Study on the Applicability of the Modified Tokuhashi Score in Patients With Surgically Treated Vertebral Metastasis

Abstract

To present the results obtained from surgical treatment of patients with vertebral metastases, comparing them with the modified Tokuhashi score in order to validate the applicability of this score for prognostic predictions and for choosing surgical treatments. Methods: This was a retrospective study on 157 patients treated surgically for spinal metastasis in Erastus Gaertner Hospital in Curitiba. The Tokuhashi score was applied retrospectively to all the patients. The patients' actual survival time was compared with the expected survival time using the Tokuhashi score. Results: There were 82 females and 75 males. The most frequent location of the primary tumor was the breast. The thoracic region was involved in 66.2%, lumbar region in 65.6%, cervical region in 15.9% and sacral region in 12.7%. All the patients underwent surgical treatment. The most frequent indication for treatment was intractable pain (89.2%). There was partial or complete improvement in a majority of the cases (52.2%). Out of 157 cases studied, 86.6% died. The maximum survival time was 13.6 years, the minimum was 3 days and the mean was 13.2 months. The following frequencies of Tokuhashi scores were found among the operated cases: up to 8 points, 111 cases; 9-11 points, 43 cases; and 12-15 points, three cases. The mean survival time in months for all 157 patients according to the Tokuhashi score was: 0-8 points, 15.4 months; 9-11 points, 11.4 months; and 12-15 points, 12 months. Conclusion: Unlike the nonsurgical approach recommended by Tokuhashi for patients with lower scores, this group in our study was sent for surgery, with better results than those of non-operated patients reported by Tokuhashi.

Outcomes and survival of spinal metastasis with epidural compression

“…[ 10 11 13 15 16 19 ] Contrary to what was reported in other countries, metastases of primary lung tumor were less frequent in our patients as well as in local reports. [ 10 13 15 19 20 ] This finding may be related to the lack of target therapies in our country, which has increased the survival of these patients. It was not possible to identify the primary tumor in 7 (6.8%) patients.…”

“…[ 1 2 4 ] The thoracic spine was the most frequent location, and breast and prostate spinal metastases were the most frequently observed primary tumor in our patients and other reports of the same country. [ 10 11 13 15 16 19 ] Contrary to what was reported in other countries, metastases of primary lung tumor were less frequent in our patients as well as in local reports. [ 10 13 15 19 20 ] This finding may be related to the lack of target therapies in our country, which has increased the survival of these patients.…”

“…The goal of surgical treatment of spinal metastasis remains palliative for pain relief, restoration or preservation of the neurological function, stabilization of spinal segment, and improvement of health-related quality of life. [ 10 11 ] The prognosis of spinal metastasis is not very promising and difficult to predict as well as the therapeutic decision. The surgical treatment is palliative, but patients with spinal metastasis and good-to-moderate prognoses seem to benefit from surgical treatment.…”

Metastatic spinal cord compression (MSCC) treated with palliative decompression: Surgical timing and survival rate

“…It implies that operation before palsy (Group A) leads to a better survival. In previous studies, with better Tomita or revised Tokuhashi score, more aggressive intervention is suggested, such as en bloc, wide, or marginal excision [ 2 , 3 ]. Our study demonstrates that palliative decompression achieves acceptable outcome in patients with good Tomita or revised Tokuhashi score.…”

“…Treatments for patients with MSCC differ based on their life expectancies [ 2 , 3 ]. To improve the quality of life, patients with a life expectancy of more than 3–6 months may undergo surgery [ 4 , 5 ].…”