AN APRAISAL OF THE TOKUHASHI SCORING SYSTEM IN MALIGNANT SPINAL CORD COMPRESSION

Abstract

The frequency with which spinal metastasis present to spinal surgeons is increasing. A logical approach needs to be taken both in justifying surgery for the individual, and in deciding on which operation to be carried out. The vertebral body typically is affected first in malignant disease, although the initial radiographic finding often will be the destruction of the pedicle. This is because 30-50% of the vertebral body must be destroyed before any changes can be recognized radiologically. In contrast minimal lysis of pedicular bone can be appreciated because the cortex of the pedicle tends to be involved early. It has been
demonstrated that more than 70% of patients (Harrington)3 who die from cancer have evidence of  vertebral metastases that are visible on careful postmortem examination.