Biomedical subjects

W Puhl

Publications and source records attributed to W Puhl.

At least 145 records · Page 8Linked to original sources

PubMedDate not supplied

[Outcome predictors of intertrochanteric osteotomy in avascular necrosis of the hip].

PURPOSE OF THE STUDY: To find radiographic predictors for the clinical outcome in patients who underwent an intertrochanteric osteotomy (ITO) because of avascular necrosis of the femoral head (AVN). METHOD: Between 1985 and 1996 in 93 patients with an AVN (mean age 39,5 years +/- 8.8 y.) an ITO was performed. 83 patients (89 %) were available for follow up at an average post-op time of 84 months +/- 40.7 mon. We used the Ficat and ARCO classifications for staging of the disease. The combined necrotic angle of Kerboul was used to measure the size of the lesion. The clinical outcome was estimated using the Harrisp hip score (HHS) and the WOMAC. Survival time of the ITO was estimated using Kaplan-Meier survivorship analysis with the implantation of a hip prosthesis as endpoint. RESULTS: 27 patients (30.8 %) underwent an arthroplasty after an average time of 35.1 mon. +/- 30,4 mon. after the osteotomy. Survival rate of an ITO was 67 % after 5 y, and 46 % after 10 y. In case of a preoperative Kerboul angle > 200 degrees the survival rate of an ITO was significantly lower and the WOMAC index (3.1 +/- 2.4) significantly worse (p < 0.05) than in patients with a Kerboul angle < 200 degrees (1,8 +/- 1.8). In Ficat stage III/IV or ARCO stage IVVI the survival rate of an ITO was significantly lower when compared to stages I/II and IIII. There was no clinical difference in the HHS comparing different stages. CONCLUSION: The Kerboul angle was the best parameter to predict the clinical outcome and the survival rate of an ITO. The classifications of Ficat and ARCO were found to be a predictor for the survival rate of an ITO but not for the clinical outcome.

Adult↗

PubMedDate not supplied

[Review and comparison of culture-techniques for articular chondrocytes].

AIM: In-vitro techniques for articular chondrocytes allow the analysis of their metabolism in the presence and absence of mediators or drugs against osteoarthritis or rheumatoid arthritis, as well as the synthesis of de-novo cartilage tissue for implantation into articular defects in vivo. This review aims to give an overview about the basics of different methods of cultivation of articular chondrocytes and about several specific demands (e.g., phenotypical stability with synthesis of aggrecan and type-II collagen, no cell-to-cell contact, low proliferation rates, low matrix molecule turn-over) to such methods. METHOD: Current techniques for the cultivation of articular chondrocytes and their development were identified via "medline". Their evaluation was based on our own experience and on data from the literature. RESULTS: Two- and three-dimensional culture systems are employed to maintain articular chondrocytes in vitro. Two-dimensional cultures (monolayer) support the proliferation of articular chondrocytes, but lead to a de-differentiation to fibroblast-like cells. Three-dimensional set-ups (e.g., organ, alginate, agarose cultures) not only maintain the articular cartilage phenotype, but they also support the re-differentiation of de-differentiated chondrocytes. CONCLUSION: The choice of a culture system for in-vitro studies with articular chondrocytes should be adapted to the question asked.

Arthritis, Rheumatoid↗

PubMedDate not supplied

[Revision total hip arthroplasty: how do metaphyseal onset, diaphyseal fill and a three-point-stem-fixation influence the postoperative subsidence of a revision straight-stem?].

AIM: It was the purpose of this study to determine the postoperative subsidence of a cementless hip revision stem in regard to the degree of metaphyseal onset, diaphyseal fit and a three-point contact of the stem in the femur. METHODS: Data of 50 revision total hip replacements using a cementless revision straight stem (PFM-R) could be investigated. The degree of subsidence was measured on pelvic X-rays 6 and 12 months postoperatively. The degree of metaphyseal onset, diaphyseal fit and a three-point contact of the stem in the femur was determined on the immediate postoperative X-rays. RESULTS: The amount of subsidence was strongly related to the degree of metaphyseal onset. With minor onset (up to 25 % of the possible) stems subsided 9.4 (6 months), respectively, 13.2 millimeters (12 months) in average within the investigation periods. If there was a large degree of metaphyseal onset (more than 75 % of the possible) the average subsidence was only 1.6 (6 months) or 0.9 millimeters, respectively (12 months). Neither the amount of diaphyseal fit nor the presence of three-point contact of the stem in the femur influenced the subsidence significantly. Conclusion The amount of the postoperative subsidence of stems in cementless revision total hip arthroplasty is predominantly influenced by the degree of the metaphyseal onset of the prosthesis.

