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Predictive Scores Underestimate Survival of Patients with Metastatic Spine Disease: A Retrospective Study of 315 Patients in Sweden.

Journal article
Authors Christian Carrwik
Claes Olerud
Yohan Robinson
Published in Spine
ISSN 1528-1159
Publication year 2019
Published at Institute of Clinical Sciences, Department of Orthopaedics
Language en
Subject categories Orthopedics, Cancer and Oncology, Orthopaedics, Neurosurgery


STUDY DESIGN: Retrospective cohort study OBJECTIVE: To validate the precision of four predictive scoring systems for spinal metastatic disease and evaluate whether they underestimate or overestimate survival. SUMMARY OF BACKGROUND DATA: Metastatic spine disease is a common complication to malignancies. Several scoring systems are available to predict survival and helping the clinician to select surgical or non-surgical treatment. METHODS: 315 adult patients (213 men, 102 women, mean age 67 years) undergoing spinal surgery at Uppsala University Hospital, Sweden, due to metastatic spine disease 2006-2012 were included. Data was collected prospectively for the Swedish Spine Register and retrospectively from the medical records. Tokuhashi scores, Revised Tokuhashi Scores, Tomita scores and modified Bauer scores were calculated and compared with actual survival data from the Swedish Population Register. RESULTS: The mean estimated survival time after surgery for all patients included was 12.4 months (CI 10.6-14.2) and median 5.9 months (CI 4.5-7.3). All four scores had significant correlation to survival (p < 0.0001) but tended to underestimate rather than overestimate survival. Modified Bauer score was the best of the four scores to predict short survival, both regarding median and mean survival. Tokuhashi score was found to be the best of the scores to predict long survival, even though the predictions were inaccurate in 42% of the cases. CONCLUSION: Predictive scores underestimate survival for the patients which might affect important clinical decisions.

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