Evaluation of the Tokuhashi prognosis score and its modifications in 217 patients with vertebral metastases.

AIM: The Tokuhashi prognosis score consists of six parameters. The sum of points rated for each parameter can be correlated with the prognosis. This study evaluates the score variations that have been done by different authors and Tokuhashi et al. themselves. METHODS: Two hundred and seventeen consecutive patients, surgically treated for vertebral metastases, were studied retrospectively. We calculated the original and modified score of Tokuhashi and evaluated the predictive value for the individual life expectancy. RESULTS: The original and modified Tokuhashi score assured a significant predictive value. Modified criteria by the authors showed the highest reliability between the predicted and real survival, and the patients could be allocated correctly to the desirable instrumentation. CONCLUSION: The original and modified Tokuhashi score showed a significant predictive value. The modified criteria by the authors showed the highest reliability between predicted and real survival.

Gene expression by human articular chondrocytes cultured in alginate beads.

Culture of articular chondrocytes in alginate beads offers several advantages over culture in monolayer; cells retain their phenotype for 8 months or longer. Earlier studies of chondrocytes cultured in alginate concentrated on collagen and proteoglycan synthesis. However, gene expression by in situ hybridization (ISH) has not been investigated. The purposes of the present study on human chondrocytes were (a) to modify the ISH procedure for the alginate beads to examine the mRNA expression of alpha1 (II) procollagen, aggrecan, and two matrix metalloproteinases (MMP-3 and MMP-8) thought to be involved in cartilage matrix degradation, and (b) to compare expression in cultured chondrocytes with that in chondrocytes of intact human cartilage. The modifications made for ISH include the presence of CaCl2 and BaCl2 in the fixation and washing steps and exclusion of cetyl pyridinium chloride. By ISH we show that aggrecan, MMP-3, and MMP-8 are continuously expressed during 8 months of culture. The alpha1 (II) procollagen gene is expressed only during the first 2 months of culture and after 3 months its expression is undetectable, which is consistent with its absence in adult articular cartilage. By Western blotting, Type II collagen protein had been synthesized and deposited in both the cell-associated and further-removed matrix compartments at 7 and 14 days of culture. These data indicate that chondrocytes cultured in alginate beads could be preserved for immunohistochemistry and ISH and that culture of human chondrocytes in alginate beads may serve as a good model for studying cartilage-specific phenotype as well as factors that influence cartilage matrix turnover.

Risk factors for development of proteinuria in chronic spinal cord injury.

A retrospective, case-control study was performed to investigate the risk factors that may contribute to the development of proteinuria in patients with chronic spinal cord injury (SCI). During an 18-month period, 31 subjects with a 24-hour protein excretion of 1.0 g or greater were identified. Three control subjects with SCIs with a 24-hour urinary protein excretion of less than 1.0 g during the same time period were randomly selected for each study subject with proteinuria. Clinical data, including level and duration of injury, age, presence of indwelling bladder catheter, number of decubitus ulcer procedures, serum albumin and creatinine concentrations, hematocrit, creatinine clearance, and the presence of hypertension and diabetes mellitus, were obtained from medical records. Subjects with proteinuria had other evidence of renal dysfunction with greater serum creatinine concentrations and reduced creatinine clearances, serum albumin concentrations, and hematocrits. Proteinuric subjects were older, had a longer duration of injury, had undergone a greater number of decubitus ulcer procedures, and were more likely to have hypertension and indwelling bladder catheters. The independent predictors for the development of proteinuria using logistic stepwise multiple linear regression analysis were the use of chronic indwelling bladder catheters, number of decubitis ulcer procedures, presence of hypertension, and older age. These data suggest that inflammatory complications associated with complications of chronic SCI, rather than SCI per se, contribute to the development of proteinuria. SCI patients with proteinuria have more impaired renal function and increased mortality compared with SCI patients without proteinuria.

Osteoarthritis in ankle and knee joints.

