BACKGROUND CONTEXT: The incidence of metastatic spinal cord compression (MSCC) 
is increasing, paralleling increasing life expectancy of patients. However, 
management of MSCC and relevance of scoring systems remain controversial.
PURPOSE: The aims of our study were to analyze the feasibility and outcomes of 
spinal surgery, to identify prognostic factors for survival, and to assess the 
accuracy of scoring systems in patients with malignancies associated with MSCC.
STUDY DESIGN: Retrospective analysis of all patients with MSCC operated in our 
institution.
METHODS: Outcomes of surgery, prognostic factors for survival, and relevance of 
Tomita and Tokuhashi scores were investigated.
RESULTS: One hundred forty-eight patients were included: 66% were hyperalgic 
(pain score >6) and Frankel score (FS) was decreased in 49%. Seventy-three 
percent of patients had laminectomy with spinal fixation. After surgery, pain 
decreased in 75% of cases, FS was improved in 31%, and 92% of patients were 
ambulatory. Postoperative complication rate was 16%. Median overall survival 
(OS) was 8.9 months (95% confidence interval, 4.4-13). Only Tokuhashi score was 
relevant, but predictive accuracy of survival was just 51%. In univariate 
analyses, hyperalgia (p=.001), primary tumor site, extrabone metastases 
(p<.001), Karnofsky performance status (KPS) less than 70 (p<.001), poor 
American Society of Anesthesiologist (ASA) score (p<.001) or FS (p=.01), and 
absence of postoperative chemotherapy (p<.001) were associated with shorter OS. 
In multivariate analysis, only extrabone metastases (p=.004), KPS (p=.001), and 
ASA score (p=.007) remained significantly associated with OS.
CONCLUSIONS: Surgery for MSCC is associated with limited morbidity, improved 
autonomy, and pain relief. Usual scores do not seem relevant, whereas ASA score, 
KPS, and extrabone metastases are significantly associated with OS.