METASTATIC SPINAL TUMOURS WITH OR WITHOUT SPINAL CORD COMPRESSION: IMPORTANCE OF EARLY PRESENTATION AND ROLE OF MODIFIED TOKUHASHI SCORE (MTS) IN DECISION MAKING FOR SURGICAL INTERVENTION

Abstract

Background: Recent evidence suggests that surgical intervention with radiotherapy is superior to radiotherapy alone. Predicting the life expectancy is critical in decision making whether to go for palliative or definitive surgery.

Aim: To assess the accuracy of Modified Tokuhashi’s score (MTS) in predicting survival in patients with metastatic spinal tumours and cord compression; and to assess the incidence and role of early referral and diagnosis.

Material and Methods: In this retrospective study, we collected two years’ data. Medical record was reviewed for the source of referral, delay in symptom onset to diagnosis and treatment, types of tumours, Karnofsky score to assess patients’ disability, Modified Tokuhashi score to assess the expected survival and final outcome.

Results: 37 patients were included. Age ranged from 39 to 87 years(avg:64, median:66).30%(n=11) patients presented with cord compression and 70%(n=26) with instability pain. Cancer diagnosis had already been established in 57% cases off which 57% were referred from oncology and 43% from haematology. Remaining 43% patients were referred from GPs(68%) and medical specialties in the hospital(32%).51% patients presented early(< 3 months) and 22% presented late(> 6 months). Functional outcome improved in 58% patient following surgical intervention in early referral group(avg MTS:9.45) and improved in 61.5% patients in late referral group(avg MTS:9.5).

In patients with cord compression, average MTS was 6.6. Expected survival was < 3 months in 45.4% and 3–12 months in the remaining patients. 81%(n=9) patients of this group had surgical intervention resulting in satisfactory functional outcome in 36%. 3 patients had surgery done within 24 hours and another 4 within 72 hours(median:58).

In patients without cord compression, average MTS was 10.1. Expected survival was > 12 months in 84%. Surgical intervention was done in 84.6%(n=22) patients. 43% patients had posterior decompression and stabilisation with average MTS of 8.5 and satisfactory outcome in 56% patients. 13.5% patients had 2-stage anterior and posterior stabilisation with average MTS of 11.2 and satisfactory outcome in 100%. Average time from referral to definitive treatment was 17 days(mean:8, mode:8). Overall functional outcome was satisfactory in 84% patients.

30% patients died subsequently due to deterioration of their tumour-related problems with mainly Lung CA(36%) and Lymphoma(36%). Average MTS in these patients was 6.8. 5 patients died within 3 months of surgery.

Conclusion: Modified Tokuhashi score was consistent with patients’ expected survival and functional outcome. There was no major difference in functional outcome in relation to early or late referral. We conclude that Modified Tokuhashi score is helpful to make a decision for intervening surgically.