The Tokuhashi score: effectiveness and pitfalls

Purpose

Accurate survival estimation is prerequisite to determine the most appropriate treatment for patients with metastatic spine disease. Several authors have proposed classification systems analyzing clinical and radiological parameters, such as, performance status, metastasis localization, and primary tumor histotype, but the modified Tokuhashi score (mTS) is the most widely used. Although it is regarded as one of the most complete and accurate systems, it does not take the effectiveness of new therapeutic strategies into consideration, contributing to a progressive loss of accuracy. The purpose of this review is to verify the ability of the mTS to accurately estimate metastatic spine patient survival, nearly 10 years after it was introduced.

Methods

A literature review was conducted to evaluate mTS accuracy to predict metastatic spine patient survival.

Results

Ten studies were selected, representing 1686 patients. The total predictive accuracy of the mTS was 63.00 %; for patients expected to survive less than 6 months (group I), it was 64.10 %; 6–12 months (group II), 55.32 %; and more than 12 months (group III), 77.21 %. A progressive decrease in accuracy over time was statistically significant in groups I and II.

Conclusions

The mTS is suggestive of actual survival for patients with a good prognosis. It is less accurate for patients with an estimated survival of less than 12 months. The decreasing trend in mTS accuracy over time will likely further reduce mTS utility. An important opportunity exists to develop new instruments to assist spine surgeons and oncologists to choose appropriate surgical or non-surgical treatment modalities for patients with metastatic spine disease.

     

Buschke-Ollendorff syndrome

Buschke-Ollendorff syndrome (BOS) is an autosomal dominant disorder characterized by elastin-rich hamartomas and osteopoikilosis. CASE REPORT: In a 21-year-old woman, osteopoikilosis led to the diagnosis of BOS. She had multiple, grouped, buff-colored papules over the thighs and trunk. There was no pain or pruritus associated with the skin lesions. Examination of a biopsy specimen from a papule showed thick uniform collagen fibers and normal numbers of broad interlacing elastic fibers. DISCUSSION: BOS is a rare disease that affects 1/20,000 population. The diagnosis rests on a thorough physical examination and careful examination of radiographs. BOS must be distinguished from other bone abnormalities such as sclerotic bone metastases, particularly when osteopoikilosis is the inaugural manifestation.     

Surgical approaches to thoracic ossification of the posterior longitudinal ligament

Thoracic ossification of the posterior longitudinal ligament is a rare but debilitating condition. It is most commonly diagnosed in the Japanese population. If left untreated, significant myelopathy and weakness can ensue. Anterior decompression and stabilization is effective but technically demanding and is associated with high rate of complications. Posterior laminectomy appears to be an acceptable approach with lower risks. This work reviews the published literature on this topic and highlights the salient points.     

Atlantoaxial stabilization utilizing atlas translaminar fixation

Atlantoaxial instability is a potentially devastating sequela of tumor invasion to the upper cervical spine. We aim to report an alternative technique for atlantoaxial stabilization. Stabilization is technically demanding due to limited bony elements and proximity of the regional neurovascular structures. While the C1 lateral masses are considered robust points of fixation, one or both of these structures may be destroyed by pathology. A 54-year-old female presented with a lytic, metastatic lesion to one of the C1 lateral masses, which precluded its use for fixation. We utilized the contralateral hemilamina of the atlas for screw fixation and devised a stable construct that provided immediate stability. Thus, atlas translaminar fixation is a feasible option when the lateral masses cannot be utilized.