Introduction: The evaluation of patients presenting with spinal metastatic disease is often challenging due to the diversity of disease and the variety of factors that influence decision-making. The Tokuhashi scoring system attempts to facilitate this process, by incorporating a variety of patient and disease specific characteristics, in order to assess prognosis and guide intervention decisions. We sought to retrospectively investigate the clinical utility of this prognostic scale in one regional tertiary center, and to assess whether neurosurgery was being utilized in the most effective way to guide the decision making process.

Methods: The oncology database was used to allocate 285 patients with spinal metastasis between 2010 and 2015. The Tokuhashi scale components were determined from a chart review.

Results: Based on the Tokuhashi scale, there were 69.1% in the non-operative/radiation group (group 1), 23.2% in the palliative/excisional surgical group (group2) and 7.7% in the surgical group (group 3). Using Kaplan-Meiers estimate, survival time was significantly different across the three groups with means 232.8±30.8, 352.3±49.2 and 568.3±206.1 days, respectively. A significantly higher proportion of patients (84.6%) were treated non-surgically in group 1, compared to 45.5% in group 3 (X2= 19.5, P<0.001). However, there was no correlation between the type of surgical interventions (i.e. instrumented decompression, decompression alone, percutaneous vertebral augmentation and instrumented vertebral augmentation) and the Tokuhashi score.

Conclusions: This review illustrates the utility of the Tokuhashi scale in predicting survival. However, it does not address the new role of emerging different surgical strategies for the treatment of spinal metastasis and lacks information concerning spinal instability.

Patient Care: The goal of this research is to better identify which patients presenting with spinal metastatic disease would be best served by which interventions, be it radiation therapy, neurosurgery or palliation. By analyzing the clinical utility of previously developed scoring systems, the hope is to create a more cohesive and integrated scoring system that incorporates important prognostic markers that can then be applied to this patient population in hopes of better stratifying patients and targeting treatment decisions to each individual patient.

Learning Objectives: By conclusion of this session, participants should be able to 1) Describe the Tokuhashi scoring system and how it is used to stratify patients presenting with spinal metastatic cancer, 2) Discuss how this scoring system correlates with clinical outcomes, and 3) Identify the need for a scoring system that combines other important prognostic data to better guide surgical treatment decisions.

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