Revised Tokuhashi Score

Predicts survival in patients with metastatic spinal disease.

Refer to the text below the score for more information on the score and its survival predictors.


The revised Tokuhashi score is a prognostic scoring system applicable to patients with metastatic spine tumors. This decision aid facilitates therapy selection, operative indications and avoidance of excessive medical treatment.

Spinal metastases are the most frequent type of bone metastases, often leading to significant morbidity. This condition generally affects older cancer patients, manifesting as axial night pain and/or neurological deficits.


The scores result from the addition of the points from the 6 items and range from 0 to 15, where the higher the score, the greater the mean survival in months.

Revised Tokuhashi Score Mean Survival
0 - 8 <6 months
9 - 11 ≥6 months
12 - 15 ≥12 months

1

General condition

2

Number of extraspinal bone metastases foci

3

Number of metastases in the vertebral body

4

Metastases to the major internal organs

5

Primary site of the cancer

6

Spinal cord palsy (Frankel Grade)

Grade A: Complete motor and sensory involvement
Grade B: Complete motor involvement, some sensory sparing including sacral sparing
Grade C: Functionally useless motor sparing
Grade D: Functional motor sparing
Grade E: No neurologic involvement.
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The Scoring System Explained

The revised Tokuhashi score is a prognostic scoring system applicable to patients with metastatic spine tumors.

Metastatic cancer is the most common cause of destructive bone lesions in adults, with bone being the 3rd most common site for metastatic disease, often occurring in older patients. Thoracic spine is the most common site of bone metastasis.

The diagnosis is usually confirmed through MRI with contrast, which can reveal a soft tissue mass along with potential spinal cord compression or vertebral fractures.

This decision aid facilitates therapy selection, operative indications and avoidance of excessive medical treatment and is based on 6 predictors:

Revised Tokuhashi Score Points
General condition
by Karnofsky Performance Status
Good (KPS 80%-100%) 2
Moderate (KPS 50%-70%) 1
Poor (KPS 10%-40%) 0
Number of extraspinal bone metastases foci None 2
One or two 1
Three or more 0
Number of metastases in the vertebral body One 2
Two 1
Three or more 0
Metastases to the major internal organs No metastases 2
Removable 1
Unremovable 0
Primary site of the cancer Thyroid, prostate, breast, carcinoid tumor 5
Rectum 4
Kidney, uterus 3
Others 2
Liver, gallbladder, unidentified 1
Lung, osteosarcoma, stomach, bladder, esophagus, pancreas 0
Spinal cord palsy (Frankel Grade)
Grade A: Complete motor and sensory involvement
Grade B: Complete motor involvement, some sensory sparing including sacral sparing
Grade C: Functionally useless motor sparing
Grade D: Functional motor sparing
Grade E: No neurologic involvement
None (Frankel E) 2
Incomplete (Frankel C, D) 1
Complete (Frankel A, B) 0

Another spinal metastasis prognostic score is the New England Spinal Metastatic Score (NESMS).

 

Result Interpretation

The score results from the addition of the points from the 6 items and range from 0 to 15, where the higher the score, the greater the mean survival in months.

Revised Tokuhashi Score Mean Survival
0 - 8 <6 months
9 - 11 ≥6 months
12 - 15 ≥12 months

Factors that influence prognosis in spinal metastasis include histology and prior treatment, functional status, patient age and extent of the metastatic disease.

 

References

Original reference

Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976). 2005; 30(19):2186-91.

Validation

Quraishi NA, Manoharan SR, Arealis G, Khurana A, Elsayed S, Edwards KL, Boszczyk BM. Accuracy of the revised Tokuhashi score in predicting survival in patients with metastatic spinal cord compression (MSCC). Eur Spine J. 2013; 22 Suppl 1(Suppl 1):S21-6.

Mezei T, Horváth A, Pollner P, Czigléczki G, Banczerowski P. Research on the predicting power of the revised Tokuhashi system: how much time can surgery give to patients with short life expectancy? Int J Clin Oncol. 2020; 25(4):755-764.

Other references

Tokuhashi Y, Uei H, Oshima M, Ajiro Y. Scoring system for prediction of metastatic spine tumor prognosis. World J Orthop. 2014; 5(3):262-71.


Specialty: Oncology

Objective: Prognostic

Type: Score

No. Of Items: 6

Year Of Study: 2005

Article By: Denise Nedea

Published On: May 20, 2024

Last Checked: May 20, 2024

Next Review: May 20, 2029