BACKGROUND: We sought to identify preoperative factors significantly correlated 
with survival. We also aimed to evaluate the validity of the prognostic scores 
in the Tomita and Tokuhashi systems and discuss several aspects to improve the 
predictive accuracy of these systems. Moreover, we suggest modified criteria for 
selecting treatment strategies.
METHODS: In total, the outcomes of 112 patients with spinal metastasis who 
underwent surgery between January 2006 and June 2011 were retrospectively 
reviewed. The validity of the prognostic scores was assessed on the basis of 
their correlation with survival. For various primary malignancies, new scoring 
criteria were applied in each system according to the survival results obtained 
in this study. Each revised scoring system was adjusted with a similar principle 
of scoring as described previously. Patient survival according to each 
preoperative factor was analyzed by the Kaplan-Meier method. The predictive 
value of each scoring system was evaluated by the log-rank test and Cox 
regression analysis.
RESULTS: The interval from the diagnosis of the primary malignancy to that of 
spinal metastasis (p = 0.023) and the interval from the diagnosis of spinal 
metastasis to surgery (p = 0.039) were significantly correlated with survival. 
Regarding Tokuhashi scores, the correlation coefficient was 0.790 before 
adjustment (p = 0.001) and 0.853 after adjustment (p < 0.001). For Tomita 
scores, the correlation coefficient was -0.994 (p < 0.001) both before and after 
adjustment.
CONCLUSIONS: Tomita scores more accurately predicted survival than Tokuhashi 
scores. It is helpful to evaluate both scoring systems with adjustment for 
primary malignancy depending on the clinical setting. Patients with Tomita 
scores less than or equal to 8 and Tokuhashi scores greater than or equal to 6 
are recommended to undergo surgical management.