A comparison of the modified Tokuhashi and Tomita scores in determining prognosis for patients afflicted with spinal metastasis

Aoude, Ahmed; Amiot, Louis-Philippe

doi:10.1503/cjs.012013

Cited by 54 publications

(43 citation statements)

References 11 publications

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“…16,32,78 Multiple studies have been performed comparing scoring systems, yet no consensus has been reached. 30,37,38 Each attempt at survival prediction has its own strengths and weaknesses.…”

Section: Discussionmentioning

confidence: 99%

The Role of Prognostic Scoring Systems in Assessing Surgical Candidacy for Patients With Vertebral Metastasis: A Narrative Review

Cassidy

Baker

Lenehan

2018

Global Spine Journal

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Study Design:Narrative review.Objectives:To review the relevant literature regarding scoring systems for vertebral metastases and quantify their role in contemporary orthopedic practice.Methods:A literature search of PubMed, Google Scholar, and Embase was performed on February 7, 2017. Eight scoring systems were selected for detailed review—7 of which were scores focused solely on patient prognosis (Tokuhashi, Tomita, Bauer, Oswestry Spinal Risk Index, Van der Linden, Rades, and Katagiri). The eighth system reviewed was the Spinal Instability Neoplastic Score, which examines for impending spinal instability in patients with vertebral metastases and represents a novel approach compared with hitherto scoring systems.Results:The Bauer and Oswestry Spinal Risk Index have the most accurate prognostic predictive ability, with the newer Oswestry Spinal Risk Index being favored by the contemporary literature as it demands less investigation and is therefore more readily accessible. There was a growing trend in studies designed to customize scoring systems for individual cancer pathological subtypes. The Spinal Instability Neoplastic Score shows good reliability for predicting instability among surgeons and oncologists.Conclusions:The increased understanding of cancer pathology and subsequent development of customized treatments has led to prolonged survival. For patients with vertebral metastases, this affects surgical candidacy not only on the basis of prognosis but also provides prolonged opportunity for the development of spinal instability. Scoring systems have a useful guidance role in these deciding for/against surgical intervention, but in order to remain contemporary ongoing review, development, and revalidation is mandatory.

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Section: Discussionmentioning

confidence: 99%

The Role of Prognostic Scoring Systems in Assessing Surgical Candidacy for Patients With Vertebral Metastasis: A Narrative Review

Cassidy

Baker

Lenehan

2018

Global Spine Journal

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“…Palliative surgery for spinal metastasis can improve the quality and length of life [23]. The revised Tokuhashi score is an important and effective tool for considering the prognosis of patients with a metastatic vertebral tumor [10–18]. Spinal metastases are considered to carry a worse prognosis in patients with lung cancer compared with other cancers [7–9, 19]; therefore, conservative treatment is selected for many lung cancer patients.…”

Section: Discussionmentioning

confidence: 99%

“…Surgery is the most effective method of pain relief and recovery from palsy due to paraparesis from vertebral metastasis, and is therefore the treatment of choice when survival longer than 3 months is predicted [5, 6]. The treatment strategy and procedure should be based on life expectancy [7–9]; the revised Tokuhashi score is generally used to evaluate the prognosis of patients with a metastatic vertebral tumor before considering surgical treatment [10–18]. The revised Tokuhashi score is based on six parameters, including patient condition, number of bone metastases outside spine, metastasis to major organs, primary site, and palsy (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Surgical intervention for vertebral metastases may benefit lung cancer patients no less than other patients: a retrospective study

et al. 2017

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BackgroundSpinal metastasis is considered to have a worse prognosis in lung cancer than in other cancers, but recent clinical studies report improved overall survival of lung cancer. We compared the postoperative prognoses of vertebral metastatic tumors from lung with other types of cancer.MethodsFrom 2011 to 2015, 31 Japanese patients (mean age 73 years, range 55–88 years; 19 males, 12 females) underwent surgery for spinal metastasis at our center. We observed patients retrospectively in March 2016, dividing them into groups by cancer type: lung (LK group, n = 10); prostate, breast, or thyroid (PB group, n = 12); and other (OT group, n = 9). We compared survival and revised Tokuhashi score, which provides a basis for choosing a treatment course. Neurologic status was graded before and after surgery using the Frankel system.ResultsMean follow-up was 16.5 months (range 1–62 months). Only seven of 31 patients (22.6%) were alive at final follow-up. Frankel grade significantly improved postoperatively only in the LK (P = 0.01) and PB (P = 0.048) groups. Revised Tokuhashi score differed across groups (P < 0.0001), and was significantly lower in the LK group than in the PB group (P = 0.00) and OT group (P = 0.02). Postoperative survival was significantly shorter in the LK group than in the PB group (P = 0.01) but did not differ between the LK and OT groups.ConclusionsThe revised Tokuhashi score may underestimate the survival of lung cancer patients, who may derive the same benefit from surgical intervention as those with vertebral metastasis from other cancer types.

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“…6 Surgeons increasingly base their decisions on objective scores that focus on prognosis, such as the validated Tomita and modified Tokuhashi scores. 25 Patients with spinal instability, good life expectancy, or radio-resistant tumours are likely to have a much better neurological outcome with tumour resection and spinal stabilisation before radiation. 10 The Spinal Instability Neoplastic Score (SINS) is a validated tool to determine clinical instability (defined as "loss of spinal integrity as a result of a neoplastic process that is associated with movement-related pain, symptomatic or progressive deformity and/or neural compromise under physiological loads").…”

Section: Surgerymentioning

confidence: 99%

Metastatic spinal cord compression: diagnosis and management

Al-Qurainy

Collis

2016

BMJ

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A comparison of the modified Tokuhashi and Tomita scores in determining prognosis for patients afflicted with spinal metastasis

Cited by 54 publications

References 11 publications

The Role of Prognostic Scoring Systems in Assessing Surgical Candidacy for Patients With Vertebral Metastasis: A Narrative Review

The Role of Prognostic Scoring Systems in Assessing Surgical Candidacy for Patients With Vertebral Metastasis: A Narrative Review

Surgical intervention for vertebral metastases may benefit lung cancer patients no less than other patients: a retrospective study

Metastatic spinal cord compression: diagnosis and management

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