Tumors of the spine

Table 1 Surgical strategy for spinal metastases

Point	Scoring system			Prognostic score	Treatment goal	Surgical strategy
	Prognostic factors
	Primary tumor	Visceral metastases	Bone metastases1
1	Slow growth (breast, thyroid, etc.)		Solitary or isolated	2	Long-term local control	Wide or marginal excision
				3
2	Moderate growth (kidney, uterus, etc.)	Treatable	Multiple	4	Middle-term local control	Marginal or intralesonal excision
				5
4	Rapid growth (lung, stomach, etc.)	Untreatable		6	Short-term palliation	Palliative surgery
				7
				8	Terminal care	Supportive care
				9
				10

No visceral metastases = 0 points;

¹Bone metastases: Including spinal metastases.

Table 2 Tokuhashi classification[14]

Characteristic	Score
General condition (performance status)
Poor (10%-40%)	0
Moderate (50%-70%)	1
Good (80%-100%)	2
No. of extraspinal bone metastasis foci
≥ 3	0
1-2	1
0	2
No. of extraspinal metastasis foci in the vertebral body
≥ 3	0
1-2	1
0	2
Metastases to the major internal organs
Unremovable	0
Removable	1
No metastases	2
Primary site of the cancer
Lung, osteosarcoma, stomach, bladder, esophagus, pancreas	0
Liver, gallbladder, unidentified	1
Others	2
Kidney, uterus	3
Rectum	4
Thyroid, breast, prostate, carcinoid tumor	5
Palsy
Complete (Frankel A, B)	0
Incomplete (Frankel C, D)	1
None (Frankel E)	2

Criteria of predicted prognosis: Total score (TS) 0-8: < 6 mo; TS 9-11: ≥ 6 mo; TS 12-15: ≥ 1 year.