Tokuhashi prognosis score: an important tool in prediction of the neurological outcome in metastatic spinal cord compression: a retrospective clinical study.
METHODS
Retrospective clinical study.


OBJECTIVE
The aim of this study was to examine whether the Tokuhashi score correlates with the neurologic outcome in early surgical treatment in metastatic spinal cord compression (MSCC). A retrospective analysis of 35 consecutive incomplete tetraplegic and paraplegic patients with vertebral metastases (VM) and spinal cord compression (SCC) was performed.


BACKGROUND
MSCC is a challenging problem in VM and constitutes an oncologic emergency. The Tokuhashi score has been modified recently and seems to constitute the best method of prediction for real survival in patients with VM. Until now the influence of the neurologic status as a prognostic factor has been discussed controversially.


METHODS
Data of 35 patients with VM and incomplete tetraplegia or paraplegia, who underwent surgical treatment, were reviewed retrospectively from 2005 to 2006 at our hospital. All patients were classified among the American Spinal Injury Association (ASIA) Impairment Scale (AIS) before and after surgery and at the follow-up. Data were analyzed with SPSS 15.0 and correlation coefficients (Spearman rho) were computed.


RESULTS
Analysis showed that 19 patients (54.3%) with an average Tokuhashi score of 9 showed an improvement in the AIS, whereas 12 (34.3%) patients with an average score of 8 had no change and 4 (11.4%) patients with a score of 7 had deterioration. AIS changes showed a positive correlation with Tokuhashi score (r = 0.33; P = 0.048).


CONCLUSIONS
Our clinical observation suggests that patients with spinal metastases and a high Tokuhashi score benefit from surgical treatment with moderate improvement in sensomotoric function even in a heterogenic collective.
Putz
Cornelia
C
Spinal Cord Injury Center, Orthopaedic University Hospital Heidelberg, Heidelberg, Germany. cornelia.putz@ok.uni-heidelberg.de
Wiedenhöfer
Bernd
B
Gerner
Hans Jürgen
HJ
Fürstenberg
Carl Hans
CH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D051341:Dependent Ambulation; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D019637:Orthopedic Procedures; D010264:Paraplegia / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests; D011782:Quadriplegia / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D013125:Spinal Neoplasms / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000556:secondary / Q000601:surgery; D016896:Treatment Outcome; D016138:Walking; D055815:Young Adult