Revised Tokuhashi metastatic spine tumor score

Tokuhashi

Sum the revised Tokuhashi 2005 score for preoperative evaluation of metastatic spine tumor prognosis from six caller-assigned items and return the published 0–15 integer total and predicted-survival band (0–8 / 9–11 / 12–15). Not an operative order and not original Tokuhashi 1990.

WEDGE $0.005 USDC GET /api/calc/tokuhashi

Markdown: /docs/tokuhashi.md · Canonical: https://magentlab.com/docs/tokuhashi

Not a medical device. Not a diagnosis, dose, or listing recommendation.

What it computes

When to use

When an agent has already assigned Tokuhashi 2005 KPS, extraspinal bone mets, vertebral mets, visceral mets, primary site group, and palsy for a metastatic spine tumor and needs the published integer sum and predicted-survival band, not a surgical order, not SINS (neoplastic spinal instability), and not the original 1990 0–12 score.

When not to use

Not a medical device. magent does not read imaging. KPS, extraspinal bone mets, vertebral mets, visceral mets, primary site, and palsy are caller-assigned.
Not an operative order. Bands 0-8, 9-11, and 12-15 follow Tokuhashi 2005 predicted survival (<6 months / ≥6 months / ≥12 months); they are not a surgical command.
Not original Tokuhashi 1990 (0–5 / 6–8 / 9–12, max 12). This tool is the revised 2005 0–15 score.
Not SINS (Fisher 2010 neoplastic spinal instability). This tool is Tokuhashi 2005 prognosis for metastatic spine tumors.

Formula

Tokuhashi = kps (poor 0, moderate 1, good 2) + extraspinal (ge_3 0, one_or_two 1, none 2) + vertebral (ge_3 0, two 1, one 2) + visceral (unremovable 0, removable 1, none 2) + primary (lung osteosarcoma stomach bladder esophagus pancreas 0; liver gallbladder unidentified 1; others 2; kidney uterus 3; rectum 4; thyroid prostate breast carcinoid 5) + palsy (complete 0, incomplete 1, none 2); Tokuhashi 2005 revised; max 15; bands 0-8 (<6 months), 9-11 (>=6 months), 12-15 (>=12 months)

Citation

Title: A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis.
Authors: Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J
Source: Spine (Phila Pa 1976). 2005;30(19):2186-2191
DOI: 10.1097/01.brs.0000180401.06919.a5

Worked example

All minimum grades

Given: extraspinal=ge_3kps=poorpalsy=completeprimary=lungvertebral=ge_3visceral=unremovable

poor 0 + ge_3 0 + ge_3 0 + unremovable 0 + lung 0 + complete 0
Score = 0 (max 15); tokuhashi_band 0-8 (<6 months). Not an operative order

Band 9-11

Given: extraspinal=nonekps=goodpalsy=noneprimary=othersvertebral=twovisceral=none

good 2 + none 2 + two 1 + none 2 + others 2 + none 2
Score = 11 (max 15); tokuhashi_band 9-11 (>=6 months)

All maximum grades

Given: extraspinal=nonekps=goodpalsy=noneprimary=breastvertebral=onevisceral=none

good 2 + none 2 + one 2 + none 2 + breast 5 + none 2
Score = 15 (max 15); tokuhashi_band 12-15 (>=12 months). Not an operative order

Also searched as

Tokuhashi score
revised Tokuhashi
Tokuhashi 2005
metastatic spine tumor prognosis
Tokuhashi revised scoring system
spine metastasis prognosis score
Tokuhashi classification
preoperative metastatic spine score
revised Tokuhashi 0-15

Try

Opens the live endpoint. Unpaid browser requests show the paywall; agents should send Accept: application/json.