Adult↗

PubMedDate not supplied

[The Knee Injury and Osteoarthritis Outcome Score--a multifunctional questionnaire to measure outcome in knee arthroplasty].

AIM: It was the purpose of this investigation to create a German version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and to test its appropriateness in patients with advanced gonarthritis. METHOD: Reliability (test-retest reliability, internal consistency), validity (convergent construct validity and divergent construct validity), sensitivity to change as well as practicability and acceptance of this questionnaire were tested in 90 patients. RESULTS: The test-retest reliability was acceptably high for all subscales, it ranged between r = 0.65 and 0.78 and the questionnaire showed a high internal consistency in almost all of the subscales. The comparison to the results of the questionnaire "Short Form-12" (SF-12) as well as to the patients self-assessment of health status showed high concordance in nearly all subscales, however it was only moderate for the symptom scale. Furthermore the KOOS was able to show significant differences between patients and healthy controls. When testing the sensitivity to change, the KOOS could demonstrate significant improvements within 3 months and the instrument has shown to be practicable with a high acceptance by the patients. CONCLUSION: With the German version of the Knee Injury and Osteoarthritis Outcome Score a multidimensional instrument is available now to measure health status as well as therapeutic effects in patients with knee problems. Modifying the subscale "symptoms" could further optimize this questionnaire in patients with advanced gonarthritis.

Adolescent↗

PubMedDate not supplied

[Posterior dynamic stabilization as an alternative for dorso-ventral fusion in spinal stenosis with degenerative instability].

AIM: Our retrospective study analyzed the outcome of patients with degenerative lumbar instability with spinal stenosis, who underwent decompression surgery with dorsoventral fusion (Group I) and decompression surgery with posterior dynamic stabilization (Group II). METHOD: For 10 patients in each group intra- and postoperative data were obtained and the functional outcome was evaluated with the "Oswestry Low Back Pain Disability Questionnaire" (OQ) and the "Short Form 36 Health Survey Questionnaire" (SF-36). The average follow up was 14.4 months in Group I, 15.2 months in Group II. RESULTS: In Group I the OQ averaged postoperatively 32 points (preoperatively 46 points), the "Physical Component Summary" (PCS) of SF-36 averaged 34 points (preoperatively 24 points), the "Mental Component Summary" (MCS) averaged 43 points (preoperatively 36). In Group II the values at follow up were as follows: OQ 33 points (preoperatively 54), PCS 34 points (preoperatively 28) and MCS 46 points (preoperatively 36). The average hospitalization was 28.4 days in Group I, 19.3 days in Group II and the average operation time was 218 minutes in Group I, 163 minutes in Group II. CONCLUSION: When compared the functional outcome, the dynamic stabilization seems to be a promising alternative to fusion in patients with degenerative lumbar instability with spinal stenosis.

Aged↗

PubMedDate not supplied

[The impact of bone morphogenetic protein-2 (BMP-2), vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (b-FGF) on osseointegration, degradation and biomechanical properties of a synthetic bone substitute].

INTRODUCTION: It was the purpose of this investigation to test the osteointegrative capacity and the degradation rate of a neutralized glass ceramic within an animal model after loading with different growth factors. MATERIALS AND METHODS: The glass ceramic GB9N was implanted in the medial tibial head of mature merino sheep (n = 48) after being loaded with either Bone Morphogenetic Protein-2 (BMP-2, 100 micro g/100 micro l), Vascular Endothelial Growth Factor (VEGF, 100 micro g/100 micro l), basic Fibroblast Growth Factor (b-FGF, 60 micro g/100 micro l) or unloaded. At 4 weeks (n = 24) and 9 months (n = 24) after operation histomorphological, histomorphometrical and biomechanical investigations were performed. RESULTS: The amount of newly formed bone was different within the study groups after 4 weeks. BMP-2 induced a significant increase in bone formation and a significant decrease of residual substitute. b-FGF and VEGF induced no such effects in comparison to the controls. Biomechanical investigations could only demonstrate slight increases of the maximal fracture load in the BMP-2 group after 4 weeks in comparison to the others. At 9 months after operation no differences concerning newly formed bone could be found in the study groups comparing to the controls. Only the amount of residual substitute was still significantly lower in the BMP-2 group. Biomechanical data could demonstrate maximal fracture loads of all study samples achieving the level of the controls. CONCLUSION: This investigation has demonstrated that by combining synthetic bone substitutes with growth factors certain parameters of the bone remodelling process can intitially be influenced in a positive way.

