Incidence Of Nerve Injury Research Articles

Psoas Muscle Morphology: A Novel Classification System and Its Anatomic Relationship with Adjacent Neurovascular Structures.

Cross-sectional radioanatomic study. To introduce a classification system using MRI to describe psoas morphology and examine the position of nearby neurovascular structures. Oblique lumbar interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) offer sagittal malignment correction and reduced morbidity. LLIF has a higher incidence of nerve injuries, while OLIF has a higher incidence of vascular injuries. Measurements were completed on the left psoas at the inferior L4 endplate. Class A was designated if the ventral border of the psoas muscle was >2mm anterior; B if it was ≤ 2mm anterior or posterior to the vertebral body, and C if >2mm posterior to the vertebral body ventral border. Modified oblique corridor, measured as the distance between two lines, one at the medial border of the psoas muscle and the other at the lateral border of the nearest vascular structure, and a preferred LLIF trajectory was projected onto an axial image of the left psoas. If the trajectory violated the posterior third of the psoas, it was considered a dangerous approach due to potential iatrogenic nerve injury. 100 patient MRIs (Class A: 44; Class B: 27; Class C: 29) were analyzed. Average modified oblique corridor was 7.49mm. Modified oblique corridor varied amongst the three types of psoas morphologies (A: 8.99mm vs. B: 8.10mm vs. C: 4.66mm, P=0.040). LLIF trajectory intersected the 'danger zone' in 34.1%, 3.7%, and 0.0% of patients, (P<0.001) respectively. Class A psoas had the largest modified oblique corridor but highest proportion of those with a dangerous LLIF trajectory. Class C psoas had the narrowest modified oblique corridor, but no dangerous LLIF trajectories were identified.

ARTHROSCOPIC SUBTALAR ARTHRODESIS: A LARGE CASE SERIES OF 135 PATIENTS

BackgroundOpen subtalar arthrodesis has been associated with a moderate rate of non-union, as high 16.3%, and high rates of infection and nerve injury. Performing this operation arthroscopically serves to limit the disruption to the soft tissue envelope, improve union rates and reduce infection. Our study describes our outcomes and experience of this operation.MethodRetrospective review of all patients who underwent an arthroscopic subtalar arthrodesis between 2023 and 2008. We excluded patients undergoing concurrent adjacent joint arthrodesis. The primary aim was to report on rates of union. Secondary outcomes included reporting on conversion to open procedure, duration of surgery, infection, and iatrogenic injury to surrounding structures.Results135 patients were included in the final analysis. 129 patients (95.5%) achieved union. The median time to fusion was 98 days. All cases were performed through sinus tarsi portals. 38 cases were performed with an additional posterolateral portal. Most cases (107/77%) were performed with 2 screws. 3 cases (2.2%) were converted to open procedures. The median tourniquet time was 86 minutes but available in only 88 (65%) cases. There were 4 (2.9%) superficial infections and no deep infections. 1 patient sustained an injury to FHL and there were no reported nerve injuries.ConclusionsAt present this is the largest series of arthroscopic subtalar arthrodeses. We demonstrate that this operation can achieve high rates of union with low rates of infection with an equally low likelihood of needing to convert to an open procedure with modest operative times. In our experience the addition of a posterolateral portal does not appear to increase the incidence of nerve injury and aids in the visualisation of all 3 facets.

Insights into optimal surgical fixation for posterior malleolar fractures.

The optimal management of posterior malleolar ankle fractures, a prevalent type of ankle trauma, is essential for improved prognosis. However, there remains a debate over the most effective surgical approach, particularly between screw and plate fixation methods. This study aims to investigate the differences in outcomes associated with these fixation techniques. We conducted a comprehensive review of clinical trials comparing anteroposterior (A-P) screws, posteroanterior (P-A) screws, and plate fixation. Two investigators validated the data sourced from multiple databases (MEDLINE, EMBASE, and Web of Science). Following PRISMA guidelines, we carried out a network meta-analysis (NMA) using visual analogue scale and American Orthopaedic Foot and Ankle Score (AOFAS) as primary outcomes. Secondary outcomes included range of motion limitations, radiological outcomes, and complication rates. The NMA encompassed 13 studies, consisting of four randomized trials and eight retrospective ones. According to the surface under the cumulative ranking curve-based ranking, the A-P screw was ranked highest for improvements in AOFAS and exhibited lowest in infection and peroneal nerve injury incidence. The P-A screws, on the other hand, excelled in terms of VAS score improvements. Conversely, posterior buttress plate fixation showed the least incidence of osteoarthritis grade progression, postoperative articular step-off ≥ 2 mm, nonunions, and loss of ankle dorsiflexion ≥ 5°, though it underperformed in most other clinical outcomes. The NMA suggests that open plating is more likely to provide better radiological outcomes, while screw fixation may have a greater potential for superior functional and pain results. Nevertheless, clinicians should still consider the fragment size and fracture pattern, weighing the advantages of rigid biomechanical fixation against the possibility of soft-tissue damage, to optimize treatment results.

