The use of the Baumber scoring system for metastatic disease of the vertebral column

The use of the Baumber scoring system for metastatic disease of the vertebral column | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report The use of the Baumber scoring system for metastatic disease of the vertebral column Sam Hodgson, Paul Pynsent, Simon Hughes, Petr Rehousek, Adrian Gardner This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3286666/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Jul, 2025 Read the published version in BMC Research Notes → Version 1 posted 12 You are reading this latest preprint version Abstract Objective The prognostic assessment of patients with metastatic spinal disease is predominantly tumour rather than patient based. Baumber et al have published a prognostic scoring system based on the patient rather than the tumour for metastatic disease of the appendicular skeleton. This paper assesses that formula for metastatic disease of the spine. Results Survival was recorded for 65 individuals who underwent surgery for metastatic disease of the spine. Using the same parameters as Baumber, the projected survival was longer than that recorded in their cohort (over-prediction of 39% at 6 months and 54% at 12 months). The relative contributions of the individual parameters as part of the overall survival was different between the groups with a greater contribution seen if the individual had hyponatraemia, hypoalbuminaemia and low levels of creatinine. The reasons for the differences seen between the spinal and appendicular groups with regards to these parameters are not clear but may represent a poorer level of general health. Further work is required to develop a specific tool for the calculation of prognosis in a metastatic spinal cohort using a general health perspective. Metastasis Spine Tumour Survival Prognosis Figures Figure 1 Figure 2 Figure 3 Introduction Metastatic spread of cancers to the spine is a growing healthcare problem [ 1 ]. From the clinical perspective, vertebral body bony destruction by malignancy leads to instability of the vertebral column which leads to pain and the inability to mobilise, along with spinal cord and nerve root dysfunction caused by compression of the neural structures leading to neurological disability [ 2 ]. The clinical decision required in the management of metastatic spinal disease is whether or not surgical intervention is both indicated from the spinal point of view and holistically is in the patient’s best interests, when assessing the risks and overall prognosis. Scoring systems used to predict the prognosis from metastatic spinal disease are reported in the literature [ 3 – 9 ]. The Tokuhashi system [ 8 ] is recommended by the National Institute of Clinical Excellence (NICE) [ 2 ] for the management of metastatic spinal cord compression in the UK. The Tokuhashi system [ 8 ] is primarily based on features of the cancer with only one question on the generalised patient condition. More recently, a prognostic scoring system for survival following surgery for metastatic disease for the appendicular skeleton was developed by Baumber et al [ 10 ]. This scoring system was different to the Tokuhashi system [ 8 ] in that it assessed the patient as a series of interlinked body systems irrespective of the cancer, as opposed to the previous scoring systems which make assessments based on the burden of disease of the cancer in that individual. Specifically, Baumber et al [ 10 ] excluded spinal disease from their patient cohort because of the presence of previous scoring systems for spinal metastatic disease. Consequently, it is not known whether the findings of Baumber et al [ 10 ] with regards the markers of body system health and survival after metastatic long bone disease are applicable to spinal metastatic disease. This paper will address this by applying the findings of Baumber et al [ 10 ] to assess the utility of the system in a cohort of patients with metastatic spinal disease in spinal metastatic disease, as compared to the original appendicular skeleton. Background and ethical considerations This is an analysis of routine care data collected as part of the emergency service offered by a supra-regional specialist spinal centre for the management of metastatic spinal disease. All the individuals in this data underwent an operative intervention. This study was given ethical and research approval by the Health Research Authority (HRA) and Health and Care Research Wales (22/HRA/1507). As this was a retrospective analysis of already collected clinical data, and that there was never going to be any contact made with any of the patients in the study, it was deemed that informed consent would not be necessary. Methods The data analysis followed the methods described by Baumber et al [ 10 ] with respect to the parameters and all data were analysed using the R statistical platform [ 11 ]. Specifically the survival of the cohort was modelled using the R survival analysis software [ 12 ]. The coefficients for the parameters specific to the spinal cohort were calculated and compared to those of the original Baumber cohort. Results Between June 2019 and March 2022, there were 65 individuals referred who underwent some form of surgical