = 9, 4 %) and others (n = 49, 24 %). All patients included in the study had surgical intervention in the form of decompression and stabilisation. Posterior decompression and stabilisation was performed in 171 patients (with vertebrectomy in 31), combined anterior and posterior approaches were used in 18 patients and 12 had an anterior approach only. The overall complication rate was 19 % (39/201)—the most common being wound infection (n = 15, 8 %). There was no difference in the neurological outcome (Frankel grade) between Groups 1 and 2 (p = 0.34) or Groups 2 and 3 (p = 0.70). However, there was a significant difference between Groups 1 and 3 (p = 0.001), with Group 3 having a significantly better neurological outcome. Median survival was 93 days in Group 1, 229 days in Group 2 and 875 days in Group 3 (p = 0.001). The predictive value between the actual and predicted survival was 64 % (Group 1), 64 % (Group 2) and 69 % (Group 3). The overall predictive value of the revised Tokuhashi score using Cox regression for all groups was 66 %.
Conclusion
We would conclude that although the predictive value of the Tokuhashi score in terms of survival time is at best modest (66 %), the fact that there were statistically significant differences in survival between the groups looked at in this paper indicates that the scoring system, and the components which it consists of, are important in the evaluation of these patients when considering surgery.
Similar content being viewed by others
References
Aaron AD (1994) The management of cancer metastatic to bone. JAMA 272:1206–1209
Cobb CA et al (1997) Indications for nonoperative treatment of spinal cord compression due to breast cancer. J Neurosurg 47:653–658
Wong DA et al (1990) Spinal metastases: the obvious, the occult, and the imposters. Spine 15:1–4
Barron KD et al (1959) Experiences with metastatic neoplasms involving the spinal cord. Neurology 9:91–106
Schaberg J, Gainor BJ (1985) A profile of metastatic carcinoma of the spine. Spine 10:19–20
Tokuhashi Y, Matsuzaki H, Toriyama S, Kawano H, Ohsaka S (1990) Scoring system for the preoperative evaluation of metastatic spine tumour prognosis. Spine 15:1110–1113
Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J (2005) A revised scoring system for preoperative evaluation of metastatic spine tumour prognosis. Spine 30:2186–2191
Tokuhashi Y, Yasumitsu A, Umezawa N (2009) Outcome of treatment for spinal metastases using scoring system for preoperative evaluation of prognosis. Spine 34:69–73
Ulmar B, Huch K, Naumann U et al (2007) Evaluation of the Tokuhashi prognosis score and its modifications in 217 patients with vertebral metastases. Eur J Surg Oncol 33(7):914–919
Putz C, Wiedenhöfer B, Gerner HJ, Fürstenberg CH (2008) Tokuhashi prognosis score: an important tool in prediction of the neurological outcome in metastatic spinal cord compression: a retrospective clinical study. Spine 33(24):2669–2674
Yamashita T, Siemionow KB, Mroz TE, Podichetty V, Lieberman IH (2011) A prospective analysis of prognostic factors in patients with spinal metastases: use of the revised Tokuhashi score. Spine (Phila Pa 1976) 36(11):910–917
Patchell RA, Tibbs PA, Regine WF et al (2005) Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet 366(9486):643–648
Majeed H, Kumar S, Bommireddy R, Klezl Z, Calthorpe D (2012) Accuracy of prognostic scores in decision making and predicting outcomes in metastatic spine disease. Ann R Coll Surg Engl 94(1):28–33
Sioutos PJ, Arbit E, Meshulam CF, Galicich JH (1995) Spinal metastases from solid tumours. Analysis of factors affecting survival. Cancer 76:453–459
Mollahoseini R, Farhan F, Khajoo A, Jouibari MA, Gholipour F (2011) Is Tokuhashi score suitable for evaluation of life expectancy before surgery in Iranian patients with spinal metastases? J Res Med Sci 16(9):1183–1188
Pointillart V, Vital JM, Salmi R, Diallo A, Quan GM (2011) Survival prognostic factors and clinical outcomes in patients with spinal metastases. J Cancer Res Clin Oncol 137(5):849–856
Padalkar P, Tow B (2011) Predictors of survival in surgically treated patients of spinal metastasis. Indian J Orthop 45(4):307–313
Leithner A, Radl R, Gruber G, Hochegger M, Leithner K, Welkerling H, Rehak P, Windhager R (2008) Predictive value of seven preoperative prognostic scoring systems for spinal metastases. Eur Spine J 17(11):1488–1495
Tokuhashi Y, Ajiro Y, Umezawa N (2008) Outcome of treatment for spinal metastases using scoring system for preoperative evaluation of prognosis. Spine 34(1):69–73
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Quraishi, N.A., Manoharan, S.R., Arealis, G. et al. Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC). Eur Spine J 22 (Suppl 1), 21–26 (2013). https://doi.org/10.1007/s00586-012-2649-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-012-2649-5