Animals↗

PubMedDate not supplied

[Evidence-based medicine in orthopedics - a sensible or unnecessary addition to clinical routine? Part 1: the diagnostics tool].

AIM: The methods of evidence based medicine (EBM) are recommended to solve problems in day-to-day routine. Aim of this article is to demonstrate the practicability of this procedure for the diagnostic module. METHODS: Within a teaching session in our department 20 participants guided by an extern al EBM teacher validated the results of an article according to the EBM criteria concerning the module "diagnosis". We demonstrate what EBM can contribute to solve day-to-day clinical problems and discuss the six formal steps for the implementation of EBM into day-to-day practice. 1) To transform the clinical problem into an answerable 4-part question. 2) To answer this question based on your internal evidence. 3) To search for external evidence to answer this question. 4) To critically appraise the evidence found with respect to its validity, importance and applicability. 5) To integrate the appraised external evidence into your existing internal evidence in order to come to a new decision if the additional new external evidence is convincing. 6) To assess the benefit which was gained for the patient. RESULTS: Statistical tests to evaluate the relevance and validity of the chosen article were performed. The following data were determined: sensitivity, specifity, pretest probability, posttest probability, likelihood ratio, positive predictive value, negative predictive value. CONCLUSION: In conclusion we show that EBM can help to solve day-to-day clinical problems, because the structured analysis of concrete questions can lead to a validation of the literature.

Clinical Competence↗

PubMedDate not supplied

[Evidence-based medicine in orthopaedics - a sensible or unnecessary addition to clinical routine? Part 2: the therapy tool].

AIM: In the second part of our project to implement evidence-based medicine into day-to-day clinical practice the module therapy is presented. METHODS: Within a teaching session in our department 20 participants guided by an extern al EBM teacher validated the results of an article according to the EBM criteria concerning the module therapy. To work with this module formal procedures are necessary, too. RESULTS: Statistical tests to evaluate the relevance and validity of the chosen article were performed. The following data were determined: relative risk reduction, absolute risk reduction, number needed to treat. CONCLUSION: In conclusion we can show, that EBM can help to solve day-to-day clinical problems, because the structured analysis concerning valid answers to concrete clinical problems is possible.

Clinical Competence↗

PubMedDate not supplied

[Revision total hip arthroplasty: analysis of the predictive value of a radiographic classification system for assessment of bone stock loss].

AIM: The aim of this study was to evaluate the predictive value of a radiographic classification system concerning implant and bone graft in revision total hip arthroplasty. This classification is used to assess bone stock loss prior to surgery, thus hypothetically enabling an adequate choice of the implant and bone graft required. METHOD: 33 consecutive patients with the diagnosis of aseptic failure of total hip arthroplasty were included in the study. The investigation was performed using the classification system according to Saleh et al. The predictive value was analyzed by comparing the radiographically based recommendation concerning implant and bone graft and the intraoperative procedure according to a blinded observer technique. The Spearman coefficient of correlation (r (s)) was used to establish levels of agreement among multiple ordinal variables. RESULTS: Analysis of correlation between preoperative radiological estimations and intraoperative conclusions concerning implant and bone graft revealed coefficients of correlation (r (s)) of 0.53 (p < 0.01) for the acetabular and of 0.63 (p < 0.01) for the femoral classification. CONCLUSION: Our results indicate that the Saleh classification does not provide sufficient information for preoperative assessment of the revision implant and bone graft required concerning the acetabular side, whereas planning of the operative procedure regarding the femoral implant seems to be possible. These ambivalent findings should be taken into account prior to revision total hip arthroplasty.

Acetabulum↗

PubMedDate not supplied

[Sagittal alignment and segmental range of motion after total disc replacement of the lumbar spine].