Retrospective analysis of regional anaesthesia in hip surgery: A clinical audit

IntroductionTotal hip arthroplasty is one of the most frequent surgical interventions in the hospital setting. Nonetheless, the ideal method to manage post-operative pain is still unknown. Multimodal analgesia techniques based on regional anaesthesia are amongst the most promising solutions. ObjectivesThe aim of this study was to evaluate postoperative pain after total hip arthroplasty according to whether peripheral nerve block was performed (femoral block, fascia iliaca block and pericapsular nerve group block). Intravenous morphine consumption during the patient’s stay in the post-anaesthesia care unit was measured, as well as the number of opioid rescues at 24 and 48 h post intervention. As secondary objectives, the prevalence of nerve injury, prolonged quadricipital block, and morphine consumption were established according to other variables of interest. Materials and methodsIn this observational retrospective study, data was collected from the electronic medical record of 656 traumatological surgery patients from April 2018 to August 2020, with the following inclusion criteria: over 18 years old, ASA I–III, primary total hip arthroplasty under general anaesthesia or subarachnoid anaesthesia (only with hyperbaric bupivacaine) and use of levobupivacaine for peripheral nerve block. ResultsA total of 362 patients were selected. The main surgical indication was coxarthrosis (61.3%), followed by hip fracture (22.6%). Peripheral nerve blocks were performed on 169 patients (66.3% femoral, 27.7% PENG, and 6.0% fascia iliaca). Mean postoperative opioid consumption in PACU was lower in patients in who received a PENG (2.2 mg) or a femoral (3.27 mg) block, compared to those who received neither (6.69 mg). There were no differences in opioid rescues at 24 and 48 h after the procedure. Nerve injury incidence was low (.8%), and not associated with nerve blocks. The incidence of prolonged quadricipital paralysis was also low (1.3%), and was mainly associated with femoral nerve block (75% of cases). ConclusionsThis retrospective study supports the use of regional blocks as opioid-sparing techniques, highlighting their role in rapid functional recovery with no motor impairment.

Outcomes of the Modified Stoppa Approach in Acetabular Fracture Management: Incidence of Nerve Injuries.

Displaced acetabular fractures are complex injuries that necessitate precise surgical intervention. Obturator nerve injuries occur in approximately 2% of cases. The modified Stoppa approach, offering enhanced exposure of the quadrilateral plate, has gained attraction as an alternative technique for anterior acetabular fractures. However, its proximity to the obturator nerve poses a risk of iatrogenic injury. This study aimed to investigate the incidence of nerve injuries and functional outcomes in patients undergoing the modified Stoppa approach for traumatic acetabular fractures. This retrospective study involved 86 patients with anterior column fractures, whose data were prospectively collected. The fractures were treated using the modified Stoppa approach. Exclusion criteria were pathological fractures, alternative surgical approaches, prior nerve injuries, hip issues, refusal to participate, or inadequate follow-up. Data collection involved pre-operative imaging, thorough post-operative neurological assessments, and post-operative radiographic evaluation. Functional outcomes were assessed using the Harris Hip Score (HHS). Most patients were male (n=54) with a mean age of 40±17.3 years. Post-operative infection occurred in six cases, with resolution in four through antibiotics and two necessitating device removal. Obturator nerve damage was detected in 14 patients, comprising nine traumatic and five iatrogenic cases. During the follow-up, symptoms improved in all patients, except for the four patients with iatrogenic nerve damage. Traumatic nerve injuries generally heal naturally over time. In contrast, iatrogenic injuries have a less optimistic prognosis, potentially resulting in lasting neurological deficits.

