Usefulness of Tokuhashi Score in Survival Prediction of Patients Operated for Vertebral Metastatic Disease

Abstract

Study Design:Retrospective study.Objective:Spinal metastasis can produce pain, deformity, neurological compromise and can decrease life expectancy. Surgical management is usually indicated for pain control, neurological decompression, and to avoid deformity progression. Tokuhashi et al created a scoring system to estimate survival and stratify surgical treatment based on established parameters. Our objective was to evaluate the usefulness of Tokuhashi scoring (TS) system by comparing the predicted and real survival times and analyze the survival time according to the type of tumor.Methods:From 2004 to 2014, 105 patients with vertebral metastasis who underwent surgical treatment were enrolled and retrospectively analyzed. Preoperative TS was performed in all cases. Patients were classified into 3 groups according to TS; group 1 (TS 0-8), group 2 (TS 9-11), and group 3 (TS 12-15). Patients’ average age was 61.5 years, main primary tumor site were as follows: kidney (23%), lung (19%), and breast (18%).Results:The Tokuhashi general concordance was 67.6%. Per group concordance was as follows: group 1 80%, in group 2, only 33% of concordance was observed. In group 3, 100% of concordance was observed. In group 2, the most common primary sites were breast and kidney and the mean survival was 20 and 22.3 months, respectively, both longer than that expected for this group.Conclusions:Tokuhashi concordance was acceptable in our study, particularly in lower and higher scores. The lesser concordance observed in group 2 (33.3%) was observed in almost all tumors. For our practice, TS constitutes an acceptable tool to define survival, particularly in lower and higher scores.

Thirty-day complication and readmission rates associated with resection of metastatic spinal tumors: a single institutional experience

“…Given the palliative nature of these procedures, the remaining survival and potential benefit to the quality of life of the patient must be carefully weighed against the risk of complication and prolonged or repeated hospitalization secondary to surgery (31). For this reason, there has been growing interest in the development of prognostic scoring systems to aid surgeons in making this challenging determination (14)(15)(16)(17). Accordingly, a number of risk calculators for spinal metastasis resection have been developed including Bauer (32), Tokuhashi (33,34), Tomita (14), van der Linden (35), and Sioutos (31,36).…”

“…However, due to the reduced state of health of these patients, there is an increased risk for peri-operative complications and morbidity associated with surgical resection (8)(9)(10)(11)(12)(13). With a growing national emphasis on reducing overall complication and readmission rates, risk stratifying patients and addressing avoidable complications after resection of spinal metastases is necessary to optimize quality of care and reduce the disparaging healthcare costs (14)(15)(16)(17). While previous studies have explored in-hospital complication rates and surgical outcomes for patients undergoing metastatic spinal tumor resections (8)(9)(10)(11)(12)(13), there is a paucity of data investigating 30-day complication and readmission rates.…”

Association Between Constipation and a Reduction in Lower Limb Muscle Strength in Preoperative Patients with Thoracic Spinal Tumors

“…In such cases, emergency surgery may carry a higher risk than scheduled surgery, despite the limited postoperative recovery. Although various evaluation methods are currently used for surgical interventions [10,11] , there is still no clear guidance on the optimal timing for surgical intervention.…”

Paraspinale Tumore: Epidemiologie, Diagnostik und Therapie

“…Entscheidungshilfe zur stabilisierenden Operation bietet der SINS-Score (spinal instability neoplastic score): Lokalisation des Tumors innerhalb der mobilen oder rigiden Wirbelsäule, Wirbelsäulendeformität, Ruhe-oder Bewegungsschmerz sowie mono-oder bilaterale Einbeziehung der tragenden hinteren Säule werden bepunktet und somit als stabil, potenziell oder sicher instabil eingestuft [6] Sprechen Gesamtprognose, Komorbiditäten, Alter des Patienten oder Lokalisation der Tumore gegen eine Operation, kann ein rein palliativer analgetischer oder strahlentherapeutischer Ansatz diskutiert und gewählt werden. Weitere Skalen, die Prognoseparameter bei unterschiedlichen Tumorentitäten zusammenfassen, können Entscheidungshilfen bei der Wahl der Therapie liefern [7], allerdings nie dem Chirurgen die individuelle Therapieentscheidung abnehmen. Ein Beispiel hierfür ist die Skala nach Tokuhashi [8] (▶ Tab.…”