BACKGROUND: The spinal metastasis occurs in up to 40% of cancer patient. We 
compared the Tokuhashi and Tomita scoring systems, two commonly used scoring 
systems for prognosis in spinal metastases. We also assessed the different 
variables separately with respect to their value in predicting postsurgical life 
expectancy. Finally, we suggest criteria for selecting patients for surgery 
based on the postoperative survival pattern.
MATERIALS AND METHODS: We retrospectively analyzed 102 patients who had been 
operated for metastatic disease of the spine. Predictive scoring was done 
according to the scoring systems proposed by Tokuhashi and Tomita. Overall 
survival was assessed using Kaplan-Meier survival analysis. Using the log rank 
test and Cox regression model we assessed the value of the individual components 
of each scoring system for predicting survival in these patients.
RESULT: The factors that were most significantly associated with survival were 
the general condition score (Karnofsky Performance Scale) (P=.000, log rank 
test), metastasis to internal organs (P=.0002 log rank test), and number of 
extraspinal bone metastases (P=.0058). Type of primary tumor was not found to be 
significantly associated with survival according to the revised Tokuhashi 
scoring system (P=.9131, log rank test). Stepwise logistic regression revealed 
that the Tomita score correlated more closely with survival than the Tokuhashi 
score.
CONCLUSION: The patient's performance status, extent of visceral metastasis, and 
extent of bone metastases are significant predictors of survival in patients 
with metastatic disease. Both revised Tokuhashi and Tomita scores were 
significantly correlated with survival. A revised Tokuhashi score of 7 or more 
and a Tomita score of 6 or less indicated >50% chance of surviving 6 months 
postoperatively. We recommend that the Tomita score be used for prognostication 
in patients who are contemplating surgery, as it is simpler to score and has a 
higher strength of correlation with survival than the Tokuhashi score.