title: Accuracy of prognostic scores in decision making and predicting outcomes in metastatic spine disease.
abstract: BACKGROUND
  Management of metastatic spinal disease has changed significantly over the last few years. Different prognostic scores are used in clinical practice for predicting survival. The aim of this study was to assess the accuracy of prognostic scores and the role of delayed presentation  in predicting the outcome in patients with metastatic spine disease.
  
  
  METHODS
  Retrospectively, four years of data were collected (2007-2010). Medical records review included type of tumour, duration of symptoms, expected survival and functional status. The Karnofsky performance score  was used for functional assessment. Modified Tokuhashi and Tomita scores were used for survival prediction.
  
  
  RESULTS
  A total of 55 patients who underwent surgical stabilisation were reviewed. The mean age was 63 years (range: 32-87 years). The main primary sources of tumours included  myeloma, breast cancer, lymphoma, lung cancer, renal cell cancer and prostate cancer. Of the cases studied, 29 patients had posterior instrumented stabilisation alone, 10 patients had an anterior procedure alone and 16 patients (with an expected survival of more than one year) had both anterior  and posterior procedures performed. Twenty-three patients presented with spinal cord compression. The mean follow-up duration was 9 months (range: 1-39 months). Patients who were treated within one week of referral survived longer than anticipated. Patients were divided into three groups  based on their expected survival. Actual survival was better in all three groups after surgery. Discrepancies in scores were prominent in patients with myeloma, breast and prostate cancers. Functional outcome was better in patients under 65 years of age.
  
  
  CONCLUSIONS
  The prognostic scoring  systems are not uniformly effective in all types of primary tumours. However, they are useful in decision making for surgical intervention, taking other factors into account, in particular the age of the patient, the type and stage of the primary tumour and general health.
authors.affiliation: Royal Derby Hospital, UK. haroonmajeed@gmail.com
authors.forename: H
authors.initials: H
authors.lastname: Majeed
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.forename: R
authors.initials: R
authors.lastname: Bommireddy
authors.forename: Z
authors.initials: Z
authors.lastname: Klezl
authors.forename: D
authors.initials: D
authors.lastname: Calthorpe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D019299:Decompression, Surgical / Q000379:methods* / Q000401:mortality; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status / Q000592:standards; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013117:Spinal Cord Compression / Q000209:etiology; D013125:Spinal Neoplasms / Q000503:physiopathology / Q000556:secondary* / Q000601:surgery