# Revised Tokuhashi metastatic spine tumor score

Tokuhashi

Status: WEDGE
Price: $0.005 USDC
`GET /api/calc/tokuhashi`
HTML: https://magentlab.com/docs/tokuhashi
Markdown: https://magentlab.com/docs/tokuhashi.md

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

## What it computes

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.

## 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

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

## Worked example

### All minimum grades

Given: `extraspinal=ge_3, kps=poor, palsy=complete, primary=lung, vertebral=ge_3, visceral=unremovable`

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


### Band 9-11

Given: `extraspinal=none, kps=good, palsy=none, primary=others, vertebral=two, visceral=none`

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


### All maximum grades

Given: `extraspinal=none, kps=good, palsy=none, primary=breast, vertebral=one, visceral=none`

1. good 2 + none 2 + one 2 + none 2 + breast 5 + none 2
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

## Parameters

- `kps` (string, required): 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): 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): 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): 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): 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): 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.

Method: `POST /api/calc/tokuhashi`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: 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:

```json
{
  "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"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/tokuhashi

Example 200:

```json
{
  "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 fields

- `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

Frozen fixture. Not a live lookup.

```json
{
  "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"
}
```

## Errors

- HTTP 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.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [SINS](https://magentlab.com/docs/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](https://magentlab.com/docs/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.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/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.