AIM: To evaluate changes in static and dynamic values, X-rays of patients who underwent total disc replacement for degenerative disc disease were analyzed. METHOD: An analysis of pre- and postoperative lateral X-rays in 22 patients with 24 total disc replacements (Prodics, Spine Solutions) was performed. The total lumbar lordosis, the segmental lordosis angle, the disc height and the range of motion in the operated level were measured. RESULTS: Postoperatively a significant increase was observed for the following parameters: the anterior (pre: 9.0 +/- 3.4 mm; post: 16.7 +/- 2.4 mm; p < 0.001) and posterior (pre: 4.4 +/- 1.3 mm; post: 8.8 +/- 1.3 mm; p < 0.001) disc height and the segmental lordosis angle (pre: 20 degrees +/- 7.2 degrees; post: 27.7 degrees +/- 7.4 degrees; p < 0.001). Statistically no significant changes could be observed postoperatively for the total lumbar lordosis (pre: 56.2 degrees +/- 10.7 degrees; post: 58.6 degrees +/- 9.3 degrees; p = 0.196) and the range of motion (pre: 5.0 degrees +/- 4.0 degrees; post: 5.9 degrees +/- 3.5 degrees; p = 0.293). CONCLUSION: Total disc replacement for degenerative disc disease of the lumbar spine with the current concept does not alter the range of motion but significantly increases the disc height. The significant increase in segmental lordosis without a change in the total lumbar lordosis accounts for a change in lordosis in adjacent segments.

Adult↗

PubMedDate not supplied

[Analysis of validity and reliability of three radiographic classification systems for preoperative assessment of bone stock loss in revision total hip arthroplasty].

AIM: It was the purpose of this prospective study to analyze validity and reliability of three different radiographic classification systems, which are used to assess bone stock loss prior to revision total hip arthroplasty. METHOD: Investigation was performed using the classification systems according to 1) Paprosky et al., 2) Hungerford et al., and 3) the German Society of Orthopaedics and Traumatology (DGOT). Twenty-eight consecutive patients with diagnosis of aseptic failure of total hip arthroplasty were enrolled in the study. Interrater agreement was analyzed by evaluating the classifications preoperatively by three investigators with different level of clinical experience using a blinded observer technique. Validity was analyzed by comparison of preoperative radiographic findings (n = 3) and an intraoperative control by visualization and palpation (n = 1). Spearman coefficient of correlation (r(s)) was used to establish levels of agreement among multiple ordinal variables. RESULTS: Interrater reliability testing using paired comparison between the three investigators revealed non-homogeneous coefficients of correlation (r(s): Paprosky femur: 0.45 - 0.67, acetabulum: 0.38 - 0.63; Hungerford: 0.46 - 0.66; DGOT femur: 0.38 - 0.59, acetabulum: 0.42 - 0.76). Paired analysis of correlation between preoperative and intraoperative findings again showed non-homogeneous coefficients of correlation (r(s): Paprosky femur: 0.59 - 0.68, acetabulum: 0.39 - 0.70; Hungerford: 0.39 - 0.74; DGOT femur: 0.44 - 0.60, acetabulum: 0.36 - 0.76). In general, defects were grossly underestimated preoperatively. The level of experience did not influence the validity of measurements. CONCLUSION: Our results indicate that these classifications do not provide valid and reliable assessment of femoral and acetabular bone stock loss prior to revision total hip arthroplasty.

Acetabulum↗

PubMedDate not supplied

[Vertebral body replacement with expandable titanium cages].

OBJECTIVES: The aim of vertebral body replacement is the stabilisation and restoration of the anterior column of the spine with removal of the diseased region. We present our results of stabilisation, pain reduction and neurological improvement using vertebral-body replacement systems METHODS: Between April 1997 and December 2002, 53 patients with malignant vertebral destruction or instability due to traumatic and osteoporotic fracture were treated. We evaluated the results after vertebrectomy and vertebral body replacement by using expandable titanium cages in a retrospective study. RESULTS: The average follow-up time was 18.9 +/- 19.9 months. The mean operation time was 173.2 +/- 77.4 minutes. Intraoperatively, we saw no implant-related complications. Perioperatively, complications appeared in 18 patients (34.0 %). 4 of them were severe, with 2 patients dying. In the total follow-up, 16 patients died, 10 of them (62.5 %) due to tumour progression. Pain reduction was reported in 52.7 %, neurological improvement in 48.0 %. One patient had a loosening of his posterior instrumentation in the further follow-up due to tumour growth with dislocation of the cage and a deterioration of his neurological deficit. CONCLUSION: By using vertebral body replacement systems, sufficient stabilisation of the vertebral column, pain reduction and neurological improvement can be achieved with an acceptable perioperative risk.