intervention for metastatic spinal disease consisting of 31 males and 33 females with a mean age of 64 years (standard deviation 12 years, range 31 to 85 years). The primary malignancies were lung (n = 17), breast (n = 9), prostate (n = 9), gastrointestinal (n = 7), renal (n = 6) and others (endometrial, haematogenous and sarcoma) (n = 9). There were also cases where the primary malignancy was unknown at time of surgery (n = 8). All cases underwent a surgical reconstruction with instrumentation apart from 4 who underwent a vertebroplasty procedure. The survival curve for the surgical cohort is shown in Fig. 1 . The range of survival was from a minimum of 6 days to a maximum of 978 days. There were 49% (n = 32) of individuals still alive at 6 months and 30% (n = 19) at 12 months. The distribution of the hazard ratio and the confidential intervals for the spinal cohort is demonstrated against those from Baumber et al [ 10 ] in Fig. 2 . Using the same formula and weighted coefficients as in the paper by Baumber et al [ 10 ], the mean survival of the cohort was predicted to be 90% at 6 months and 84% at 12 months (10% risk of death at 6 months and 16% at 12 months). Histograms of the individual risk of death using the same formula and weighted coefficients as in the paper by Baumber et al [ 10 ] at 6 and 12 months are seen in Fig. 3. Discussion Metastatic spinal disease, as a consequence of an ageing population who are benefitting from a more successful survival from the treatment for their primary disease, is a growing issue for healthcare providers [ 1 ]. Providing evidence based information to individual patients about their condition, and their specific prognosis following the different options for treatment that exist is key to maximising good outcomes and minimising morbidity and mortality as a consequence of that intervention. Prognostic scoring systems, developed following the analysis of key parameters of health and disease in a large numbers of patients with metastatic spinal disease are a method of quantifying risk and prognosis on an individual basis. This has been done in a number of formats in the literature [ 3 – 9 ]. Baumber et al [ 10 ] approached this in a different fashion but specifically for only limb metastatic disease using a patient organ system approach, similar in nature to a standard assessment of fitness for general anaesthesia, rather than an assessment based on the burden of the malignancy. Using this approach, a number of significant parameters (with associated hazard ratios) that could be used to predict survival at 6 and 12 months. In their paper, Baumber et al [ 10 ] specifically excluded patients with spinal metastatic disease because of the presence of other scoring prognostic systems. This paper reproduces the methodology used by Baumber et al [ 10 ] in a cohort of individuals with metastatic spinal disease, from a number of different primary malignancies, who underwent surgery on their spine. It has been found that survival following surgery for metastatic spinal disease is not as good as that reported for metastatic disease in the appendicular skeleton. As a consequence of this, the survival prediction of the Baumber tool is not as accurate for spinal disease as for limb disease with an over prediction of survival by 39% at 6 months and 54% at 12 months. Of interest, there is a difference between the hazard ratios of the Baumber paper [ 10 ] and this spinal cohort, particularly seen for the parameters of Albumin (< 35), Creatinine (< 44), Sodium ( 11). It is difficult to identify why certain parameters are more influential in the spinal cohort when compared to that of metastatic disease in the appendicular skeleton. Inferences that could be drawn here are that individuals with spinal metastatic disease are generally less well overall, and thus have less resilience and reserve to derangements of other organs in the body. This is indicated by the effects of hyponatraemia, hypoalbuminaemia and low creatinine levels, which are all markers of global poor health. However, it does also raise questions about the generalisability of the work of Baumber et al [ 10 ] because of the number of similarities between metastatic disease of limbs and spine when assessed in a holistic, non-skeletal, body organ way, and it may be reasonable to expect there to be a closer relationship. Conclusion Baumber et al [ 10 ] have developed and published a method of assessing risk of death from appendicular skeletal metastatic disease which, when applied to metastatic spinal disease, under-estimates the true survival over time. The reasons for this are not clear. However, the parameters that have the greatest effect on survival and appear to be different between the appendicular and axial skeletons are indicators of poor health and may suggest that spinal patients with metastatic disease are generally less well when compared to similar appendicular patients with metastatic disease. This work demonstrates that there is promise in the prediction of survival from metastatic cancer in both the limbs and spine using a holistic, body system approach but there is a need to validate in appropriate populations of sufficient size to create a robust model. Future work will be aimed to address this. Limitations