Page 640 - Read Online

Page 4 of 12 Adler et al. J Cancer Metastasis Treat 2019;5:45 I http://dx.doi.org/10.20517/2394-4722.2019.03

Table 3. Spinal Instability Neoplastic Score for the determination of vertebral body stability from 2010 [23]
SINS parameter Description Score
Location Junctional (C0-2, C7-T2, T11-L1, L5-S1) 3
Mobile spine (C3-6, L2-4) 2
Semirigid segments (T3-10) 1
Rigid segments (S2-5) 0
Mechanical pain Yes 3
Sometimes 1
No 0
Bone lesion Lytic 2
Lytic/blastic (mixed) 1
Blastic 0
Spinal alignment Subluxation/translation present 4
De-novo-deformity (Kyphosis/Scoliosis) 2
Normal alignment 0
Vertebral body collapse ˃ 50% collapse 3
˂ 50% collapse 2
No collapse with ˃ 50% body involved 1
None of the above 0
Posterolateral involvement Bilateral 3
Unilateral 1
None of the above 0

Table 4. Interpretation of Spinal Instability Neoplastic Score [23]
Score Stability
0-6 Stable
7-12 Potentially unstable
13-18 Unstable

Table 5. Revised Tokuhashi-Score parameter [48]
Score 0 1 2 3 4 5
Karnofsky-score (%) 10-40 50-70 80-100
Extraspinal bone metastases 3 or more 1-2 0
Spinal metastases 3 or more 2 1
Frankel Frankel A/B Frankel C/D Frankel E
Visceral metastases Unremovable Removable None
Primary site of cancer Lung Liver, Gall Bladder Others Kidney Rectum Breast
Stomach Unidentified Uterus Thyroid
Bladder Prostata Carzinoid
Esophagus Pancreas
Osteosarcoma

Table 6. Iterpretation of the revised Tokuhashi-Score [48]
Score Prognosis of survival Recommendation
0-8 85% of patients survive up to 6 months Conservative therapy or palliative surgery
9-11 73% of patients survive ˃ 6 months; 30% ˃ 12 Monate Palliative surgery or in exceptions tumor excision
12-15 95% of patients survive ˃ 12 Monate Tumor excision

[18]
[19]
these patients have to be filtered out. According to Tomita et al and Tokuhashi et al anterior spine
surgery is indicated with a life expectancy of 12 months or more. If the patient is in good general condition
and asks for surgery, we therefore recommend anterior-posterior techniques after critical evaluation.
[18]
[45]
Furthermore, in 2012 Majeed evaluated 55 patients according to the revised Tokuhashi and Tomita
[45]
[19]
score and reported continuously longer survival times than initially estimated. Majeed concluded, that
prognosis of survival times is not reliable with the current scoring systems.