Incidence of nerve injury following acupuncture treatments in Taiwan

ObjectiveAcupuncture, a widely employed traditional therapeutic modality known for its efficacy in pain alleviation and diverse condition management, may inadvertently result in mechanical nerve injury due to its invasive nature. This research aimed to ascertain the incidence of nerve injuries post-acupuncture, identify associated risk factors, and map the distribution of nerve injury sites. MethodsA case-control study nested in the National Health Insurance Research Database (NHIRD) 2000–2018 two million cohort was conducted. Patients previously diagnosed with nerve injury, surgery, or degeneration before acupuncture were excluded. Cases were defined as patients receiving acupuncture and seeking medical attention for nerve injury (ICD9-CM code 950–957) within 14 days post-procedure, while control groups comprised patients undergoing acupuncture without subsequent adverse events. Invasive treatments prior to adverse events and adverse events occurring more than 14 days post-acupuncture were excluded. To ensure case-control comparability, factors such as age, gender, socioeconomic status, and medical facility environment were controlled using propensity score matching. ResultsThe study encompassed 14,507,847 acupuncture treatments administered to 886,753 patients, with 8361 instances of post-acupuncture nerve injury identified, representing an incidence rate of approximately 5.76 per 10,000 procedures. Age emerged as a significant risk factor, with the adjusted odds ratios escalating with age. Several comorbidities including diabetes, hypothyroidism, liver cirrhosis, chronic kidney disease, herpes zoster, hepatitis virus, rheumatoid arthritis, systemic lupus erythematosus, dementia, and cerebrovascular accidents were associated with an elevated risk of nerve injury post-acupuncture. ConclusionThis study underscores the importance of meticulous patient profiling and cautious therapeutic approach in acupuncture, considering the evident influence of various demographic, systemic, and treatment-related factors on the incidence of nerve injuries.

A Systematic Review of Outcomes of Total Ankle Arthroplasty with INBONE II

Category: Ankle Arthritis; Ankle Introduction/Purpose: The INBONE II is a fixed-bearing implant with a stemmed tibial component commonly used for total ankle arthroplasty (TAA). Despite its frequent use and previously reported outcomes within individual clinical studies, no study has systematically reviewed outcomes of TAA with this implant. The purpose of this study was to perform a systematic review of the literature and report on outcomes of TAA with the INBONE II. Methods: A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Databases searched included PubMed, Google Scholar, SCOPUS and CINAHL from database date of inception through February 28th, 2023. Clinical studies of INBONE II outcomes in peer reviewed journals were included. Outcomes included were survivorship, patient reported outcome measures (PROMs), and complications. Outcome results were compiled using weighted averages when possible. This review of 26 articles included 808 patients with 667 primary TAA and 141 revision TAA. Results: Survivorship, with failure defined as metal component revision, was 97.8% at an average follow-up of 49 months (range, 14-85.4 months) and 94.2% at an average follow-up of 25.7 months (range, 9.1-47.5) months for primary and revision TAA respectively. Complication rates for primary TAA included: 3.8% intra-operative fractures, 2.5% post-operative fractures, 1.8% deep infection, 8.0% wound complications, 1.6% rate of poly exchange, and 1.6% nerve injuries. Revision TAA complication rates included: 12.3% intra-operative fractures, 6.9% wound complications, 3.3% deep infections, and a 5.5% incidence of nerve injury. Average PROMs for primary TAA included: AOFAS American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score improved 41 points, visual analog scale (VAS) scores decreased 5.9, and patient satisfaction of 92.6%. Revision TAA PROMs were not consistently reported. Conclusion: This study is the largest compilation of INBONE II outcomes and survivorship. Primary and revision TAA with the INBONE II results in satisfactory improvement in PROMs and low complication rates. The overall survivorship is 97.8% and 94.2% at an average follow-up of 49 months (range, 14-85.4 months) and 25.7 months (range, 9.1-47.5) for primary and revision total ankle arthroplasty respectively. These findings support continued use of this implant in primary and revision TAA.

The Association Between Humeral Lengthening and Clinical Outcomes After Reverse Shoulder Arthroplasty: A Systematic Review and Meta-analysis.

