Abstract
Following the diagnosis of spinal metastatic disease, patients, their families, and clinicians must formulate a treatment plan, make decisions regarding surgery, and coordinate expeditious care delivery. In many situations, the anticipated clinical course and recommendations regarding treatment are supported by prognostic utilities such as the Tokuhashi, Tomita, or modified Bauer score. These tools are not always appropriate for specific populations, however, and many of the scoring systems available have not been independently validated. At this time, there are several prognostic utilities and scoring systems intended to facilitate prognosis and decision-making regarding care. Beyond providing a structured rubric around which to discuss important factors to consider when determining treatment, the different scoring algorithms may not be congruent with each other and individual estimates can certainly be incorrect. Disagreements in reliability may stem from differences between the populations in which the scores were derived and the context in which they are being applied, advancements in oncology, radiation and surgical care in the modern age, and other (unmeasured) factors that may be important to prognosis and are not encapsulated in the scoring system employed. It is up to the provider to select the scoring tool that they feel works best for them and their patients and which seems to reasonably prognosticate outcomes in their specific practice.
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Funding and Disclosure
Dr. Schoenfeld is supported by the National Institutes of Health (NIH-NIAMS) grant (K23-AR071464). The views expressed in this chapter are those of the authors and do not necessarily reflect the position or policy of the NIH or the Federal government.
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Schoenfeld, A.J., Ferrone, M.L. (2020). Prognosis and Decision-Making in Spinal Metastases. In: Singh, K., Colman, M. (eds) Surgical Spinal Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-50722-0_12
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