Tokuhashi Revised Scoring System for Spinal Metastasis Prognosis
Predicts survival in patients with spinal metastases to guide surgical versus palliative treatment decisions
- Highest activation tier
- Recommended
- How it is scored
- Scored in code; a stated value is compared only from the structured summary or a supplied value
- Scoring type
- point sum
- Care settings
- Inpatient, Outpatient
When it activates
Scribeable activates a calculator from the encounter. The Tokuhashi Revised Scoring System for Spinal Metastasis Prognosis can activate when the transcript or pasted chart context documents any of these:
- Spinal metastasis evaluation
- Spine tumor surgical planning
- Metastatic spine disease prognosis
- Vertebral metastasis treatment decision
- Pathological spine fracture management
A coded diagnosis can also activate it. ICD-10 prefixes carried by the registry: C79.5, M49.5.
Inputs the note needs
6 inputs. Each is resolved from the transcript, the pasted chart context and charted labs; at this calculator’s tier a missing input is never requested, and a missing required input keeps the score out of the draft.
| Input | Type | Unit / options | Guidance |
|---|---|---|---|
| General condition (poor=0, moderate=1, good=2) | history | ||
| Number of extraspinal bone metastases (>=3=0, 1-2=1, 0=2) | history | ||
| Number of vertebral body metastases (>=3=0, 2=1, 1=2) | history | ||
| Metastases to major internal organs — lung, liver, kidney, brain (unresectable=0, resectable=1, none=2) | history | ||
| Primary tumor site (lung/osteosarcoma/stomach/bladder/esophagus/pancreas=0, liver/gallbladder/unidentified=1, others=2, kidney/uterus=3, rectum=4, thyroid/breast/prostate/carcinoid=5) | history | ||
| Spinal cord palsy (complete=0, incomplete=1, none=2) | history |
Scoring
Six parameters scored 0-2 or 0-5. Total score 0-15. 0-8: predicted survival <6 months, excisional surgery not recommended. 9-11: predicted survival 6-12 months, palliative surgery considered. 12-15: predicted survival >12 months, excisional surgery possible.
Interpretation
Score 0-8: Life expectancy <6 months — conservative treatment or palliative surgery (decompression/stabilization). Score 9-11: Life expectancy ~12 months — palliative surgery appropriate, consider posterior decompression with stabilization. Score 12-15: Life expectancy >12 months — excisional surgery (en bloc resection) can be considered if technically feasible. Primary tumor type is the strongest prognostic factor (accounts for up to 5 points).
Evidence
Sources carried in Scribeable's citation registry for this calculator; guideline version: Tokuhashi 2005.
- Tokuhashi Y et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosisTokuhashi (Revised) 2005 · 2005 · link last verified 2026-03-28
How Scribeable handles it in the note
When an encounter activates the Tokuhashi Revised Scoring System for Spinal Metastasis Prognosis (its highest tier is recommended), Scribeable does not ask you for missing inputs. The score is computed in code from whatever inputs resolve from the transcript, the pasted chart context or charted labs; a computed value is written into the draft only when every required input already resolves.
The score is computed in code from the resolved inputs, not recalled by the language model. A stated Tokuhashi Revised Scoring System for Spinal Metastasis Prognosis value is compared against the computed one when the draft's structured summary carries it; a disagreement found there is flagged to the second drafting pass, which is instructed to correct the score and its interpretation, unless Scribeable has supplied the computed value to that pass, in which case the value the draft writes is checked against the supplied one and a detected difference is shown beside the note for you to adjudicate rather than silently rewritten.
Classified as a staging or classification system: activated strictly, because a wrong stage on the wrong patient is a documentation hazard.
See it activate on your own encounter
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