Changes in physical function after palliative surgery for metastatic spinal tumor: association of the revised Tokuhashi score with neurologic recovery.
METHODS
A retrospective study of patients undergoing palliative surgery for metastatic spinal tumors.


OBJECTIVE
To investigate short-term functional recovery and duration of improvement after palliative surgery, to correlate these outcomes with the revised Tokuhashi score, and to examine the relationship between function and neurologic deterioration.


BACKGROUND
The revised Tokuhashi score is a scoring system used to predict life expectancy for patients with metastatic spinal tumors. The relationship between the revised Tokuhashi score and physical functional improvement after palliative surgery has not been examined previously.


METHODS
The clinical charts of 86 patients were reviewed. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was used to assess physical function. Each score was documented before surgery and at every month after surgery. The duration of ECOG-PS improvement, defined as the period between surgery and deterioration to the preoperative ECOG-PS grade, was correlated with the revised Tokuhashi score.


RESULTS
The ECOG-PS grade improved in 44 (51.1%) patients at 1 month postoperative. When ECOG-PS improvement was found after surgery, it persisted above the preoperative level for an average of 9.3 months. At 1 month postoperative, patients scoring 0 to 8 on the total revised Tokuhashi score had significantly lower ECOG-PS improvement (26 of 55 patients) when compared to patients with higher scores (18 of 27 patients, P < 0.05). In 44 patients with ECOG-PS improvement, the existence of major internal organ metastases significantly shortened the duration of improvement (P < 0.05).


CONCLUSIONS
Palliative surgery benefited half of the patients with metastatic spinal tumor, with a greater probability of benefit found in persons with a higher total revised Tokuhashi score (score 9-15) and/or primary cancers with longer survival times.
Yamashita
Takayuki
T
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan. takaccf@aol.com
Aota
Yoichi
Y
Kushida
Kazuyoshi
K
Murayama
Hitoshi
H
Hiruma
Toru
T
Takeyama
Masanobu
M
Iwamura
Yuichi
Y
Saito
Tomoyuki
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000503:physiopathology / Q000601:surgery*; D010166:Palliative Care / Q000639:trends*; D011237:Predictive Value of Tests; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013125:Spinal Neoplasms / Q000503:physiopathology / Q000556:secondary* / Q000601:surgery*