Ankle and knee joints differ in their susceptibility to osteoarthritis (OA). This article reviews literature on differences between these joints. A Medline search and search of bibliographies of review articles was conducted. Knee cartilage degeneration leads to the development of OA with clinical symptoms, whereas the ankle cartilage develops fissures that do not appear to progress to later stages of OA. Epidemiological studies support these findings. Factors that might explain this phenomena include differences in joint motion, cartilage thickness, congruency, mechanical forces, and even evolutionary changes. Data suggest that chondrocytes from the two joints may respond differently to stimuli. Comparisons of cartilage from the knee and ankle joint of the same donor may provide a better understanding of the biochemical and molecular processes that induce the pathogenesis of OA and may provide new approaches to early detection and treatment.

Benefits of various dextrans after delayed therapy in necrotizing pancreatitis of the rat.

OBJECTIVE: Ultrahigh-molecular dextran (500,000 Da) has been shown to prevent pancreatic necrosis when given 30 min after induction of pancreatitis. This study should clarify the following: (a) are dextrans still effective after prolongation of the therapy-free interval? (b) what is the impact of the molecular weight of the dextrans? and (c) is their effect influenced by the dextran concentration or by the addition of hypertonic saline? ANIMALS AND INTERVENTIONS: Acute pancreatitis was induced in 70 male dextran-tolerant Wistar rats using intraductal bile-salt infusion and intravenous hyperstimulation. After 3 h, animals were assigned to one of seven groups (n = 10 per group) receiving either Ringer solution or different dextrans (10%) including 70,000 Da (DEX-70), 160,000 Da (DEX-160), 300,000 Da (DEX-300) or 500,000 Da (DEX-500). Additional groups included DEX-70 (6%) and DEX-70 (10%) in combination with hypertonic NaCl (7.5%) (HHS-70). Ringer solution was given at 24 ml/kg and all dextrans at 8 ml/kg. MEASUREMENTS AND RESULTS: Trypsinogen activation peptides (TAP) were quantified in ascites and acinar necrosis after death or sacrifice at 9 h. As an index of less pathological trypsinogen activation, the mean TAP levels in ascites were significantly lower in DEX-70 and DEX-160 compared to Ringer controls (p < 0.05, t-test). Furthermore, the amount of acinar necrosis was significantly lower in all dextran groups except the HHS-70 in comparison with Ringer controls (p < 0.01, t-test). Finally, mortality was significantly reduced from 60% in Ringer controls to 10 and 0%, respectively, in the groups treated with DEX-70 and DEX-160 (p < 0.03, Fisher's Exact test). There was a similar trend in all other groups except the HHS-70. CONCLUSIONS: Despite a therapy-free interval of 3 h, dextrans reduce trypsinogen activation, prevent acinar necrosis, and improve survival in necrotizing rodent pancreatitis. The molecular weight and concentration of dextran are of secondary importance for these beneficial effects.

Oral contraceptive steroid induced platelet coagulant hyperactivity: dissociation of in vivo and in vitro effects.

The use of oral contraceptives (OC) has been associated with an increased risk of thromboembolic events in a subset of women. Factors predisposing to this problem are still not clearly defined although an increased platelet coagulant activity (CA) has been reported. This study was designed to evaluate the CA of platelets from asymptomatic current OC users compared with control subjects. The asymptomatic OC users were found to have evidence of hypercoagulability in the form of increased availability of platelet CA. These findings were present in both collagen stimulated and unstimulated platelets. In order to understand the mechanism we examined the in vitro effects of estradiol and/or progesterone on platelets. Platelets from normal males were incubated for one hour with estrogen and/or progesterone. There was no significant difference in CA of hormone treated platelets compared with control platelets from the same donor. CA was analyzed in platelets exposed to epinephrine, adenosine diphosphate, and collagen in the platelet aggregometer. Although a dose dependent effect was observed on CA of platelets exposed to the range of aggregating agents, the results show no significant difference between CA of the hormone treated and control platelets (p greater than 0.05). Likewise, platelet aggregation and release of nucleotide were not different between hormone treated and control platelets. Thus a direct effect of the hormones on platelets is an unlikely mechanism causing the increased CA seen in OC users.

Long-term effects of osteogenic protein-1 on biosynthesis and proliferation of human articular chondrocytes.

