Predicting prognosis is the key factor in selecting the proper treatment 
modality for patients with spinal metastases. Therefore, various assessment 
systems have been designed in order to provide a basis for deciding the course 
of treatment. Such systems have been proposed by Tokuhashi, Sioutos, Tomita, Van 
der Linden, and Bauer. The scores differ greatly in the kind of parameters 
assessed. The aim of this study was to evaluate the prognostic value of each 
score. Eight parameters were assessed for 69 patients (37 male, 32 female): 
location, general condition, number of extraspinal bone metastases, number of 
spinal metastases, visceral metastases, primary tumour, severity of spinal cord 
palsy, and pathological fracture. Scores according to Tokuhashi (original and 
revised), Sioutos, Tomita, Van der Linden, and Bauer were assessed as well as a 
modified Bauer score without scoring for pathologic fracture. Nineteen patients 
were still alive as of September 2006 with a minimum follow-up of 12 months. All 
other patients died after a mean period of 17 months after operation. The mean 
overall survival period was only 3 months for lung cancer, followed by prostate 
(7 months), kidney (23 months), breast (35 months), and multiple myeloma (51 
months). At univariate survival analysis, primary tumour and visceral metastases 
were significant parameters, while Karnofsky score was only significant in the 
group including myeloma patients. In multivariate analysis of all seven 
parameters assessed, primary tumour and visceral metastases were the only 
significant parameters. Of all seven scoring systems, the original Bauer score 
and a Bauer score without scoring for pathologic fracture had the best 
association with survival (P < 0.001). The data of the present study emphasize 
that the original Bauer score and a modified Bauer score without scoring for 
pathologic fracture seem to be practicable and highly predictive preoperative 
scoring systems for patients with spinal metastases. However, decision for or 
against surgery should never be based alone on a prognostic score but should 
take symptoms like pain or neurological compromise into account.