The purpose of this study was to evaluate the relationship between humeral lengthening and clinical outcomes after reverse shoulder arthroplasty (RSA) with stratification based on measurement method and implant design. This systematic review was performed using PRISMA-P guidelines. PubMed/Medline, Cochrane Trials, and Embase were queried for articles evaluating the relationship between humeral lengthening and clinical outcomes inclusive of range of motion (ROM), strength, outcome scores, and pertinent complications (acromial and scapular spine fractures, nerve injury) after RSA. The relationship between humeral lengthening and clinical outcomes was reported descriptively overall and stratified by measurement method and implant design (globally medialized versus lateralized). A positive association was defined as increased humeral lengthening being associated with greater ROM, outcome scores, or a greater incidence of complications, whereas a negative association denoted that increased humeral lengthening was associated with poorer ROM, outcome scores, or a lower incidence of complications. Meta-analysis was performed to compare humeral lengthening between patients with and without fractures of the acromion or scapular spine. Twenty-two studies were included. Humeral lengthening was assessed as the acromiohumeral distance (AHD), the distance from the acromion to the greater tuberosity (AGT), the acromion to the deltoid tuberosity (ADT), and the acromion to the distal humerus (ADH). Of 11 studies that assessed forward elevation, a positive association with humeral lengthening was found in six, a negative association was found in one, and four studies reported no association. Of studies assessing internal rotation (n=9), external rotation (n=7), and abduction (n=4), all either identified a positive or lack of association with humeral lengthening. Studies assessing outcome scores (n=11) found either a positive (n=5) or no (n=6) association with humeral lengthening. Of the studies that assessed fractures of the acromion and/or scapular spine (n=6), two identified a positive association with humeral lengthening, one identified a negative association, and three identified no association. The single study that assessed the incidence of nerve injury identified a positive association with humeral lengthening. Meta-analysis was possible for AGT (n=2) and AHD (n=2); greater humeral lengthening was found in patients with fractures for studies using the AGT (mean difference, 4.5 mm [95%CI, 0.7-8.3]), but not the AHD. Limited study inclusion and heterogeneity prohibited identification of trends based on method of measuring humeral lengthening and implant design. The relationship between humeral lengthening and clinical outcomes after RSA remains unclear and requires future investigation using a standardized assessment method.

Advantages of Intraoperative Neuromonitoring Over Direct Visualization of the Recurrent Laryngeal Nerve During Thyroidectomy.

The well-recognized risk of injury to the recurrent laryngeal nerve (RLN) during thyroidectomy has instigated various preventive measures. One such measure involves directly visualizing the RLN, but this is not always feasible in practice. A more recent approach involves usingintraoperative neuromonitoring to identify and preserve the RLN. This study aims to evaluate the effectiveness of intraoperative neuromonitoring compared tosingle visualization of the RLN in averting nerve injury. We conducted a retrospective, observational, and descriptive study on a cohort of 218 patients. A Chi-square test was employed to determine the influence of intraoperative neuromonitoring on the incidence of nerve injury, with P< 0.05 considered statistically significant. We used Jamovi software version 2.3.18to analyze the data. Of the 218 patients, intraoperative neuromonitoring was used in 150 (68.8%) cases; none of which resulted in nerve injury. Conversely, 68 (31.2%) patients underwent surgery without the use of neuromonitoring, with two (2.9%) patients in this group experiencing nerve injury (p=0.037). In comparison, the risk of nerve injury was 0% in the group monitored intraoperatively and 2.94% in the groupthat did not undergo intraoperatively neuromonitoring. Further, the relative risk of complications was 0.66% in patients operated with neuromonitoring, while it was 5.88% in the group operated without neuromonitoring, thus demonstrating a clinically significant protectiveagainst vasculonervous complications. The results advocate for the use of intraoperative neuromonitoring, whenever available,as it is a safe method for significantly decreasing the incidence of RLN injury during thyroidectomy compared with only visualization.

Retrospective Study on the Risk of Nerve Injury After Distal Biceps Tendon Repair Using Cortical Button.

Distal biceps tendon ruptures are relatively rare injuries that typically require surgical intervention to restore flexion and supination strength. Concerns have been raised regarding the risk of nerve injuries, particularly the posterior interosseous nerve (PIN), associated with the use of cortical buttons in distal biceps repair. This study aimed to estimate the incidence of PIN injury as well as injuries to the lateral cutaneous nerve of the forearm and superficial branch of the radial nerve following distal biceps repair using cortical buttons. A retrospective review was conducted on all patients who underwent distal biceps repair with cortical buttons at a district general hospital between January 2014 and May 2022. Patient data, including age, gender, time from injury to surgery, type of procedure, and postoperative nerve injuries, were collected. The incidence of nerve injuries was analyzed, and the outcomes were assessed during postoperative follow-up visits. Ninety-six male patients were included in the study, with an average age of 45.6 years. The average time from injury to surgery was 22.6 days. All patients underwent primary repairexcept for two patients who underwent reconstruction with hamstring grafts. None of the patients experienced a PIN injury. However, 16 patients (16.7%) developed lateral cutaneous nerve injuries of the forearm, and three patients (3.1%) had superficial radial nerve injuries. Our study, encompassing a large cohort of patients over an eight-year period, demonstrates the safety of distal biceps repair using cortical buttons with regard to PIN nerve injury. However, there were incidences of lateral cutaneous nerve of the forearm and superficial radial nerve injuries, consistent with previous studies.

Nerve Injuries after Glenohumeral Dislocation, a Systematic Review of Incidence and Risk Factors.

