OBJECTIVE: To evaluate the predictive value of the Tokuhashi revised scoring 
system for the life expectancy of patients with spinal metastases.
METHODS: A retrospective review of 447 patients with spinal metastases was 
performed, which comprised 291 men and 156 women with a mean age of 56. 1 years. 
All of the patients were scored with the Tokuhashi revised scoring system based 
on the available clinical, pathological and radiographic data. The relation 
between the survival time and the Tokuhashi revised score was analyzed.
RESULTS: The patients had a median survival time of 7. 9 months and a mean 
Tokuhashi revised score of 8. 23 points. The median survival time of 155 
patients with high grade primary tumor of lung, liver, gastrointestinal tract, 
esophagus, bladder and pancreas was 4. 7 months. The median survival time of 146 
patients with low grade primary tumor of thyroid, breast and prostate was 12 
months. The median survival time of 146 patients with medium grade primary tumor 
of kidney, lymphoma, ovary and uterus, and unknown primary tumor was 7. 1 
months. The median survival time of 211 patients with the Tokuhashi revised 
score of 0 to 8 points was 4 months. The median survival time of 147 patients 
with the Tokuhashi revised score of 9 to 11 points was 10 months. The median 
survival time of 89 patients with the Tokuhashi revised score of 12 to 15 points 
was 29 months. The differences between the groups were significant (P<0. 01 or 
0. 0001). The Tokuhashi revised score was positively correlated with survival 
time (r=0. 833, P<0. 001).
CONCLUSION: The Tokuhashi revised score could support decision making with 
reliable estimation of life expectancy of patients with spinal metastases. 
Surgery could be a better choice to extend life span for those patients with 
solitary spinal metastasis of slow-growth primary tumor and those with the 
Tokuhashi revised score of 12 to 15 points.