/api/calc/tokuhashi?kps=poor&extraspinal=ge_3&vertebral=ge_3&visceral=unremovable&primary=lung&palsy=complete

Full URL: https://api.magentlab.com/api/calc/tokuhashi?kps=poor&extraspinal=ge_3&vertebral=ge_3&visceral=unremovable&primary=lung&palsy=complete

Call

Expect HTTP 402 until you retry with PAYMENT-SIGNATURE. Incomplete query params return HTTP 400 before any quote or charge.

curl -i -H "Accept: application/json" "https://api.magentlab.com/api/calc/tokuhashi?kps=poor&extraspinal=ge_3&vertebral=ge_3&visceral=unremovable&primary=lung&palsy=complete"

Parameters

Name	Type	Required	Description
`kps`	string	required · poor, moderate, good	Caller-assigned Karnofsky performance status band (Tokuhashi 2005). poor (KPS 10–40%) scores 0; moderate (50–70%) scores 1; good (80–100%) scores 2. magent does not observe the patient.
`extraspinal`	string	required · ge_3, one_or_two, none	Caller-assigned number of extraspinal bone metastases (Tokuhashi 2005). ge_3 (≥3) scores 0; one_or_two scores 1; none scores 2. magent does not read imaging.
`vertebral`	string	required · ge_3, two, one	Caller-assigned number of vertebral metastases (Tokuhashi 2005). ge_3 (≥3) scores 0; two scores 1; one scores 2. There is no vertebral none token. magent does not read imaging.
`visceral`	string	required · unremovable, removable, none	Caller-assigned metastases to major internal organs (Tokuhashi 2005). unremovable scores 0; removable scores 1; none scores 2. magent does not read imaging.
`primary`	string	required · lung, osteosarcoma, stomach, bladder, esophagus, pancreas, liver, gallbladder, unidentified, others, kidney, uterus, rectum, thyroid, prostate, breast, carcinoid	Caller-assigned Tokuhashi 2005 primary site group. lung, osteosarcoma, stomach, bladder, esophagus, pancreas score 0; liver, gallbladder, unidentified score 1; others scores 2; kidney, uterus score 3; rectum scores 4; thyroid, prostate, breast, carcinoid score 5. others is the published catch-all token. magent does not infer histology.
`palsy`	string	required · complete, incomplete, none	Caller-assigned spinal cord palsy (Tokuhashi 2005). complete (Frankel A/B) scores 0; incomplete (Frankel C/D) scores 1; none (Frankel E) scores 2. magent does not examine the patient.

Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

POST /api/calc/tokuhashi Max 25 unit_amount + extra_item_amount * (n - 1) extra $0.002 PREVIEW

1 to 25 items. Each item uses the same keys as the GET query parameters.
POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request (fixture)

{
  "items": [
    {
      "extraspinal": "ge_3",
      "kps": "poor",
      "palsy": "complete",
      "primary": "lung",
      "vertebral": "ge_3",
      "visceral": "unremovable"
    },
    {
      "extraspinal": "ge_3",
      "kps": "poor",
      "palsy": "complete",
      "primary": "lung",
      "vertebral": "ge_3",
      "visceral": "unremovable"
    }
  ]
}

Open bulk paywall →

Opens a two-item fixture on the API host. Unpaid browsers get the same MetaMask paywall as GET; Pay retries POST with those items.

Example 200 (fixture)