Glenohumeral dislocation is a common shoulder injury that can result in nerve injury. However, the full impact of these injuries on patient function and recovery remains unclear. This systematic review aimed to determine (1) the incidence, (2) risk factors, and (3) functional outcomes following nerve injuries after glenohumeral dislocation. The study followed PRISMA guidelines and used the PICO strategy. PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases were searched for studies. Two reviewers independently assessed the study eligibility, and data extraction was conducted by two authors. The quality of included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Thirteen studies comprising 17,087 patients were included. The incidence of nerve injury ranged from 0.4% to 65.5%, with the axillary nerve being most commonly affected. The time to reduction did not significantly affect the incidence of nerve injury. The mechanism of injury, the affected side, associated injuries, and recovery time were found to be potential risk factors for nerve injury. Motor recovery was incomplete in many patients, and sensory recovery was less complete. By synthesizing the available evidence, this systematic review underscores the importance of considering nerve injury in the management of patients with glenohumeral dislocations. Future research can build on these findings to develop targeted prevention and treatment approaches that optimize patient outcomes.

Beneficial Perioperative Aspects Favor the Use of Percutaneous Crossed Pinning over Antegrade Nailing in Pediatric Supracondylar Fractures-A Retrospective Comparative Study.

(1) Background: Displaced supracondylar humeral fractures in pediatric patients can be treated by either antegrade nailing (AN) or percutaneous crossed pinning (PCP). The aim of this study was to compare the intra- and perioperative management, complications and outcome of AN and PCP. (2) Methods: This retrospective study enrolled 271 individuals (median age 5 years, IQR 4-7 years) who underwent AN (n = 173) or PCP (n = 98). Patient history was analyzed for incidence of nerve injuries, postoperative treatment, postoperative malrotation, time of hospital stay, time to implant removal and revision rate. Operative procedures were investigated for duration and radiation exposure. (3) Results: PCP was associated with a significantly lower radiation exposure (dose area product: PCP mean 20.1 cGycm2 vs. AN mean 34.7 cGycm2, p < 0.001; fluoroscopy time: PCP mean 1.1 min, range 0.1-8.1 min, vs. AN mean 1.5 min, range 0.1-7.1 min, p < 0.001), duration of surgery (PCP mean 32.2 min vs. AN mean 48.3 min, p < 0.001) and time to implant removal (PCP mean 37 days vs. AN mean 113 days, p < 0.001). Cast removal was performed earlier in the AN group (PCP mean 30.2 days vs. AN mean 20.4 days, p < 0.001) and there were fewer iatrogenic nerve lesions (PCP: 24% vs. AN: 8%, p < 0.001). (4) Conclusions: In the investigated study population, the analyzed parameters seem to favor the use of PCP. The advantages of AN should be weighed against its drawbacks. For special indications, AN remains a relevant technique in supracondylar fracture treatment, and surgeons should be familiar with this procedure.

Specific foraminal changes originate from degenerative spondylolisthesis on computed tomographic images.

Operative treatment for degenerative spondylolisthesis (DS) is accompanied by the high incidence of nerve injury. Foraminal structures, especially the hypertrophied facet joints, have significant impacts on the adjacent nerve. This study aims to identify the specific foraminal changes relating to DS and nerve injury. The CT images of 70 patients with DS and 50 patients without lumbar disease were collected. The length and height of the foraminal structure were measured horizontally and vertically on sagittally reconstructed images. Horizontal stenosis, meaning to pending compression to nerve root after complete reduction, was evaluated on the image located to the middle of the foramen. Chi-square test or T-test were carried out using SPSS 26.0. The hyperplasia of the superior articular process (SAP) and articular capsule (Ac) incidence rates in DS group was significantly more common than that of the control group (9.2 vs 0.0%, 42.9 vs 2.0%). The height and width of the SAP and Ac in vertical and horizontal directions were significantly greater than those in the control group (4.95mm vs - 0.47mm, P < 0.0001; 3.28 vs 0.02mm, P < 0.0001; 5.27 vs3.44mm, P < 0.0001; 2.60 vs 0.37mm, P < 0.0001). In the DS group, hyperplasia of the SAP and Ac accounted for 9 and 43% respectively, 85 and 45% of which were accompanied by horizontal stenosis of the intervertebral foramen. DS is usually characterized of excessive hyperplasia of the SAP and Ac, both of which are possible elements of nerve root injury after complete reduction in operation and should be focused on during surgery.