This work has limitations. It is based on the work by Baumber et al [ 10 ] which is not validated in a population outside of the authors institution and so there is a query over the generalisability of their work in the first instance. This paper has applied their work to a different population with the same pathology at a different anatomical location, but using the same coefficients. A larger sample size than available would be required to be able to validate the original coefficients, or to calculate new coefficients, for this spinal population. Abbreviations NICE National Institute for Clinical Excellence HRA Health Research Authority Declarations Ethical approval and consent to participate: This study was given ethical and research approval by the Health Research Authority (HRA) and Ethics Committee of Health and Care Research Wales (22/HRA/1507). The requirement for informed consent was waived by the Ethics Committee Health and Care Research Wales because of the retrospective nature of the study. All research work conducted here was performed in line with the relevant guidelines and regulations (Declaration of Helsinki). Consent for publication: Not applicable. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: There are no funding sources to declare. Authors contributions: AG defined the research question, obtained ethical approvals and supervised the project. SHo collected all of the data and drafted the first version of the manuscript. PP analysed the data. SHu and PR provided clinical context. All authors read and approved the final manuscript. Acknowledgements: Not applicable. References Van den Brande R, Cornips E, Peeters M, et al. Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathological vertebral compression fractures in patients with solid tumours: a systematic review. J Bone Oncol. 2022;35:100446. NICE CG75. : Metastatic spinal cord compression in adults: risk assessment, diagnosis and management. https://www.nice.org.uk/guidance/CG75/chapter/Recommendations#treatment-of-spinal-metastases-and-mscc . Accessed 6/8/23. Bauer H, Wedin R. Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients. Acta Orthop Scand. 1995;66:143–6. Bollen L, van der Linden Y, Pondaag W, et al. Prognostic factors associated with survival in patients with symptomatic spinal bone metastases: a retrospective cohort study of 1,043 patients. Neuro Oncol. 2014;16:991–8. Choi D, Pavlou M, Omar R, et al. A novel risk calculator to predict outcome after surgery for symptomatic spinal metastases; use of a large protective patient database to personalise surgical management. Eur J Cancer. 2019;107:28–36. Rades D, Fehlauer F, Schulte R, et al. Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression. J Clin Oncol. 2006;24:3388–93. van der Linden Y, Dijkstra S, Vonk E, et al. Prediction of survival in patients with metastases in the spinal column: results based on a randomised trial of radiotherapy. Cancer. 2005;103:320–8. Tokuhashi Y, Matsuzaki H, Oda H, et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine. 2005;19:2186–91. Tomita K, Kawahara N, Kobayashi T, et al. Surgical strategy for spinal metastases. Spine. 2001;26:298–306. Baumber R, Gerrand C, Cooper M, Aston W. Development of a scoring system for survival following surgery for metastatic bone disease. Bone Joint J. 2001;103–B:1725–30. R Core Team. R: A Language and Environment for Statistical Computing. https://www.R- project. org/. R Foundation for Statistical Computing; 2020. Therneau T. (2022). A Package for Survival Analysis in R. R package version 3.3-1, : https://CRAN.R-project.org/package=survival . Accessed 1/7/23. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Jul, 2025 Read the published version in BMC Research Notes → Version 1 posted Editorial decision: Revision requested 18 Nov, 2024 Reviews received at journal 11 Nov, 2024 Reviewers agreed at journal 20 Oct, 2024 Reviewers agreed at journal 26 Jul, 2024 Reviewers agreed at journal 25 Jul, 2024 Reviews received at journal 21 Jul, 2024 Reviewers agreed at journal 21 Jul, 2024 Reviewers invited by journal 07 Nov, 2023 Editor invited by journal 29 Aug, 2023 Submission checks completed at journal 26 Aug, 2023 Editor assigned by journal 26 Aug, 2023 First submitted to journal 22 Aug, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3286666","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":229032372,"identity":"48802d60-f52f-46bb-a01e-f177628c08f3","order_by":0,"name":"Sam Hodgson","email":"","orcid":"","institution":"University of Birmingham Edgbaston","correspondingAuthor":false,"prefix":"","firstName":"Sam","middleName":"","lastName":"Hodgson","suffix":""},{"id":229032373,"identity":"e9c4cef5-5a22-4f97-b9fa-08eaa205396c","order_by":1,"name":"Paul Pynsent","email":"","orcid":"","institution":"University of Birmingham 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16:44:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3286666/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3286666/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13104-025-07390-1","type":"published","date":"2025-07-22T15:57:54+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":42380931,"identity":"2d606dc0-788b-40c3-ad02-3e41e639c25b","added_by":"auto","created_at":"2023-08-30 16:41:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65302,"visible":true,"origin":"","legend":"\u003cp\u003eSurvival curve of the surgical cohort\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3286666/v1/64d94a09078e688949c50b41.png"},{"id":42381715,"identity":"402702b1-efda-4670-88d4-def07280c7f4","added_by":"auto","created_at":"2023-08-30 16:49:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":125745,"visible":true,"origin":"","legend":"\u003cp\u003eA comparison of the hazard ratios and 95% confidence intervals of the parameters from the Baumber et al [10] and those calculated from the spinal data.