Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group

Abstract

Choosing the right operation for metastatic spinal tumours is often difficult, and depends on many factors, including life expectancy and the balance of the risk of surgery against the likelihood of improving quality of life. Several prognostic scores have been devised to help the clinician decide the most appropriate course of action, but there still remains controversy over how to choose the best option; more often the decision is influenced by habit, belief and subjective experience. The purpose of this article is to review the present systems available for classifying spinal metastases, how these classifications can be used to help surgical planning, discuss surgical outcomes, and make suggestions for future research. It is important for spinal surgeons to reach a consensus regarding the classification of spinal metastases and surgical strategies. The authors of this article constitute the Global Spine Tumour Study Group: an international group of spinal surgeons who are dedicated to studying the techniques and outcomes of surgery for spinal tumours, to build on the existing evidence base for the surgical treatment of spinal tumours.

A study investigating the validity of modified Tokuhashi score to decide surgical intervention in patients with metastatic spinal cancer

“…Original Tokuhashi and modified scores excluded them. However, Choi et al [10] on behalf of the Global Spine Tumor Study Group have included myeloma and lymphoma to be one of the commonest causes of metastatic spinal cancer. Yilmazlar et al [11], in their study, have also included myeloma and lymphoma cases in their comparison of prognostic scores in metastatic spinal cancer groups.…”

Assessment of Scores in Decision Making in Metastases of the Spine

“…However, this system is excessively oversimplified, resulting in broad categories of patients who can have very different prognoses. 2 For example, a patient with radicular pain but good function can be allocated to the same group as a patient with complete paralysis from a large tumor. 2 In 1990 Tokuhashi et al 10 elaborated a treatment and procedure selection strategy based on life expectancy.…”

“…2 For example, a patient with radicular pain but good function can be allocated to the same group as a patient with complete paralysis from a large tumor. 2 In 1990 Tokuhashi et al 10 elaborated a treatment and procedure selection strategy based on life expectancy. In 2005 they revised the tool to improve the precision of this system.…”

“…1,2 Patients with cancer present spinal metastases in 70% of cases and up to 10% develop spinal cord compression. 2,3 The ratio of these lesions to primary tumors is 40:1 and skeletal dissemination should be considered in the differential diagnosis of a patient with a spinal cord lesion.…”

“…1,2 Patients with cancer present spinal metastases in 70% of cases and up to 10% develop spinal cord compression. 2,3 The ratio of these lesions to primary tumors is 40:1 and skeletal dissemination should be considered in the differential diagnosis of a patient with a spinal cord lesion. 1,4,5 Metastatic involvement of the spine is more common in primary tumors of the breast, lung, kidney, thyroid gland, and the prostate, in that order, according to Papastefanou et al 6 In our practice, Valesin Filho et al 7 described the prevalence in 55 patients: breast (32.7%), multiple myeloma (25.4%), prostate (14.5%), gastric carcinoma (5.4%), neoplasia of the lung (3.6%), neoplasia of the kidney (3.6%), and others (14.5%).…”