BACKGROUND & OBJECTIVE: Clinically, whether and how to make a surgical 
interventional decision for the patients with spinal metastases is still 
controversial. Life expectancy is a significant determinant in the selection of 
surgical procedure for spinal metastases. This study was to evaluate Tomita and 
Tokuhashi scoring systems in selecting surgical procedure and predicting 
prognosis of extradural spinal metastases.
METHODS: A total of 169 patients with spinal metastases, treated in the Spine 
Unit of Aarhus University Hospital, Denmark, from Jan. 2001 to Apr. 2004, were 
enrolled. The life expectancy was scored according to both Tomita system and 
Tokuhashi system before operation, the spinal metastases were classified 
according to Tomita system, and the patients underwent surgery accordingly. 
Follow-up was done 6, 12, and 24 months after operation. The precise of Tomita 
system and Tokuhashi system in estimating "death within 3 months", "death within 
6 months", and "death within 12 months" was compared using Receiver Operating 
Characteristic curves (ROC curves). The mean survival time of the patients was 
calculated by Kaplan-Meier method.
RESULTS: ROC curves of "death within 3 months", "death within 6 months", and 
"death within 12 months" showed no significant difference between Tomita score 
and Tokuhashi score in each group (P = 0.16, P = 0.47, and P = 0.38, 
respectively). Kaplan-Meier survival curves showed that Tomita system 
overestimated the prognosis in scores from 4 to 7, and Tokuhashi system 
underestimated the prognosis in scores from 0 to 8.
CONCLUSIONS: Both Tomita and Tokuhashi scoring systems could be used to predict 
prognosis of spinal metastases after operation. Tokuhashi scoring system can 
predict early death more accurately, which can be used to avoid major operation 
for these patients.