OBJECTIVE: To study the long-term effects of OP-1 on the biosynthesis and proliferation of human articular chondrocytes. METHODS: Chondrocytes were released from human cartilage from 10 organ donors of different ages and cultured in alginate. They were exposed to OP-1 (0-200 ng/ml) for 3 to 60 days. Proteoglycan (35S-sulfate) and collagen (3H-proline) synthesis were measured by radiolabeling. Proteoglycan content was determined by a dimethylmethylenblue assay, hydroxyproline content by a colorimetric assay, and DNA content by a fluorometric assay. RESULTS: Long-term (60 days) cultures of human adult articular chondrocytes stimulated by OP-1 (50 ng/ml) revealed a relative decrease of proteoglycan and collagen synthesis. However, proteoglycan (5-fold) and collagen (1.4-fold) content were increased even after 60 days in culture when compared to controls. Maintaining the chondrocyte phenotype (aggrecan synthesis as the main proteoglycan) in long-term culture, OP-1 (50 ng/ml) stimulated proliferation up to 2.4-fold. CONCLUSION: Maintaining a stable phenotype and accelerating matrix assembly and proliferation in long-term culture OP-1 might support the tissue engineering of human cartilage.

Interactions between human osteoarthritic chondrocytes and synovial fibroblasts in co-culture.

OBJECTIVE: To imitate the in vivo joint situation and to allow cell interactions, a co-culture system of human osteoarthritic chondrocytes and synovial fibroblasts from a single joint was established and characterized with or without stimulation by IL-1 beta. METHODS: Culture settings included chondrocytes in alginate alone, synovial fibroblasts in monolayer alone and a co-culture of both. Proteoglycan (PG) synthesis was measured by 35S-incorporation, PG content by a dimethylmethylene blue assay, DNA content by a fluorometric assay, and prostaglandin-E2 and IL-1 beta release by ELISA. RESULTS: In co-culture PG synthesis by chondrocytes was significantly reduced in the presence of IL-1 beta (1 ng/ml) compared to controls. PG content of chondrocyte cultures was reduced for controls and IL-1 beta treated co-cultures. Synovial fibroblasts in co-culture did not show significant change of PG synthesis or content when compared to cells in mono-cell culture. PG release into the medium was relatively high in co-cultures. IL-1 beta significantly decreased the proliferation rate of chondrocytes in co-cultures and slightly increased prostaglandin-E2 release. CONCLUSIONS: Co-culturing of osteoarthritic chondrocytes and synovial fibroblasts from a single human joint allows interactions between both entities and may offer a useful tool to study the effects of mediators or new drugs under more in vivo like conditions compared to mono-cell cultures.

Hemodynamic response to vasopressin in dehydrated human subjects.

BACKGROUND: Despite the known potent vasoconstrictor effects of vasopressin, the role of this hormone in the maintenance of blood pressure is incompletely understood. In studies performed in animals with increased plasma vasopressin concentrations, several complex cardiovascular effects have been noted, including decreases in heart rate and cardiac output, which may account for a lack of effect on arterial pressure despite the vasopressin-induced increase in total peripheral resistance. Only a few studies have been done to assess the cardiovascular effects of vasopressin in human subjects, and most of these have been limited to measurement of heart rate and arterial pressure only. The present study was designed to identify more fully the cardiovascular effects of vasopressin when plasma vasopressin concentrations are increased by osmotic stimulation without the superimposition of major nonosmotic stimuli associated with severe volume depletion. METHOD: Studies were performed on 11 normal human subjects in supine and erect posture before and after 24 hours of fluid deprivation, and following administration of a selective V1 receptor antagonist, [d(CH2)5Tyr(ME)]AVP, after dehydration. Cardiovascular parameters were measured noninvasively by thoracic electrical bioimpedance cardiography and blood samples for measurements of plasma concentrations of vasopressin and other hormones affected by dehydration and differences in posture were collected for subsequent analysis. RESULTS: After 24 hours of fluid restriction, plasma osmolality was increased from 287 +/- 0.9 to 294 +/- 0.7 mosm/kg H20 and plasma vasopressin concentrations (Pavp) were increased in both supine and erect posture. Mean arterial (MAP) and systolic blood pressure (SBP) were reduced by fluid restriction but were higher in erect than in supine posture both before and after fluid restriction. Heart rate (HR), diastolic blood pressure (DBP), and systemic vascular resistance (SVRI) were also higher in erect than in supine posture, while cardiac index (CI), stroke index (SI), end-diastolic index (EDI), and an index of total thoracic fluid content (TFC) were all reduced in erect posture, both before and after dehydration. Plasma renin activity (PRA) and plasma norepinephrine concentrations (Pne) were increased in erect posture, both before and after dehydration, but there was no effect of erect posture on plasma vasopressin concentrations (Pavp), either before or after dehydration. Administration of the V1 receptor antagonist after dehydration had no effect on hemodynamic parameters other than small reductions in DBP and cardiac preload. CONCLUSION: It is concluded from these studies that small increases in Pavp associated with moderate dehydration do not play a role in the maintenance of arterial pressure in normal human subjects in either supine or erect posture.

