Rehabilitation Palliative Care for Metastatic Spinal Disease Based on Tokuhashi-Tomita Score: A Case Report

Abstract

Metastatic spinal disease is considered a terminal stage of primary cancer and palliative treatment focuses around symptom control and reducing spinal complications such as cord compression. A 60 years man with complete spinal cord injury AIS A post laminectomy with Th2-Th4 decompression and tumor biopsy due to canal stenosis et causa Th3 compression fracture. Patient has history of paraparesis in level Th4-Th8, also bladder and bowel incontinence. The prognosis of patients with epidural metastasis is not promising and difcult to predict. Tokuhashi and Tomita scores are one of tools that used widely to predict the patient’s survival prognosis, in particularly for spinal metastatic treatment decision. These scores provide guidance decision whether aggressive operative or palliative. Tokuhashi score in this patient indicated the survival rate was below 6 months and Tomita score referred to palliative treatment. Physical medicine and rehabilitation treatment focus on palliative treatment for this patient include diminished pain, maintain vertebral stability, improve physical tness and mobility to reduce further complication of prolonged bedridden and improve quality of life. Other treatment was given according to complaint and symptom. Patient was died less than 2-month post-surgery after readmission to the hospital due to bed ridden complications.