Study design: We conducted a prospective cohort study of 448 patients with a variety of spinal metastases. To compare the predictive value of the Tokuhashi scoring system (T12) and its revised edition (T15) for life expectancy both in the entire study group as well as in the various primary tumor subgroups. In 1990 Tokuhashi and coworkers formulated a one point-addition-type prognostic scoring system with a total sum of 12 points for preoperative prediction of life expectancy as an adjunct in selecting appropriate treatment. Because the site of the primary tumor influences ultimate survival, the scoring system was revised in 2005 to a total sum of 15 points based on the origin of the primary tumor.Objective
Summary of background data
The purpose of our study is to analyze retrospectively our patients, who had received conservative treatment or either posterior or combined approach.
The diagnosed was based on clinical examination, cultures, bone histology, X-rays, bone scan and MRI with gadolinium. The location of the infection was in 13 (8%) patients the cervical spine, in 62 (38%) the thorachic, in 10 (6%) the thoracolumbar junction and in 78 (48%) the lumbo-sacral spine. In 95 cases, concomitant diseases were present. In 67 (41%) patients was not able to detect any microorganism. From the remaining patients, 53 (33%) were infected by staph.aureus and 22 (13%) by mycob tuberculosis. The patients according to the treatment provided, were divided in three groups:
Group A: 70 patients, which had conservative treatment with antibiotics and bracing. Group B: 56 patients, which, sustained posterior decompression alone Group C: 37 patients, which had anterior debridemant and posterior decompression and stabilizations or anterior stabilization.
The group A patients had not neurological symptoms. In group B, 11 had altered neurology and the operation was beneficial for 5 of them (45.5%), 4 remained unchanged and in 2 was deteriorate. In group C, 11 patients had altered neurology, from which 9 (81.8%) were improved and 2 remained unchanged. The in-hospital complications were: 2 pulmonary embolism, 2 post operative haematomas, 1 persistent anaimia, 1 diafragm paralysis, 2 atelectasia and 1 cerebral thrombosis. In addition 3 patients had residual psoas abscess, 2 pancreas abscess, 1 cerebelum abscess and 3 lung infection. The in-hospital mortality was 3 patients, other 17 patients died during the follow up
The conservative management in selected patients is effective up to 89%. From the operations performed the decompression alone had unacceptable high re-operation rate and also, it wasn’t so beneficial regarding the neurological improvement. If it is combined with anterior reconstruction and posterior stabilization provides better results.
