Accuracy of Preoperative Scoring Systems for the Prognostication and Treatment of Patients with Spinal Metastases
Table 1
Preoperative prognostic scoring systems for patients with spinal metastases.
Scoring system
Prognostic variables (score)
Total score
Predicted prognosis (months)
Treatment strategy
Tokuhashi
(i) General condition (KPS) (0, 1, 2) (ii) Extraspinal bone mets (0, 1, 2) (iii) Number of vertebral body mets (0, 1, 2) (iv) Major organ metastasis (0, 1, 2) (v) Primary site of cancer (0, 1, 2) (vi) Spinal cord palsy (Frankel) (0, 1, 2) Total score: 0–12
5 6–8 9–12
<3 12 12
Palliative surgery (not specified) Excisional surgery
Revised Tokuhashi
(i) General condition (KPS) (0, 1, 2) (ii) Extraspinal metastasis (0, 1, 2) (iii) Number of vertebral body mets (0, 1, 2) (iv) Major organ metastasis (0, 1, 2) (v) Primary site of cancer (0–5) (vi) Palsy (Frankel) (0, 1, 2) Total score: 0–15
0–8 9–11 12–15
<6 ≥6 ≥12
Conservative Palliative surgery: SC decompression and stabilisation Excisional surgery: en bloc resection, curettage, and stabilisation
Bauer
Positive prognostic factors (i) Pathologic fracture (0, 1) (ii) No visceral metastases (0, 1) (iii) Solitary skeletal metastases (0, 1) (iv) No lung cancer (0, 1) (v) Primary cancer: breast/kidney/myeloma/lymphoma (0, 1) Total score: 0–5
0-1 2-3 4-5
<6 >6 >12
Conservative Palliative surgery Excisional surgery
Modified Bauer
(i) No visceral metastases (0, 1) (ii) Solitary skeletal metastases (0, 1) (iii) No lung cancer (0, 1) (iv) Primary tumour: breast/kidney/myeloma/lymphoma (0, 1) Total score: 0–4
0-1 2 3-4
<6 >6 >12
Conservative Dorsal surgery (palliative) Ventral-dorsal surgery (excisional)
Sioutos
Negative prognostic factors
0
>12
Excisional surgery
(i) Preoperative leg strength 0/5–3/5 (0, 1)
1
>6
Palliative surgery
(ii) Lung or colon cancer (0, 1)
2
<6
Conservative: surgery not recommended
(iii) Multiple vertebral body disease (0, 1) Total score: 0–3
3
<6
Tomita
(i) Primary tumour growth rate (1, 2, 4) (ii) Visceral metastases (0, 2, 4) (iii) Bone metastases (1, 2) Total score: 2–12
2-3 4-5 6-7 8–10
>18 >12 >6 <6
Wide or marginal excision Marginal or intralesional excision Palliative surgery (decompression/stabilisation) Conservative: supportive care
van der Linden
(i) General condition (KPS) (0, 1, 2) (ii) Primary tumour type (0, 1, 2, 3) (iii) Visceral metastases (0, 1) Total score: 0–6
0–3 (Group A) 4-5 (Group B) 6 (Group C)
<6 >6 >12
Radiotherapy Radiotherapy Surgery, only if imminent