NERVE MONITORING IN THYROID SURGERY: A RETROSPECTIVE COHORT STUDY

Background:The proximity of the Recurrent Laryngeal and External Branch of Superior Laryngeal Nerve to the Thyroid Gland has been a key factor for a profound interest of surgeons and clinicians in the clinical outcomes and Vocal changes in the post operative period in the patients undergoing thyroid surgery. The presence of Recurrent Laryngeal nerve in proximity of Thyroid poses a significant risk of damage to the nerve during surgery. The Recurrent Laryngeal Nerve SuppliesLarynx below the level of vocal cords and all the muscles except Cricothyroid. Posterior Cricoarytenoid, the only abductor of vocal cord is also supplied by this nerve. So, any damage to the nerve during surgery causes significant changes in pitch and texture of voice, commonly referred to as hoarseness.Intra-operative Nerve Monitoringwas introduced about 50 years ago and various neuromonitoring methods (glottis pressure method, glottic monitoring method, insertion of needle electrodes invocal cords endoscopically or through cricothyroid membrane, laryngeal palpationmethod, and monitoring via endotracheal tube with surface electrodes) have been utilized. We present a retrospective cohort study to surmise the effect of the use of Intraoperative nerve monitoring devices during Thyroid surgery and compare the clinical outcome in two cohorts. First, the study group where the nerve monitoring was used intraoperatively and the Second, where no intraoperative nerve monitoring was used. All the Patients included in the study underwent Thyroid surgery in the Department of Otorhinolaryngology-Head and Neck Surgery, MBS Hospital, Kota. Methods:This retrospective cohort study includes 100 patients as per the inclusion criteria specified in this article and all the included patients were studied after dividing them into two groups with one group where intraoperative nerve monitoring was used and the other group where no nerve monitoring was used. Each group had 50 patients each. All the patients are regularly documented for with Video Laryngoscopic Examination as a standard. All the data collected from the archives and put to statistical evaluation to analyse the data Age wise, Sex wise, Residential address wise, according to mean Thyroid volume, according to presenting complaints, according to history, according to mean operative time, according to the type of Nerve Injury, according to duration of hospital stay and other parameters as followed in the study. Results: On appropriate statistical analysis of the data, it was seen that there were no demographic variables within groups that ensured statistical similarity in the groups, there was also no statistical correlation of functional preservation attributable to mean Thyroid volume. The incidence of nerve injury was higher in the patients who got themselves operated for the malignancy of thyroid and the revision surgeries. The patients being operated for controlled toxic goitre reported ni nerve injury in the post operative period. The intraoperative nerve monitoring reported lower mean time required to do the surgery. There was a similar incidence of permanent and transient nerve injury in both the cohort groups.

Safety and Efficacy of Rescue Nerve Blocks

Background: The overall incidence of complications following peripheral nerve blocks is very low. Peripheral nerve blocks performed under ultrasound guidance are widely thought to present a lower risk to direct needle trauma than paresthesia and nerve stimulation techniques and have been shown to decrease opioid consumption by providing analgesia directly to the site of injury. Currently, when a nerve block fails altogether or provides inadequate analgesia, pain and opioid consumption increases which in turn decrease patient satisfaction and increases healthcare costs. Concerns remain whether the benefits of opioid reduction outweigh the risk of inadvertent needle trauma and other potential complications when performing a nerve block replacement, or ‘rescue block’. Objective: Examine whether performing a rescue peripheral nerve block provides adequate analgesia to elicit a decrease in opioid consumption. Analyze the incidence of nerve injury following ultrasound-guided ‘rescue’ continuous peripheral nerve blocks. Methods: Data was retrospectively collected from patient electronic medical records from a Level 1 academic Trauma Center at Regional One Hospital in Memphis, Tennessee from March 1, 2019 to May 31 2021. Inclusion criteria was patients over 18-years of age at time of admission who received consecutive continuous peripheral nerve blocks in the same relative location during a time when the peripheral nerves were likely partially or fully anesthetized (a rescue block). The primary outcomes assessed were 24-hour opioid consumption prior to the initial continuous nerve block, just prior to and after the ‘rescue’ block. Adverse outcomes potentially due to performing a ‘rescue’ block were also examined, including direct needle trauma, nerve injury related to extended exposure to local anesthetics, and local anesthetic systemic toxicity. Types of nerve blocks performed, range and median number of catheter days, and reason for rescue block was recorded for all patients. All available electronic healthcare records were reviewed to identify potential injury. Nerve blocks were categorized into low and high-risk for direct needle trauma based on the incidence of needle trauma found in the literature and whether the needle was required to be adjacent to a discrete nerve or nerve bundle in order to perform the procedure. Results: Fifty-five (55) patients were examined. Of the 55 patients, 5 had multiple locations both blocked and rescued, bringing the total rescue procedures examined up to 60. Additionally, 10 patients had their rescue site re-blocked multiple times due to either multiple surgeries, displacements, or duration of analgesia required bringing the total number of rescue blocks performed to 74. Patients that received an initial continuous peripheral nerve block consumed significantly fewer opioids during the 24-hour period following the block than the 24-hour period before the block was performed (p=0.033). Continuous peripheral nerve blocks (CNPB) were replaced or ‘rescued’ for two general reasons: Failed or inadequate analgesia (21) and to extend the utilization of adequately functioning infusions (35). Once a rescue nerve block was performed, there was no significant change in opioid consumption than after the original block (p=0.64). Of the 60 rescue blocks that were recorded, there were 0 adverse outcomes that were attributed to the rescue block procedure. Conclusion: Following failed CPNB or when performed to extend the utilization of CPNB infusions, ultrasound-guided ’rescue’ nerve blocks result in reduced opioid consumption to a similar level as the initial peripheral nerve block, and do not result in an increase in the incidence direct needle trauma. Given the relatively low incidence of needle trauma and other nerve block-related complications, larger studies are needed to confirm these initial findings, however, ultrasound provides numerous clinical strategies that can be employed that may reduce the incidence of direct needle trauma compared with traditional nerve localization techniques.

