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Changes in Physical Function After Palliative Surgery for Metastatic Spinal Tumor: Association of the Revised Tokuhashi Score With Neurologic Recovery

Yamashita, Takayuki MD*; Aota, Yoichi MD*; Kushida, Kazuyoshi MD; Murayama, Hitoshi MD; Hiruma, Toru MD; Takeyama, Masanobu MD; Iwamura, Yuichi MD; Saito, Tomoyuki MD*

doi: 10.1097/BRS.0b013e3181878733
Health Services Research

Study Design. 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.

Summary of Background Data. 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).

Conclusion. 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.

The Eastern Cooperative Oncology Group Performance Status grade improved in approximately half of patients with metastatic spinal tumor at 1 month after palliative surgery. Short-term functional improvement was related to the revised Tokuhashi score and primary cancer type. The existence of major internal organ metastases significantly shortened the duration of functional improvement.

From the *Department of Orthopaedic Surgery, Yokohama City University; †Department of Bone and Soft Tissue Tumor Surgery, Kanagawa Cancer Center Hospital; and ‡Department of Orthopaedic Surgery, Yokohama Ekisaikai Hospital, Yokohama, Japan.

Acknowledgment date: April 30, 2007. First revision date: March 6, 2008. Acceptance date: May 8, 2008.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any forms have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Takayuki Yamashita, MD, Department of Orthopaedic Surgery, Yokohama City University, 3–9 Fukuura, Kanazawa-ku, Yokohama, Japan 236-0004; E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.