Case report: acute renal vein thrombosis in patients with spinal cord injury and secondary amyloidosis.

Chronic spinal cord injury, when complicated by chronic suppurative infections, has replaced chronic tuberculosis as a leading cause of secondary amyloidosis. Renal involvement with secondary amyloidosis is characterized by the presence of nephrotic range proteinuria and an increased incidence of renal vein thrombosis. Two cases of acute renal vein thrombosis associated with secondary amyloidosis in patients with spinal cord injury are presented. In both cases, a past history of extensive decubitus ulcerations and urinary tract infections preceded the development of nephrotic range proteinuria. In case 1, nonoliguric acute renal failure occurred after the development of acute bilateral renal vein thrombosis. The patient declined dialytic therapy and expired with uremia. In case 2, worsening renal function and increased proteinuria resulted after the development of acute unilateral renal vein thrombosis. These cases include the clinical and anatomic findings of acute renal vein thrombosis that occur as a complication of secondary amyloidosis. Acute renal vein thrombosis should be considered whenever an acute change in renal function or increase in proteinuria is noted in this setting.

Expression of collagen type I, II, X and Ki-67 in osteochondroma compared to human growth plate cartilage.

In order to characterize the consequences for the process of endochondral ossification we performed an immunohistochemical study and compared the expression of collagen type I, II and X as markers of cartilage differentiation and Ki-67 as a marker of cell proliferation in solitary (7-26 years, n=9) and multiple (11-42 years, n=6) osteochondromas with their expression in human fetal and postnatal growth plates. In fetal and young postnatal controls, we found a thin superficial layer of articular cartilage that stained positive for collagen type I while collagen II was expressed in the rest of the cartilage and collagen type X was restricted to the hypertrophic zone. Osteochondromas from children showed lobular collagen type II-positive areas surrounded by collagen type I. In adults, the separation of collagen type I- and type II-positive areas was more blurred, or the cartilaginous cap was missing. Collagen type X was detected in a pericellular distribution pattern within hypertrophic zones but also deeper between bone trabecula. The proliferative activity of osteochondromas from children younger than 14 years of age was comparable to postnatal growth plates, whereas in cartilage from individuals older than 14 years of age, we could not detect significant proliferative activity.

[Modified presentation of a lung embolism by a rare variant of pulmonary vein anomalous connection]. / Modifizierte Präsentation einer Lungenembolie durch eine seltene Variante der Lungenvenenfehlmündung.

Partial anomalous pulmonary venous return of the left lung is an extremely rare cardiovascular abnormality. Mostly, this rare entity is found incidentally when patients undergo angiography of the pulmonary artery because of suspected pulmonary embolism. In this case hemodynamic data obtained by a swan ganz catheter suggested a cardiovascular abnormality presenting as left-right shunt. Surgical therapy of anomalous venous return of the left lung is only required if volume overload of the left ventricle occurs.