A Retrospective Clinical Study of Endoscopic Treatment of Carpal Tunnel Syndrome using the Modified Soft Tissue Release kit.

Carpal tunnel syndrome (CTS) is the most common peripheral entrapment neuropathy, and endoscopic carpal tunnel release (ECTR) is one of the minimally invasive procedures for the treatment of CTS. Based on the shortcomings of ECTR, we designed the "Modified Soft Tissue Release Kit" to assist the endoscopic operation. This study aimed to evaluate the effectiveness and safety of endoscopic treatment of CTS using this kit. This retrospective review included 57 patients (86 wrists) who underwent ECTR using the "Modified Soft Tissue Release Kit" at our department between January 2017 and August 2019. Three scale scores (i.e., Quick-Disabilities of the Arm, Shoulder, and Hand [QDASH]; Boston Carpal Tunnel Syndrome Questionnaire [BCTSQ]: symptom severity [BCTSQ-SS] and functional status [BCTSQ-FS]) were recorded to assess hand function and symptoms preoperatively, 1 month postoperatively, 3 months postoperatively, and at the last follow-up. We also asked patients to answer a satisfaction question during follow-up. Pre- and post-operation scores were compared using paired Wilcoxon signed-rank test. Spearman's rank-order correlation was used to evaluate the relationship between scale scores and patient satisfaction. A total of 55 patients (83 wrists) were followed up, with an average follow-up of 27.2 ± 9.3 months. The median preoperative QDASH score was 45.5; the scores at 1 month postoperatively, 3 months postoperatively, and the last follow-up were 4.5, 0, and 0, respectively, with a significant decrease noted compared with the preoperative scores (P < 0.001). The median preoperative BCTSQ-SS and BCTSQ-FS scores were 3.3 and 2.8, respectively; the scores at 1 month postoperatively, 3 months postoperatively, and the last follow-up were 1.2, 1.0, and 1.0, and 1.1, 1.0, and 1.0, respectively, all of which decreased significantly compared with the preoperative scores (P < 0.001). The incidence of nerve injury was 0. The incidence of pillar pain was 0 at the last follow-up. One patient showed no improvement in hand symptoms and function postoperatively, and two patients showed long-term recurrence despite postoperative symptom remission. Approximately 94.5% (52/55) of the patients were satisfied or very satisfied with the outcome. ECTR with the "Modified Soft Tissue Release Kit" can significantly relieve symptoms and improve function in patients with CTS, with significant short- and mid-term efficacy and high safety.

Does the addition of cone-beam CT to panoral imaging reduce inferior dental nerve injuries resulting from third molar surgery? A systematic review

ObjectiveThis systematic review aims to examine whether cone-beam CT (CBCT) assessment influences the incidence of nerve injury following high-risk mandibular third molar (MTM) surgery.Study DesignRandomised controlled trials comparing two and three-dimensional imaging for assessing high-risk MTMs were included. MEDLINE, EMBASE, CENTRAL and the Dentistry and Oral Science Source (DOSS) were systematically searched along with extensive grey literature searches, hand searching of web sites, and detailed citation searching up to 3 September 2022. Risk of bias was assessed against the Cochrane Risk of Bias Tool (RoB 2.0). Certainty of the evidence was assessed using GRADE.ResultsTwo authors independently screened 402 abstracts prior to full text screening of 27 articles, which culminated in seven RCTs for inclusion. Two studies were assessed as high risk of bias overall. The other five raised some concerns largely due to unblinded patients and lack of prior trial registration. Just one study reported significantly less nerve injuries following CBCT. The remaining six articles found no significant difference.ConclusionThe seven RCTs included in this systematic review offered moderate quality evidence that CBCT does not routinely translate to reduced incidence of nerve injury in MTM removal. A single study provided low quality evidence for a consequent change in the surgical approach. Low quality evidence from 3 studies suggested CBCT does not influence the duration of third molar surgery.