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3286666/v1/b7725d5268e64b71dc6aaa52.png"},{"id":42380933,"identity":"3294a407-0160-4025-b6cd-573475d5bc9d","added_by":"auto","created_at":"2023-08-30 16:41:16","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":38367,"visible":true,"origin":"","legend":"\u003cp\u003eIndividual risk of death at 6 and 12 months calculated using the formula for Baumber et al [10].\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-3286666/v1/62bb8639d8be22c2c74cbdf3.png"},{"id":87756876,"identity":"c94f3b49-5afe-4f0b-ac16-79c1bab4931a","added_by":"auto","created_at":"2025-07-28 16:10:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":583967,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3286666/v1/9aa8f4a0-9ed6-4e97-b0cd-2185023490af.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The use of the Baumber scoring system for metastatic disease of the vertebral column","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMetastatic spread of cancers to the spine is a growing healthcare problem [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. From the clinical perspective, vertebral body bony destruction by malignancy leads to instability of the vertebral column which leads to pain and the inability to mobilise, along with spinal cord and nerve root dysfunction caused by compression of the neural structures leading to neurological disability [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The clinical decision required in the management of metastatic spinal disease is whether or not surgical intervention is both indicated from the spinal point of view and holistically is in the patient\u0026rsquo;s best interests, when assessing the risks and overall prognosis. Scoring systems used to predict the prognosis from metastatic spinal disease are reported in the literature [\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The Tokuhashi system [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] is recommended by the National Institute of Clinical Excellence (NICE) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] for the management of metastatic spinal cord compression in the UK. The Tokuhashi system [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] is primarily based on features of the cancer with only one question on the generalised patient condition.\u003c/p\u003e\u003cp\u003eMore recently, a prognostic scoring system for survival following surgery for metastatic disease for the appendicular skeleton was developed by Baumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This scoring system was different to the Tokuhashi system [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] in that it assessed the patient as a series of interlinked body systems irrespective of the cancer, as opposed to the previous scoring systems which make assessments based on the burden of disease of the cancer in that individual. Specifically, Baumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] excluded spinal disease from their patient cohort because of the presence of previous scoring systems for spinal metastatic disease. Consequently, it is not known whether the findings of Baumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] with regards the markers of body system health and survival after metastatic long bone disease are applicable to spinal metastatic disease.\u003c/p\u003e\u003cp\u003eThis paper will address this by applying the findings of Baumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] to assess the utility of the system in a cohort of patients with metastatic spinal disease in spinal metastatic disease, as compared to the original appendicular skeleton.\u003c/p\u003e"},{"header":"Background and ethical considerations","content":"\u003cp\u003eThis is an analysis of routine care data collected as part of the emergency service offered by a supra-regional specialist spinal centre for the management of metastatic spinal disease. All the individuals in this data underwent an operative intervention. This study was given ethical and research approval by the Health Research Authority (HRA) and Health and Care Research Wales (22/HRA/1507). As this was a retrospective analysis of already collected clinical data, and that there was never going to be any contact made with any of the patients in the study, it was deemed that informed consent would not be necessary.