Leithner et al proposed a modification of the score of Bauer and Wedin for metastatic carcinoma to the spine. This can help to identify a patient who may or may not benefit from more aggressive management. The authors are from the Medical University of Graz in Austria and Waldkrankenhaus St. Marien in Erlangen, Germany.
Patient selection: spinal metastasis
Parameters:
(1) absence of visceral metastases
(2) solitary skeletal metastasis
(3) not primary lung cancer
(4) primary cancer myeloma, lymphoma, breast or kidney
Differences from the original score:
(1) brain metastases not mentioned with visceral metastasis
(2) pathologic fracture
Parameter
Finding
Points
visceral metastases
no
1
yes
0
solitary skeletal metastasis
no
0
yes
1
primary lung cancer
no
1
yes
0
primary myeloma, lymphoma, breast or kidney
no
0
yes
1
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
• The higher the score the better the prognosis.
Score
50% Survival
Other
0 or 1
3 months
almost all dead in 1 year
2
10 months
3 or 4
20 months
30% survive 100 months
Score
Management
Surgical Strategy
0 or 1
supportive care
none
2
short term palliation
dorsal
3 or 4
middle term local control
ventral-dorsal
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