Introduction The ability to predict the outcome of surgical intervention in patients with metastatic spine tumor will help reduce unnecessary surgery in patients with advance disease, while encouraging surgery in patients who are likely to benefit. The Tokuhashi predictive score has provided a template that can be used to assess the suitability of treatment modality. The aim of the study is to compare outcomes of surgeries done with the Tokuhashi predictive score over a 5-year period at the Amrita Institute of Medical Sciences, Kochi, India, from January 1, 2007 to December 31, 2012. Methods Medical records of all patients who had diagnostic and/or therapeutic surgeries for metastatic spine tumor during the study period were retrieved and data were extracted and analyzed. Phone calls and letters were used to trace patients or their relations to ascertain whether the patients were alive or not on June 30, 2014. Results Data of 38 patients, 27 male and 11 female patients, were analyzed. Median age was 55 years. Unknown primary tumor accounts for the highest tumor (13), while carcinoma occurred in 24 patients (63.16%), making it the highest histological type. The Tokuhashi predictive scores are as follows: 0–8 (39.49%), 9–11 (52.63%), and 12–15 (7.89%). Nine patients (23.68%) were alive as on June 30, 2013. Conclusions Tokuhashi score is a reliable parameter for predicting outcome of life expectancies following surgery in patients with metastatic spine tumors. Tokuhashi score can be used to select the choice of treatment modalities in patients with metastatic spine tumors.