Anatomical Risk Factors of Nerve Injuries Following Surgical Removal of Mandibular Third Molar

Introduction: Surgical removal of the mandibular third molar has its own set of complications. The mandibular impacted teeth are in proximity to the Inferior Alveolar Nerve (IAN), Buccal Nerve, and Lingual Nerve (LN). Therefore, each of these nerves is always at risk of injury during extraction. Objectives: This study was to evaluate the anatomical risk factors of nerve injury after the surgical extraction of mandibular third molars in patients visiting the department of oral and maxillofacial surgery of People’s Dental College and Hospital. Methods: This prospective study was conducted with 315 participants who presented with a mandibular third molar impaction and underwent Intraoral Periapical Radiograph (IOPAr), panoramic radiograph, as well as Cone Beam, Computed Tomography (CBCT). CBCT was done in those patients in which the mandibular third molar was in close contact with the mandibular canal. Results: Collected data from 315 patients showed that the incidence of Inferior alveolar nerve (IAN) and lingual nerve(LN)injury was 0.31%. Of which one had mesioangular class B, level II type of impaction in 17year male and the other had horizontal class C, level II type of impaction in 47year female respectively. In both cases, the tooth was lingually placed in relation to IAN. Conclusions: Various factors are responsible for nerve injury after the removal of the mandibular third molar. In our study, the incidence of nerve injury to IAN and LN was comparatively low and the most common risk factor was angulation and anatomical position of the impacted mandibular third molar.

Zoning laminectomy for the treatment of ossification of the thoracic ligamentum flavum

Spinal cord injury is a common occurrence during spinal surgery. In this study, we proposed a zoning laminectomy, which could reduce the incidence of nerve injury. We also discussed the safety and clinical efficacy of the zoning laminectomy for thoracic ossification of the ligamentum flavum (TOLF). Forty-five patients with TOLF who underwent zoning laminectomy from October 2016 to February 2020 were included in the retrospective analysis. The Japan Orthopedic Association (JOA) score was used to evaluate clinical outcomes. Meanwhile, the occurrence of complications was recorded. All 45 patients underwent the operation successfully, and the mean follow-up period was 25.3 months, the mean operation time was 160.2min, the average blood loss was 474.2ml, and the average hospital time was 8.0 days. At the final evaluation, the JOA score was significantly higher than the preoperative JOA score (P<0.001) and the overall recovery rate of the JOA score averaged 69.6%. Seventeen patients were graded as excellent, twenty-six as good, and two as fair. The complications included dural tears in nine patients (20.0%), cerebrospinal fluid leakage in seven patients (15.6%), deep infection in one patient (2.2%), and epidural hematoma in one patient (2.2%). All patients recovered well after treatment. Besides, there was no neurological deterioration and thoracic kyphosis occurred. Zoning laminectomy adopts a phased resection from "safe zone" to "danger zone" and defines the safe removal range of the lamina, which reduces the risks of spinal cord injury caused by instrument manipulation. Therefore, it is a safe and effective surgical option.

Analysis of outcomes and complications of 187 coronectomies

IntroductionThis is a retrospective audit of 187 cases of coronectomies of mandibular third molars (M3M) carried out at a two large teaching hospitals in London. MethodsWe collected data from the electronic patient records on all mandibular third molar coronectomy procedures performed between April 2017 and November 2020. Data was collected on complications including dry socket, infection, re-operation and nerve injuries to the inferior dental and lingual nerves. Results187 coronectomies were performed on 153 patients during the study period. This represents approximately 3% of the total number of third molars managed surgically. Almost 80% of these cases had cone beam computed tomography imaging prior to surgery. The majority (64%) of cases performed under general anaesthetic. Seven consultants and their teams managed the patients. Over half of the patients were prescribed antibiotics post-operatively. Complications were as follows: dry socket 2.1%; infection 4%; re-operation 1.6%; lingual nerve injury 0.5%, inferior alveolar nerve injury 1%. Of these nerve injuries, only one (0.5%) was considered to be permanent after two years of follow up. One patient (0.5%) had roots removed 12 months after coronectomy. ConclusionWe found that coronectomy is a safe and effective modality for treating high risk mandibular third molars. Complication rates are similar to those seen from surgical removal of such teeth with a lower than expected incidence of nerve injuries.