gms | German Medical Science

Objective: Due to their prognosis spinal metastases from different primary tumors are usually treated in different ways. Surgery is indicated in most cases of neurologic deficit or risk of acute fracture. At our department the decision for surgery is frequently bound to an interdisciplinary consultation. Different scores are available to facilitate the decision about surgery or conservative treatment, for example the original or revised Tokuhashi score. We checked both scores on an independently treated (surgery) group with spinal metastases.

Method: Patients with spinal metastases were collected from our clinical database. Integrity of the data was controlled with regard to the Tokuhashi scores. Survival curves were calculated.

Results: Between 2007 and 2012 out of 89 patients 65 matched the inclusion criteria, including 18 women and 47 men. 55% were posteriorly instrumented over a mean of 2 levels and 82% decompressed. A combination of a dorsal and ventral stabilization was used in 6%. Bone cement was used in 14% (additionally or alone). Mean Karnofsky was 77%, 9% improved after surgery in the ASIA Impairment Scale, 2 % worsened due to bleeding. A Tokuhashi-Score of 0-5 (old) (0-8 new) („conservative“) had 23% (45%), from 6-8 (9-11) („palliative“) 42% (33%) and from 9-12 (12-15) („surgery“) 35% (22%) of all patients. Mean survival in the Tokuhashi surgery group was 19 months (13) [still living (29.11.2012): 6 (3)], in the palliative group 14 months (13) [still living: 5 (4)] and in the conservative group 7 months (14), [still living: 1 (5)]

Conclusions: We need decision-making support in the treatment of spinal metastases, for example the Tokuhashi scores. The remaining lifetime in tumor diseases is often unpredictable. Patients within this study showed survival superior to the prediction of Tokuhashi. The presented results support a more aggressive surgical approach also in patients within the Tokuhashi ‘conservative group'. There is no exact border to the surgical groups ('palliative, surgery'). In this ongoing process we need to reevaluate our decisions and in doubt even reassess patients scheduled for conservative treatment in an evolving tumor therapy.