\u003c/p\u003e\n"},{"header":"Methods","content":"\u003cp\u003eThe data analysis followed the methods described by Baumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] with respect to the parameters and all data were analysed using the R statistical platform [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Specifically the survival of the cohort was modelled using the R survival analysis software [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The coefficients for the parameters specific to the spinal cohort were calculated and compared to those of the original Baumber cohort.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBetween June 2019 and March 2022, there were 65 individuals referred who underwent some form of surgical intervention for metastatic spinal disease consisting of 31 males and 33 females with a mean age of 64 years (standard deviation 12 years, range 31 to 85 years). The primary malignancies were lung (n\u0026thinsp;=\u0026thinsp;17), breast (n\u0026thinsp;=\u0026thinsp;9), prostate (n\u0026thinsp;=\u0026thinsp;9), gastrointestinal (n\u0026thinsp;=\u0026thinsp;7), renal (n\u0026thinsp;=\u0026thinsp;6) and others (endometrial, haematogenous and sarcoma) (n\u0026thinsp;=\u0026thinsp;9). There were also cases where the primary malignancy was unknown at time of surgery (n\u0026thinsp;=\u0026thinsp;8). All cases underwent a surgical reconstruction with instrumentation apart from 4 who underwent a vertebroplasty procedure.\u003c/p\u003e \u003cp\u003eThe survival curve for the surgical cohort is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The range of survival was from a minimum of 6 days to a maximum of 978 days. There were 49% (n\u0026thinsp;=\u0026thinsp;32) of individuals still alive at 6 months and 30% (n\u0026thinsp;=\u0026thinsp;19) at 12 months.\u003c/p\u003e \u003cp\u003eThe distribution of the hazard ratio and the confidential intervals for the spinal cohort is demonstrated against those from Baumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Using the same formula and weighted coefficients as in the paper by Baumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], the mean survival of the cohort was predicted to be 90% at 6 months and 84% at 12 months (10% risk of death at 6 months and 16% at 12 months). Histograms of the individual risk of death using the same formula and weighted coefficients as in the paper by Baumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] at 6 and 12 months are seen in Fig.\u0026nbsp;3.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMetastatic spinal disease, as a consequence of an ageing population who are benefitting from a more successful survival from the treatment for their primary disease, is a growing issue for healthcare providers [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Providing evidence based information to individual patients about their condition, and their specific prognosis following the different options for treatment that exist is key to maximising good outcomes and minimising morbidity and mortality as a consequence of that intervention. Prognostic scoring systems, developed following the analysis of key parameters of health and disease in a large numbers of patients with metastatic spinal disease are a method of quantifying risk and prognosis on an individual basis. This has been done in a number of formats in the literature [\u003cspan additionalcitationids=\"CR4 CR5 CR6 CR7 CR8\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Baumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] approached this in a different fashion but specifically for only limb metastatic disease using a patient organ system approach, similar in nature to a standard assessment of fitness for general anaesthesia, rather than an assessment based on the burden of the malignancy. Using this approach, a number of significant parameters (with associated hazard ratios) that could be used to predict survival at 6 and 12 months. In their paper, Baumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] specifically excluded patients with spinal metastatic disease because of the presence of other scoring prognostic systems.\u003c/p\u003e \u003cp\u003eThis paper reproduces the methodology used by Baumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] in a cohort of individuals with metastatic spinal disease, from a number of different primary malignancies, who underwent surgery on their spine. It has been found that survival following surgery for metastatic spinal disease is not as good as that reported for metastatic disease in the appendicular skeleton. As a consequence of this, the survival prediction of the Baumber tool is not as accurate for spinal disease as for limb disease with an over prediction of survival by 39% at 6 months and 54% at 12 months. Of interest, there is a difference between the hazard ratios of the Baumber paper [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and this spinal cohort, particularly seen for the parameters of Albumin (\u0026lt;\u0026thinsp;35), Creatinine (\u0026lt;\u0026thinsp;44), Sodium (\u0026lt;\u0026thinsp;133) and White Cell Count (\u0026gt;\u0026thinsp;11). It is difficult to identify why certain parameters are more influential in the spinal cohort when compared to that of metastatic disease in the appendicular skeleton. Inferences that could be drawn here are that individuals with spinal metastatic disease are generally less well overall, and thus have less resilience and reserve to derangements of other organs in the body. This is indicated by the effects of hyponatraemia, hypoalbuminaemia and low creatinine levels, which are all markers of global poor health. However, it does also raise questions about the generalisability of the work of Baumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] because of the number of similarities between metastatic disease of limbs and spine when assessed in a holistic, non-skeletal, body organ way, and it may be reasonable to expect there to be a closer relationship.