Prospective validation of a clinical prediction score for survival in patients with spinal metastases: the New England Spinal Metastasis Score

Spine J. 2021 Jan;21(1):28-36. doi: 10.1016/j.spinee.2020.02.009. Epub 2020 Feb 19.


Background context: The New England Spinal Metastasis Score (NESMS) was proposed as an intuitive and accessible prognostic tool for predicting survival in patients with spinal metastases. We designed an appropriately powered, prospective, longitudinal investigation to validate the NESMS.

Purpose: To prospectively validate the NESMS.

Study design: Prospective longitudinal observational cohort study.

Patient sample: Patients, aged 18 and older, presenting for treatment with spinal metastatic disease.

Outcome measures: One-year mortality (primary); 6-month mortality and mortality at any time point following enrollment (secondary).

Methods: The date of enrollment was set as time zero for all patients. The NESMS was assigned based on data collected at the time of enrollment. Patients were prospectively followed to one of two predetermined end-points: death, or survival at 365 days following enrollment. Survival was visually assessed with Kaplan-Meier curves and then analyzed using multivariable logistic regression, followed by Bayesian regression to assess for robustness of point estimates and 95% confidence intervals (CI).

Results: This study included 180 patients enrolled between 2017 and 2018. Mortality within 1-year occurred in 56% of the cohort. Using NESMS 3 as the referent, those with a score of 2 had significantly greater odds of mortality (odds ratio 7.04; 95% CI 2.47, 20.08), as did those with a score of 1 (odds ratio 31.30; 95% CI 8.82, 111.04). A NESMS score of 0 was associated with perfect prediction, as 100% of individuals with this score were deceased at 1-year. Similar determinations were encountered for mortality at 6-months and overall.

Conclusions: This study validates the NESMS and demonstrates its utility in prognosticating survival for patients with spinal metastatic disease, irrespective of selected treatment strategy. This is the first study to prospectively validate a prognostic utility for patients with spinal metastases. The NESMS can be directly applied to patient care, hospital-based practice and health-care policy.

Keywords: Decision-making; NESMS; Predictive score; Spinal metastases; Surgery; Survival.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bayes Theorem
  • England / epidemiology
  • Humans
  • Prognosis
  • Prospective Studies
  • Spinal Neoplasms*
  • Survival Analysis