Bone Plates↗

PubMedDate not supplied

[Reliability of transcutaneous measurement of oxygen tension on the lower leg].

AIM: Measurement of transcutaneous oxygen tension is increasingly used to determine the appropriate level of amputation in patients with vascular disease. The purpose of the present study was to analyze the intra- and interrater reliability of transcutaneous oxygen [tcpO (2)] measurements in a homogeneous study group. METHOD: Five investigators assessed the transcutaneous oxygen tension of both lower legs of seven persons in a fixed setting. Assessment was repeated with the same examiners and the same examinees after 24 hours. TcpO (2) was measured at the posterior aspect of the lower leg twenty centimeters below the knee joint line. The TCM 400 Monitoring System (Radiometer Medical AIS, Bronshoj, Denmark) was used. Statistical analysis of the intra- and interrater reliability was performed with the Spearman coefficient of correlation. RESULTS: An overall mean of 56.2 +/- 10.6 mmHg was found. For the first examination, a mean of 55.3 +/- 10.6 mmHg was observed, whereas for the second examination it was 57.0 +/- 10.5 mmHg. Analysis of intrarater reliability showed a coefficient of correlation of r (s) = 0.56 (p < 0.0001). For interrater reliability, we found coefficients of correlation ranging from r (s) = 0.20 (p = 0.20) to r (s) = 0.69 (p = 0.0004). CONCLUSION: Analysis of transcutaneous oxygen tension measurements performed by different investigators in a fixed setting revealed a non- homogeneous intra- and interrater reliability, which should be taken into account prior to initiating therapy.

Adult↗

PubMedDate not supplied

[Calcaneal cyst: a classical simple bone cyst?].

INTRODUCTION: In the calcaneus differentiation between a solitary cyst and intraosseus lipoma is difficult. Radiologists frequently diagnose an intraosseus lipoma, whereas histology shows the classical signs of a solitary bone cyst. We present 12 cases of a solitary cyst of the calcaneus. MATERIAL AND METHODS: Between 1993 and 2001 we operated on 12 patients (8 men, 4 women, median age 28 +/- 14 years) with calcaneal cysts. 9 patients received a curretage and an autologous, one patient a homologous, one patient a mixed autologous-homologous bone-grafting and one patient only a curretage (due to the small diameter of the cyst) of their cysts. RESULTS: No case revealed the histological picture of a fatty formation, which appears to be typical for an intraosseus lipoma. All of the microscopic findings resembled the characteristics seen in cysts of the long bones. A pathological fracture has not been observed. CONCLUSION: The histologically confirmed calcaneal cysts showed the radiological signs that are supposed to be typical for an intraosseous lipoma. It cannot be decided whether the histologically diagnosed calcaneal lipomas described by others can be interpreted as fatty degeneration of a calcaneal cyst, or whether fatty areas of the bone marrow have given a wrong impression. Since the literature only describes single isolated cases of a pathological fracture of the calcaneal cyst or lipoma, asymptomatic patients should be treated non-operatively.

Adolescent↗

PubMedDate not supplied

[Minimally invasive therapy for osteoid osteoma].

AIM: We describe a minimally invasive procedure for the treatment of osteoidosteoma and present the outcome of the treatment in our collective. Additionally, a review of the literature for minimally invasive therapy for osteoidosteoma was performed. METHODS: Within approximately three years, ten male patients with the clinical and radiological diagnosis of osteoidosteoma were treated. First, during the procedure for the purpose of orientation, a CT scan of the affected area was performed. Then, under CT-guidance, the nidus of the osteoidosteoma was marked with a k-wire and destroyed with a drill, moulding cutter or the k-wire. The patients' charts and films were reviewed in a retrospective manner, all patients participated in a personal telephone interview. RESULTS: In all cases the intraoperative course was free of complications. After surgery 90 % of the patients were free of pain, in 10 % a significant reduction of the pain was reported. Both in those 10 % and the whole collective there were no clinical symptoms of relapse, the average follow-up in all cases was 19 months. Our results are in accord with data in the literature. CONCLUSION: In our collective the CT-guided, percutaneous removal of osteoidosteoma has been shown to be a safe and effective method. Under DRG conditions it can be performed within a short period of hospitalization or in the out-patient clinic.