{
  "count": 2,
  "path": "/api/calc/tokuhashi",
  "items": [
    {
      "primary": "lung",
      "components": [
        {
          "value": "poor",
          "factor": "kps",
          "points": 0,
          "present": true
        },
        {
          "value": "ge_3",
          "factor": "extraspinal",
          "points": 0,
          "present": true
        },
        {
          "value": "ge_3",
          "factor": "vertebral",
          "points": 0,
          "present": true
        },
        {
          "value": "unremovable",
          "factor": "visceral",
          "points": 0,
          "present": true
        },
        {
          "value": "lung",
          "factor": "primary",
          "points": 0,
          "present": true
        },
        {
          "value": "complete",
          "factor": "palsy",
          "points": 0,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J",
        "doi": "10.1097/01.brs.0000180401.06919.a5",
        "id": "tokuhashi-2005",
        "pmid": "16205345",
        "source": "Spine (Phila Pa 1976). 2005;30(19):2186-2191",
        "title": "A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis."
      },
      "formula": "tokuhashi",
      "formula_expression": "Tokuhashi = kps (poor 0, moderate 1, good 2) + extraspinal (ge_3 0, one_or_two 1, none 2) + vertebral (ge_3 0, two 1, one 2) + visceral (unremovable 0, removable 1, none 2) + primary (lung osteosarcoma stomach bladder esophagus pancreas 0; liver gallbladder unidentified 1; others 2; kidney uterus 3; rectum 4; thyroid prostate breast carcinoid 5) + palsy (complete 0, incomplete 1, none 2); Tokuhashi 2005 revised; max 15; bands 0-8 (<6 months), 9-11 (>=6 months), 12-15 (>=12 months)",
      "max_score": 15,
      "score": 0,
      "kps": "poor",
      "extraspinal": "ge_3",
      "palsy": "complete",
      "tokuhashi_band": "0-8",
      "vertebral": "ge_3",
      "visceral": "unremovable"
    },
    {
      "primary": "lung",
      "components": [
        {
          "value": "poor",
          "factor": "kps",
          "points": 0,
          "present": true
        },
        {
          "value": "ge_3",
          "factor": "extraspinal",
          "points": 0,
          "present": true
        },
        {
          "value": "ge_3",
          "factor": "vertebral",
          "points": 0,
          "present": true
        },
        {
          "value": "unremovable",
          "factor": "visceral",
          "points": 0,
          "present": true
        },
        {
          "value": "lung",
          "factor": "primary",
          "points": 0,
          "present": true
        },
        {
          "value": "complete",
          "factor": "palsy",
          "points": 0,
          "present": true
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J",
        "doi": "10.1097/01.brs.0000180401.06919.a5",
        "id": "tokuhashi-2005",
        "pmid": "16205345",
        "source": "Spine (Phila Pa 1976). 2005;30(19):2186-2191",
        "title": "A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis."
      },
      "formula": "tokuhashi",
      "formula_expression": "Tokuhashi = kps (poor 0, moderate 1, good 2) + extraspinal (ge_3 0, one_or_two 1, none 2) + vertebral (ge_3 0, two 1, one 2) + visceral (unremovable 0, removable 1, none 2) + primary (lung osteosarcoma stomach bladder esophagus pancreas 0; liver gallbladder unidentified 1; others 2; kidney uterus 3; rectum 4; thyroid prostate breast carcinoid 5) + palsy (complete 0, incomplete 1, none 2); Tokuhashi 2005 revised; max 15; bands 0-8 (<6 months), 9-11 (>=6 months), 12-15 (>=12 months)",
      "max_score": 15,
      "score": 0,
      "kps": "poor",
      "extraspinal": "ge_3",
      "palsy": "complete",
      "tokuhashi_band": "0-8",
      "vertebral": "ge_3",
      "visceral": "unremovable"
    }
  ]
}

Response

Field	Type	Description
`formula`	string	tokuhashi
`formula_expression`	string	Exact expression used
`score`	integer	Revised Tokuhashi 2005 integer sum 0-15. Not an operative order.
`max_score`	integer	15
`tokuhashi_band`	string	Tokuhashi 2005 predicted-survival band: 0-8 (score 0–8, <6 months), 9-11 (score 9–11, ≥6 months), or 12-15 (score 12–15, ≥12 months). Not a surgical order.
`kps`	string	Caller-assigned KPS band used (poor, moderate, or good)
`extraspinal`	string	Caller-assigned extraspinal bone mets used (ge_3, one_or_two, or none)
`vertebral`	string	Caller-assigned vertebral mets used (ge_3, two, or one)
`visceral`	string	Caller-assigned visceral mets used (unremovable, removable, or none)
`primary`	string	Caller-assigned Tokuhashi 2005 primary site group used
`palsy`	string	Caller-assigned palsy used (complete, incomplete, or none)
`components`	array	Per-factor Tokuhashi 2005 points
`citation`	object	Tokuhashi et al. Spine 2005 citation
`disclaimer`	string	Not-a-device notice

Example JSON

Machine form of the same example. Frozen fixture. Not a live lookup.

