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Clinical calculator summary

Revised 2005 Tokuhashi score

A six-factor pretreatment additive score for historical survival classification in established metastatic spinal tumors.

Evidence-based context for fast calculator use

Purpose:
Reproduce the revised 2005 score and matched historical survival band.
Population:
Patients with established metastatic spinal tumors assessed before treatment.
Factors:
KPS, Extraspinal bone-metastasis count, Vertebral-body-metastasis count, Major-organ metastases, Primary site, Spinal-cord palsy
Reference:
Tokuhashi et al. Spine. 2005;30(19):2186-2191. doi:10.1097/01.brs.0000180401.06919.a5.
HomeTokuhashi Score Calculator — Spine Metastases Surgical Prognosis
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Tokuhashi Score Calculator — Spine Metastases Surgical Prognosis

Clinical Context & Background

This calculator reproduces the revised 2005 Tokuhashi score. It adds six source-defined contributions: general condition, raw extraspinal bone-metastasis count, raw vertebral-body-metastasis count, major-organ metastases, primary-tumor site, and spinal-cord palsy. The corrected primary-site table assigns 2 points to other primaries and 3 points to kidney or uterus.\n\nThe score maps to the original historical survival bands: 0-8 for less than 6 months, 9-11 for at least 6 months, and 12-15 for at least 1 year. These are cohort classifications, not individualized survival estimates. The original treatment principles also considered vertebral multiplicity, so the score must not be used alone to direct surgery, radiotherapy, or supportive care.\n\nUse only for pretreatment assessment after metastatic spinal disease is established. It is not a diagnostic tool, post-treatment reassessment, or standalone treatment recommendation.\n\nReference: Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976). 2005;30(19):2186-2191. doi:10.1097/01.brs.0000180401.06919.a5.
Formula Logic
Revised 2005 Tokuhashi score = KPS points + extraspinal bone-metastasis points + vertebral-body-metastasis points + major-organ-metastasis points + primary-site points + spinal-cord-palsy points (0-15).

Reference Data

Total ScoreHistorical Predicted Survival
0 - 8< 6 months
9 - 11≥ 6 months
12 - 15≥ 1 year

Clinical Workflow

Use, Interpret, And Continue The Patient Pathway

Expand for workflow guidance, limitations, examples, and related next steps.

When To Use

  • Use before treatment after metastatic spinal disease has been established.
  • Enter raw metastasis counts and clinician-assessed semantic categories.

How To Interpret

  • Add the six revised 2005 source contributions for a total from 0 to 15.
  • Match the total to the original historical survival band without converting it into an individualized probability.

What To Do Next

  • Interpret the classification within contemporary multidisciplinary assessment.
  • Consider disease distribution, neurologic and mechanical status, systemic disease, goals, and patient preferences independently.

Limitations

  • Not for diagnosis or post-treatment reassessment.
  • Historical survival bands are not individualized predictions.
  • The original treatment principles also considered vertebral multiplicity; score bands alone are not surgical instructions.

Validated Population

Patients with metastatic spinal tumors evaluated in the revised 2005 Tokuhashi study.

Brain and spinal metastases hubReview neurologic, mechanical, and prognostic tools together.Tokuhashi clinical guideReview the historical score, evidence, and modern limitations.SINS spinal instability scoreAssess a separate mechanical-stability question.Tomita surgical scoreReview a separate historical spine-metastasis framework.Katagiri bone metastases scoreReview a separate bone-metastasis prognostic model.

Calculation verification history

Verified

  1. : Production browser revalidation

    • Three source-backed Tokuhashi cases passed through visible production controls at scores 0, 10, and 15 across all survival bands.
    • No unexpected N/A, literal undefined value, stale control, or browser-console error was observed.
    Download latest production check (Excel)

    Case-level evidence is retained in validation/browser-revalidation/tokuhashi-spine-metastases-prognosis-2026-08-03.json.

  2. : Production browser validation

    • Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
    • Overall browser status: failed-console. medium: Production emitted minified React error #418 during route loads/reloads used by this run.
    • Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.

    Case-level production evidence is retained in validation/browser-production/tokuhashi-spine-metastases-prognosis.json.

  3. : Browser input adapter corrected and reverified

    • Accepted finite number values already normalized by the shared calculator form while retaining strict malformed-input rejection.
    • No equation, cutoff, unit, classification, or applicability rule changed; calculator-specific verification and the calculator-wide browser-input audit passed.

  4. : Full validation test

    • 1,666/1,666 exhaustive source-combination, count and score-boundary, strict-input, UI/reset, trace, wording, immutability, registry, and no-panel checks passed with zero score or classification mismatches.
    • Scope is the revised 2005 pretreatment score for established metastatic spinal tumors; no panel calculates Tokuhashi or inherits this verification.

  5. : Calculation and input-contract correction

    • Corrected the revised primary-site table: other primaries now score 2 points and kidney/uterus score 3 points, while rectum remains 4 and thyroid/prostate/breast/carcinoid remain 5.
    • Replaced favorable point-coded defaults and unsafe summation with six required source-semantic inputs, raw integer metastasis counts, exact-key validation, and rejection of missing, extra, coercive, fractional, nonfinite, or unsupported values.
    • Added an immutable six-contribution trace, exact 0-8, 9-11, and 12-15 historical survival rows, the correct publication citation, and explicit wording that vertebral multiplicity also informed the original treatment principles.

Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.

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Frequently Asked Questions

Which Tokuhashi score is implemented?

This calculator reproduces the revised 2005 six-factor Tokuhashi score for pretreatment assessment of established metastatic spinal tumors.

Which factors are included in the revised Tokuhashi score?

It uses Karnofsky performance status, extraspinal bone-metastasis count, vertebral-body-metastasis count, major-organ metastases, primary-tumor site, and spinal-cord palsy.

What is the revised Tokuhashi score range?

The six contributions sum to 0-15 points. The original historical bands were 0-8, 9-11, and 12-15.

Are the Tokuhashi survival bands individualized predictions?

No. They are historical cohort classifications and may not reflect outcomes with modern systemic therapy, radiotherapy, surgery, or supportive care.

Does the Tokuhashi score determine whether surgery should be performed?

No. Mechanical stability, neurologic status, disease biology, systemic burden, treatment options, goals, and patient preferences require independent multidisciplinary assessment.

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