Adolescent↗

PubMedDate not supplied

[What influence doe the implant have on the perioperative morbidity following internal fixation of proximal femur fracture? Analysis of dynamic hip screw and proximal femoral nailing].

RATIONALE: Proximal femur fracture is a frequent finding in elderly patients. Both the dynamic hip screw (DHS) and the proximal femur nail (PFN) are established implants. The aim of our study was to assess the perioperative morbidity in a sample of 112 patients with proximal femur fracture, operated on with either DHS or PFN. MATERIAL AND METHODS: Data of 112 consecutive patients (59 DHS, 53 PFN), which consisted of 20 variables, were obtained. Nine variables were selected, which were considered to possess a potential impact on the complication rate. These variables were type of implant, sex, age, period between trauma and surgery, ASA classification, fracture classification of the ASIF, duration of surgery, blood loss, and antibiotics. They were transformed into dichotomous data to enable univariate statistical analysis and logistic regression. RESULTS: The ASA classification only was evaluated to have a predictive value as shown by the odds ratio of 2.23 (90 % confidence interval: 1.09 - 4.56). ASA 3 or 4 patients had an expected frequency, which was 2.2-fold increased as compared to patients classified as ASA 1 or 2, to suffer from perioperative complications. Using logistic regression, again the ASA classification only was shown to have a significant impact (p = 0.066, level of significance: p < 0.1) on the perioperative morbidity. CONCLUSION: As suggested by our results, neither the type of implant nor the other variables mentioned above had a significant impact on the resulting complication rate in our study sample. The ASA classification only was found to significantly increase the probability of an adverse event. This finding should be taken into account prior to initiating therapy.

Aged↗

PubMedDate not supplied

[Outcome assessment in total knee arthroplasty: is the clinical measurement of range of motion a reliable measurable outcome variable?].

AIM: The aim of this clinical study was to investigate the reliability of the clinical assessment (visual and goniometric) of the range of motion of the knee joint. METHOD: 30 patients were assessed concerning the range of motion of their knee joints by visual and goniometric measurements. Assessment was performed by three investigators. The obtained data were used to analyse the intra- and interobserver reliability. Statistical analysis was performed using the Spearman coefficient of correlation [r (s)]. RESULTS: Intraobserver agreement was consistent across observers regarding the visual and goniometric assessment of flexion (r (s) > 0.6), whereas reliability was uniformly low for both measurements regarding the assessment of extension (r (s) < 0.6). Interobserver agreement was consistent across all three goniometric and two out of three visual assessments regarding the measurement of flexion (r (s) > 0.6); the interobserver reproducibility of extension, however, was uniformly low both for the visual and goniometric measurements (r (s) < 0.6). CONCLUSION: Reliability of clinical assessment of range of motion should be taken critically into consideration whilst performing classical function-related scoring systems when measuring outcome after total joint arthroplasty, since these scoring systems are strongly based on a valid and reliable assessment of range of motion.

Arthroplasty, Replacement, Knee↗

PubMedDate not supplied

[Prognosis, surgical therapy and progression in cervical and upper-thoracic tumor osteolysis].

INTRODUCTION: This study analyzes the early and mid-term results of our modular rod-screw implant system for the posterior instrumentation of the occipito-cervical, cervical and cervico-thoracic spine (neon occipito-cervical system, Ulrich, Germany) in patients with tumor osteolysis. The prognosis of the patients was evaluated using the Tokuhashi score. METHODS: The cervical and upper thoracic spines of 14 patients (7 males, 7 females, mean age 61 years, range 40-77 years) with osteolysis due to plasmocytoma (n = 2), bronchial (n = 3), mamma (n = 4), thyroid (n = 2), esophageal (n = 1) and pancreatic (n = 1) carcinomas as well as melanoma (n = 1) were instrumentated between June 2001 and April 2004. RESULTS: A stable fixation without loosening or failure of the fixator system was achieved in all cases. No impairment of the neurological status was observed. In our cohort different prognosis scores failed to make a reliable estimate of the expected survival at the time of surgery. CONCLUSION: Posterior instrumentation of the cervical spine including the occipito-cervical and the cervico-thoracic regions with a modular angle-stable rod-screw implant system (neon) offers good stabilization and allows simultaneous decompression. Since tumor masses are predominantly located in the anterior portion of the spine, blood loss can be controlled well. In this patient collective appears difficult to estimate the time of survival by a scoring system.

Adult↗