[Embolisation of aneurysmal bone cysts as a minimally invasive treatment option - presentation of two cases]. / Die Embolisation stammnaher aneurysmatischer Knochenzysten als minimalinvasive Therapieoption - zwei Fallbeispiele.

AIM: The aim of this study was to evaluate embolisation as a therapy option for aneurysmal bone cysts of the trunk. METHOD: Case reports about two males with intermittent pseudo-radicular lumboischialgia and coxalgia are discussed. RESULTS: The diagnostic work-up and biopsies verified an aneurysmal bone cyst in both males. In one patient the tumour-like lesion was localised in the fifth lumbar vertebral body, in the other in the left ischium and pubis. Arterial embolisation was performed in both cases. Follow-up at 6 and 24 months after embolisation showed a significant increase of sclerosis and a reduced volume of the cysts. CONCLUSION: In accord with literature data, arterial embolisation seems to be a sufficient and minimally invasive therapy option in aneurysmal bone cysts of the spine and the pubis.

[The prognostic influence of primary tumour and region of the affected spinal segment in 217 surgical patients with spinal metastases of different entities]. / Der prognostische Einfluss von Primärtumor und Höhe des befallenen Wirbelsäulenabschnitts bei 217 operativen Patienten mit Wirbelsäulenmetastasen unterschiedlicher Entität.

AIM: A retrospective study to evaluate the prognostic influence of the primary tumour and the anatomic level of spinal metastases was carried out. MATERIAL AND METHODS: Between January 1984 and May 2005, 217 patients were surgically treated because of spinal metastases. The prognostic influence for the survival was analysed for the entity of the primary tumour and the localisation of the spinal metastases. RESULTS: The median survival of the study group was 8.0 months (range: 0-191.5 months). Mamma carcinoma was the most frequent primary tumour with 62 cases (28.6 %). The spinal level of the metastases did not influence the postoperative survival (p = 0.9058). The entity of the primary tumour showed a significant influence for the postoperative survival (p < 0.0001). CONCLUSION: In spinal metastases, the entity of the primary tumour was of prognostic value; the localisation of the spinal metastases at different spinal levels did not influence the postoperative survival. Therefore, the evaluation of the primary tumour is mandatory for an estimation of the expected survival.

[Surgical treatment and evaluation of prognostic factors in spinal metastases of renal cell carcinoma]. / Chirurgische Therapie und Evaluation von Prognosefaktoren bei Wirbelsäulenmetastasen durch Nieren-Zell-Karzinome.

AIM: The aim of this study was the evaluation of surgical results and prognostic factors in spinal metastases of renal cancer. METHODS: 37 surgical patients with spinal metastases of renal cell carcinoma were retrospectively analysed. In 2 patients the cervical, in 16 patients the thoracic, in 4 patients the thoraco-lumbar and in 16 patients the lumbar spine was involved. RESULTS: In 11 cases (29.7 %) a combined posterior-anterior spondylodesis with vertebral body replacement, in 26 cases (70.3 %) a single posterior instrumentation was done. Perioperatively, 24 complications appeared, 4 of them were lethal. Postoperatively, the neurological situation was unchanged in 26 patients, dischanged in 4 patients and improved in 7 patients. The level of pain was unchanged in 10 patients, dischanged in 3 patients and improved in 24 patients. The mean postoperative survival was 13.6 months. For the postoperative survival the Karnofsky-Index and the Frankel-Score were univariate highly significant, the factors nutritional condition and latency between the primary tumor and the development of spinal metastases showed a lower significancy. No prognostical influence for the postoperative survival could be detected for the factors gender, age, localisation of the metastases, type of operation and the factor solitary/multiple metastases. The multivariate analyses did not attempt any of the univariate significant prognostic factors for the postoperative survival. The postoperative survival was significantly (p: 0.0030) influenced by postoperative adjuvant therapy (radio- and/or chemotherapy). The analysis of each adjuvant therapy form (i. e. chemo-, radio- and combined therapy) attempts this prognostic effect (p: 0.0229). CONCLUSION: In most patients with spinal metastases of renal cell carcinoma, the singular posterior intrumentation combined with a decompression is a sufficient therapy. To avoid posterior implant failure, in patients with a prognosticated survival of more than one year, a combined posterior-anterior spondylodesis with vertebral body replacement should be done. The prognostic influence of an adjuvant postoperative treatment in the present study must be interpreted in the context of this small, highly selected patient collective. Further standardized studies should be performed to evaluate the prognostic influence of an adjuvant therapy.