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBaumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] have developed and published a method of assessing risk of death from appendicular skeletal metastatic disease which, when applied to metastatic spinal disease, under-estimates the true survival over time. The reasons for this are not clear. However, the parameters that have the greatest effect on survival and appear to be different between the appendicular and axial skeletons are indicators of poor health and may suggest that spinal patients with metastatic disease are generally less well when compared to similar appendicular patients with metastatic disease. This work demonstrates that there is promise in the prediction of survival from metastatic cancer in both the limbs and spine using a holistic, body system approach but there is a need to validate in appropriate populations of sufficient size to create a robust model. Future work will be aimed to address this.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis work has limitations. It is based on the work by Baumber et al [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] which is not validated in a population outside of the authors institution and so there is a query over the generalisability of their work in the first instance. This paper has applied their work to a different population with the same pathology at a different anatomical location, but using the same coefficients. A larger sample size than available would be required to be able to validate the original coefficients, or to calculate new coefficients, for this spinal population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNICE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Institute for Clinical Excellence\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHRA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth Research Authority\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eThis study was given ethical and research approval by the Health Research Authority (HRA) and Ethics Committee of Health and Care Research Wales (22/HRA/1507). The requirement for informed consent was waived by the Ethics Committee Health and Care Research Wales because of the retrospective nature of the study. All research work conducted here was performed in line with the relevant guidelines and regulations (Declaration of Helsinki).\u003c/p\u003e\n\u003cp\u003eConsent for publication:\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials:\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests:\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding:\u003c/p\u003e\n\u003cp\u003eThere are no funding sources to declare.\u003c/p\u003e\n\u003cp\u003eAuthors contributions:\u003c/p\u003e\n\u003cp\u003eAG defined the research question, obtained ethical approvals and supervised the project. SHo collected all of the data and drafted the first version of the manuscript. PP analysed the data. SHu and PR provided clinical context. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements:\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVan den Brande R, Cornips E, Peeters M, et al. Epidemiology of spinal metastases, metastatic epidural spinal cord compression and pathological vertebral compression fractures in patients with solid tumours: a systematic review. J Bone Oncol. 2022;35:100446.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNICE CG75. : Metastatic spinal cord compression in adults: risk assessment, diagnosis and management. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nice.org.uk/guidance/CG75/chapter/Recommendations#treatment-of-spinal-metastases-and-mscc\u003c/span\u003e\u003cspan address=\"https://www.nice.org.uk/guidance/CG75/chapter/Recommendations#treatment-of-spinal-metastases-and-mscc\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 6/8/23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBauer H, Wedin R. Survival after surgery for spinal and extremity metastases. Prognostication in 241 patients. Acta Orthop Scand. 1995;66:143\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBollen L, van der Linden Y, Pondaag W, et al. Prognostic factors associated with survival in patients with symptomatic spinal bone metastases: a retrospective cohort study of 1,043 patients. Neuro Oncol. 2014;16:991\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi D, Pavlou M, Omar R, et al. A novel risk calculator to predict outcome after surgery for symptomatic spinal metastases; use of a large protective patient database to personalise surgical management. Eur J Cancer. 2019;107:28\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRades D, Fehlauer F, Schulte R, et al. Prognostic factors for local control and survival after radiotherapy of metastatic spinal cord compression. J Clin Oncol. 