Outcome of Treatment for Spinal Metastases Using Scoring System for Preoperative Evaluation of Prognosis

Tokuhashi, Yasuaki; Ajiro, Yasumitsu; Umezawa, Natsuki

doi:10.1097/brs.0b013e3181913f19

Cited by 168 publications

(112 citation statements)

References 14 publications

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“…The revised Tokuhashi score is considered to be a reasonable tool for predicting the prognosis of patients' life expectancy as has been confirmed by numerous authors [8][9][10][11][12][13][14]. In a retrospective review of 246 patients, Tokuhashi and colleagues showed a predictive value of 85.3 % in the group with a score of 0-8, 73.1 % with a score of 9-11 and 95.4 % in the 12-15 group.…”

Section: Discussionmentioning

confidence: 88%

“…Tokuhashi himself has suggested that flexible revisions are necessary (to the scoring system) for an improved prognostic evaluation system based on the effects of new treatment methods in various fields [19]. We would conclude that although the predictive value of the Tokuhashi score in terms of survival time is at best modest, 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.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few reports have been published which have evaluated the revised Tokuhashi scoring system in a mixed population of patients with various forms cancer [8][9][10][11]. Furthermore, our own experience suggested that survival in patients was often greater than what was predicted by this scoring system.…”

Section: Introductionmentioning

confidence: 93%

“…The Tokuhashi score-designed in 1987 and revised in 1998-has been used to determine the prognosis for these patients to guide adequate treatment approaches [6][7][8]. The scoring system is used to evaluate surgical candidates and is based on six parameters: (1) general condition, (2) number of extraspinal bone metastases, (3) number of metastases in the vertebral body, (4) presence or absence of metastases to major internal organs, (5) site of the primary lesion and (6) severity of palsy.…”

Section: Introductionmentioning

confidence: 99%

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Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC)

et al. 2013

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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.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC)

et al. 2013

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“…6,8 The development of classifications help with communication and proper referrals between oncologists, radiologists, and spine surgeons, and facilitate optimized treatment plans. [9][10][11][12] The main classification systems take into account instability (the Spine Instability Neoplastic Score [SINS] 8 and Harrington 13 ) and the prognosis (Tokuhashi et al 10 and Tomita et al 14 ), and help reduce uncertainty in the decision-making process. 6 This study therefore attempts to evaluate the intra-and interobserver concordances in the SINS, 8 Harrington, 13 Tokuhashi et al, 10 and Tomita et al 14 scores between general orthopedic surgeons and spine surgeons with more than 5 and 10 years of experience in the evaluation of patients with vertebral metastasis.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Scores in Decision Making in Metastases of the Spine

et al. 2015

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Objective: The aim of this study is to assess the intra-and interobserver concordance of SINS, Harrington, Tokuhashi and Tomita scores among general orthopedic surgeons and spine surgeons with experience above 5 and 10 years in the evaluation of patients with spinal metastasis. Methods: Twenty cases of patients with metastatic lesion of the spine were presented to 10 examiners and the scores aforementioned have been applied. After six weeks, the cases were reintroduced in a different order and data were analyzed. Results: The intraobserver reliability showed better agreement in SINS score among examiners with less experience and Harrington and Tomita scores among those who had more than 10-year experience. The interobserver reliability of the examiners of the group with over 10-year experience showed higher precision when using these scores, especially Harrington and Tomita. The SINS score was the choice for daily practice and was able to modify the management more often. Conclusions: This study demonstrated that the use of predictive scores of instability, Harrington, and prognosis, Tomita, had a higher intra-and interobserver reliability particularly among spine surgeons with experience above 10 years.Keywords: Prognosis; Neoplasm metastasis; Spinal neoplasms; Life expectancy. RESUMO Objetivo: O objetivo deste estudo é avaliar a concordância intra e interobservador dos escores SINS, Harrington

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Interventions for the treatment of metastatic extradural spinal cord compression in adults

George

Jeba

Govindaraj

et al. 2008

Cochrane Database of Systematic Reviews

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Patients with stable spines retaining the ability to walk may be treated with radiotherapy. One trial indicates that short course radiotherapy suffices in patients with unfavourable histologies or predicted survival of less than six months. There is some evidence of benefit from decompressive surgery in ambulant patients with poor prognostic factors for radiotherapy; and in non-ambulant patients with a single area of compression, paraplegia < 48 hours, non-radiosensitive tumours and a predicted survival of more than three months. High dose corticosteroids carry a significant risk of serious adverse effects.

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Outcome of Treatment for Spinal Metastases Using Scoring System for Preoperative Evaluation of Prognosis

Cited by 168 publications

References 14 publications

Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC)

Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC)

Assessment of Scores in Decision Making in Metastases of the Spine

Interventions for the treatment of metastatic extradural spinal cord compression in adults

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