{
  "primary": "lung",
  "components": [
    {
      "value": "poor",
      "factor": "kps",
      "points": 0,
      "present": true
    },
    {
      "value": "ge_3",
      "factor": "extraspinal",
      "points": 0,
      "present": true
    },
    {
      "value": "ge_3",
      "factor": "vertebral",
      "points": 0,
      "present": true
    },
    {
      "value": "unremovable",
      "factor": "visceral",
      "points": 0,
      "present": true
    },
    {
      "value": "lung",
      "factor": "primary",
      "points": 0,
      "present": true
    },
    {
      "value": "complete",
      "factor": "palsy",
      "points": 0,
      "present": true
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Tokuhashi Y, Matsuzaki H, Oda H, Oshima M, Ryu J",
    "doi": "10.1097/01.brs.0000180401.06919.a5",
    "id": "tokuhashi-2005",
    "pmid": "16205345",
    "source": "Spine (Phila Pa 1976). 2005;30(19):2186-2191",
    "title": "A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis."
  },
  "formula": "tokuhashi",
  "formula_expression": "Tokuhashi = kps (poor 0, moderate 1, good 2) + extraspinal (ge_3 0, one_or_two 1, none 2) + vertebral (ge_3 0, two 1, one 2) + visceral (unremovable 0, removable 1, none 2) + primary (lung osteosarcoma stomach bladder esophagus pancreas 0; liver gallbladder unidentified 1; others 2; kidney uterus 3; rectum 4; thyroid prostate breast carcinoid 5) + palsy (complete 0, incomplete 1, none 2); Tokuhashi 2005 revised; max 15; bands 0-8 (<6 months), 9-11 (>=6 months), 12-15 (>=12 months)",
  "max_score": 15,
  "score": 0,
  "kps": "poor",
  "extraspinal": "ge_3",
  "palsy": "complete",
  "tokuhashi_band": "0-8",
  "vertebral": "ge_3",
  "visceral": "unremovable"
}

Client errors (HTTP 400)

Invalid params return 400 without charge. Shared HTTP 402 and 503 meanings: Payments.

HTTP	Code	When
400	`invalid_tokuhashi`	kps must be poor, moderate, or good; extraspinal must be ge_3, one_or_two, or none; vertebral must be ge_3, two, or one; visceral must be unremovable, removable, or none; primary must be a Tokuhashi 2005 site group; palsy must be complete, incomplete, or none (revised Tokuhashi 0-15). Returned before settlement; you are not charged.
400	`invalid_items`	POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
400	`invalid_item_count`	items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
400	`invalid_item`	each items entry must be a JSON object Returned before settlement; you are not charged.

Related tools

SINS — Sum the Fisher 2010 Spinal Instability Neoplastic Score from six caller-assigned items and return the published 0–18 integer total. Not later SOSG stability strata and not an operative order.
Mirels — Sum the Mirels 1989 score for diagnosing impending pathologic fractures in long-bone metastatic disease from four caller-assigned items and return the published 4–12 integer total and band (≤7 / 8 / ≥9). Not an operative order and not SINS.

Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. Unpaid valid requests return HTTP 402 with a base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote: retry the same PAYMENT-SIGNATURE. Full handshake and shared payment errors: Payments. Stdio MCP: /docs/mcp.

Guarantees

HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
Execution is timeout-bounded and concurrency-capped.
Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.