2006;24:3388\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan der Linden Y, Dijkstra S, Vonk E, et al. Prediction of survival in patients with metastases in the spinal column: results based on a randomised trial of radiotherapy. Cancer. 2005;103:320\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTokuhashi Y, Matsuzaki H, Oda H, et al. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine. 2005;19:2186\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTomita K, Kawahara N, Kobayashi T, et al. Surgical strategy for spinal metastases. Spine. 2001;26:298\u0026ndash;306.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaumber R, Gerrand C, Cooper M, Aston W. Development of a scoring system for survival following surgery for metastatic bone disease. Bone Joint J. 2001;103\u0026ndash;B:1725\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eR Core Team. R: A Language and Environment for Statistical Computing. https://www.R- project. org/. R Foundation for Statistical Computing; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTherneau T. (2022). A Package for Survival Analysis in R. R package version 3.3-1, : \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://CRAN.R-project.org/package=survival\u003c/span\u003e\u003cspan address=\"https://CRAN.R-project.org/package=survival\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 1/7/23.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Metastasis, Spine, Tumour, Survival, Prognosis","lastPublishedDoi":"10.21203/rs.3.rs-3286666/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3286666/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThe prognostic assessment of patients with metastatic spinal disease is predominantly tumour rather than patient based. Baumber et al have published a prognostic scoring system based on the patient rather than the tumour for metastatic disease of the appendicular skeleton. This paper assesses that formula for metastatic disease of the spine.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSurvival was recorded for 65 individuals who underwent surgery for metastatic disease of the spine. Using the same parameters as Baumber, the projected survival was longer than that recorded in their cohort (over-prediction of 39% at 6 months and 54% at 12 months). The relative contributions of the individual parameters as part of the overall survival was different between the groups with a greater contribution seen if the individual had hyponatraemia, hypoalbuminaemia and low levels of creatinine. The reasons for the differences seen between the spinal and appendicular groups with regards to these parameters are not clear but may represent a poorer level of general health. Further work is required to develop a specific tool for the calculation of prognosis in a metastatic spinal cohort using a general health perspective.\u003c/p\u003e","manuscriptTitle":"The use of the Baumber scoring system for metastatic disease of the vertebral column","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-08-30 16:41:12","doi":"10.21203/rs.3.rs-3286666/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-19T04:14:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-11T22:45:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2024-10-21T00:50:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202974011960548991392561310282187198661","date":"2024-07-26T21:06:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"204225130216931192816819871010156089560","date":"2024-07-26T00:57:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-22T01:24:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86046771229816352992802891359718071465","date":"2024-07-22T01:18:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-11-08T01:57:04+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-08-29T09:50:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-08-26T11:34:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-08-26T11:34:17+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Research Notes","date":"2023-08-22T16:41:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-research-notes","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"resn","sideBox":"Learn more about [BMC Research Notes](http://bmcresnotes.biomedcentral.com)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/resn/default.aspx","title":"BMC Research Notes","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b7ae7385-71bf-4706-9740-008bc1e81f78","owner":[],"postedDate":"August 30th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-28T16:06:19+00:00","versionOfRecord":{"articleIdentity":"rs-3286666","link":"https://doi.org/10.1186/s13104-025-07390-1","journal":{"identity":"bmc-research-notes","isVorOnly":false,"title":"BMC Research Notes"},"publishedOn":"2025-07-22 15:57:54","publishedOnDateReadable":"July 22nd, 2025"},"versionCreatedAt":"2023-08-30 16:41:12","video":"","vorDoi":"10.1186/s13104-025-07390-1","vorDoiUrl":"https://doi.org/10.1186/s13104-025-07390-1","workflowStages":[]},"version":"v1","identity":"rs-3286666","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3286666","identity":"rs-3286666","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}