Gait analysis and WOMAC are complementary in assessing functional outcome in total hip replacement.

OBJECTIVE: To investigate the correlation between objective and subjective evaluation of patients with total hip replacement. DESIGN: Prospective preliminary trial comparing the Western Ontario and McMaster University questionnaire (WOMAC) and gait analysis preoperatively and three months postoperatively. SETTING: A German academic orthopaedic centre specializing in total hip replacement surgery. SUBJECTS: Seventeen patients (median age 70 years) with hip osteoarthritis. INTERVENTION: All patients had had a primary unilateral total hip replacement. MAIN MEASURES: WOMAC questionnaire to assess self-perceived health status and gait analysis to determine objective gait parameters. RESULTS: Performance of walking as well as subjective judgement of health status improved following surgery (gait speed P = 0.0222; stride length P = 0.038; stance phase ratio P = 0.0466; WOMAC P < 0.0001). However, the correlation between gait parameters and WOMAC was poor (r = -0.27 or less). Correlation between changes of walking parameters and WOMAC was bad to good (r = 0.01 to r = -0.72). CONCLUSION: The WOMAC questionnaire might not reflect walking performance. The addition of gait analysis is recommended to gain objective information about the quality of gait.

[Reliability of transcutaneous measurement of oxygen tension on the lower leg]. / Reliabilität der transkutanen Sauerstoffpartialdruckmessung an der unteren Extremität.

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.

[Surgical treatment and prognosis factors in spinal metastases of breast cancer]. / Chirurgische Behandlung und Prognosefaktoren von Wirbelsäulenmetastasen bei Mamma-Karzinom.

AIM: The aim of this study was the evaluation of surgical therapy results and prognosis factors in patients with spinal metastases of breast cancer. METHODS: 55 patients with spinal metastases of breast cancer who were treated surgically were retrospectively evaluated. In 11 patients the cervical, in 27 patients the thoracic and in 17 patients the lumbar spine was affected. RESULTS: Postoperatively, 45 patients (81.8 %) described a reduction in pain and 5 patients (50 %) reported a neurological improvement. Perioperative complications appeared in 27 patients (49.1 %), 2 patients died. For the entire group, the mean postoperative survival was 27.2 +/- 28.6 months and the median survival 16.2 months. In patients with solitary metastasis the univariate analysis did not show a significantly longer postoperative survival than in patients with additional visceral metastases (p = 0.0659), but patients with solitary metastasis showed a significantly longer survival than those with multiple osseous and/or visceral metastases (p = 0.0325). In the univariate analysis, the classification of the primary tumour, the duration of symptoms, the localisation of the metastases, the patient's age and the kind of surgical procedure (posterior stabilising instrumentation versus combined posterior-anterior treatment with intralesional resection of the affected vertebra and vertebral body replacement) did not show a significant influence on the postoperative survival. The multivariate analysis did not show a significant prognostic influence for the potentially prognostic factors, however, solitary and multiple metastasis showed the highest statistical influence for the prognosis (p = 0.1187), followed by the classification of the primary tumour (p = 0.1243). CONCLUSION: Pain reduction and neurological improvement can be reached by a stabilisation of the diseased spinal region. Patients with spinal metastases due to breast cancer showed a relatively long postoperative median and mean survival. Therefore, the preoperative evaluation of extent of the disease and the therapy concept should be individually adapted. The surgical procedure (posterior stabilising instrumentation versus combined posterior-anterior approach with vertebrectomy and vertebral body replacement) does not significantly influence the survival.

[Prognosis, surgical therapy and progression in cervical and upper-thoracic tumor osteolysis]. / Prognose, operative Therapie und Verlauf bei zervikalen und hochthorakalen Tumorosteolysen.

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.