Malposition Rate Research Articles

Enhanced Safety and Efficacy of O-Arm Navigation Over C-Arm Guidance in Percutaneous Kyphoplasty for Patients With Osteoporotic Vertebral Compression Fractures and Spinal Deformity: A Comparative Study.

Although percutaneous kyphoplasty (PKP) under C-arm guidance is an effective treatment for osteoporotic vertebral compression fractures (OVCF), obtaining high-definition images in patients with OVCF and spinal deformities can be challenging or insufficient using traditional C-arm guidance, prompting our institution to adopt the O-arm navigation system-which offers comprehensive 3D imaging and precise navigation-and this study compares its safety and efficacy with conventional C-arm-assisted PKP. This was a retrospective study. From February 2019 to February 2022, we enrolled 28 patients with OVCF (44 vertebrae) with spinal deformity treated with O-arm navigation-assisted PKP and 30 patients with OVCF (42 vertebrae) with spinal deformity treated with C-arm-guided PKP. We recorded puncture times, single-segment operation time, number of cases with bone cement leakage, and length of stay. The visual analog scales (VASs), Oswestry disability indexes (ODIs), recovery of Cobbs angle, and vertebral height were used to assess treatment effect before the operation, on the first day postoperation, the first month postoperation, and at the final follow-up. The chi-squared test was utilized for comparing discrete variables, an independent samples t-test was used for continuous variables, and Pearson's chi-squared test and Fisher's exact test were applied for categorical data. Demographic features were comparable between the groups. The O-arm navigation group showed a significant reduction in puncture adjustment per vertebrae, single-segment operation time, and the rate of trocar needle malposition compared to the C-arm guidance group. The rate of cement leakage was decreased in the O-arm-guided PKP group, and other complications did not differ between the two groups. Intragroup comparisons revealed significant improvements in VAS scores and ODI on the first day, first month, and final follow-up after the operation (p < 0.05). The VAS score was significantly lower in the O-arm navigation-assisted PKP group than in the C-arm-guided PKP group on the first day postoperatively (p = 0.049). However, no significant differences in VAS scores were observed between the groups at the first month postoperatively or at the final follow-up. In each follow-up period, there was no significant difference in ODI, Cobb angle, and the percent of anterior vertebral height (AVH %) between the groups. O-arm navigation-assisted PKP demonstrates better clinical safety and efficacy than C-arm-guided PKP, marking it as a minimally invasive, safe, and effective procedure for treating patients with OVCF with spinal deformity.

Analysis on the related factors of misplacement of freehand pedicle screws via posterior approach in degenerative scoliosis

BackgroundTo study the risk factors associated with misplacement of freehand pedicle screws through a posterior approach for degenerative scoliosis.MethodsA total of 204 patients who underwent posterior pedicle screw-rod system surgery for degenerative scoliosis in our hospital from December 2020 to December 2023 were retrospectively analyzed. Patient demographics, radiographic accuracy, and surgery-related information were recorded.ResultsA total of 204 patients were included. A total of 2496 screws were placed. 2373 (95.07%) were in good position. Misplacement screws were 123 (4.93%). None of the patients had postoperative spinal nerve symptoms due to screw malposition. The misplacement rate of thoracic (T10-T12) pedicle screws was 11.11% (60/540). Misplacement of pedicle screws in the lumbar spine (L1-L5) was 3.22% (63/1956). Age, gender, surgeon, and operation time had no significant effect on misplacement of pedicle screws (P>0.05). Body mass index, Hu value, number of screw segments, Cobb angle, vertebral rotation, and spinal canal morphology had some correlation with pedicle screw misplacement. Among them, BMI, Hu value, number of screw segments, Cobb angle, and vertebral rotation grade were independent risk factors for PS misplacement (P<0.05). The height of the posterior superior iliac spine had a significant effect on pedicle screw misplacement in the lower lumbar spine (L4/5) (P<0.05).ConclusionBMI, Hu value, number of screw levels, Cobb angle, and vertebral rotation grade were independent risk factors for pedicle screw misplacement in patients with degenerative scoliosis. Posterior superior iliac spine height has a large impact on PS placement in the lower lumbar spine. Patients with degenerative scoliosis should be preoperatively planned for the size and direction of the placed screws by X-ray and CT three-dimensional, to reduce the misplacement rate of pedicle screws.

Smooth Operator: Nanotextured Breast Tissue Expanders Are Associated with Lower Rates of Capsular Contracture

Background: Continuous research on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has introduced a focus on surface texturizations and a shift towards smooth breast devices, yet outcomes comparing the complication profiles of differently textured tissue expanders (TEs) remain conflicting. The study aim was to compare the complication profile of a new nanotextured and MRI-compatible TE to micro- and macrotextured TEs and to identify possible predictors for complications. Methods: A retrospective analysis of women undergoing expander-based breast reconstruction after mastectomy between January 2016 and March 2022 was conducted. The primary endpoint was the development of capsular contracture. Possible predictors were analyzed in a mixed-effects model using the least absolute shrinkage and selection operator (LASSO). Moreover, a comparison of complications and an evaluation of predictors were carried out. Results: A total of 147 breasts, encompassing 82 nanotextured, 43 microtextured and 22 macrotextured TEs, were analyzed. Breasts with nanotextured TEs were less likely to develop capsular contracture overall (OR, 0.12; 95%CI 0.05–0.28, p &lt; 0.001). Post-mastectomy radiotherapy (PMRT) was identified as a predictor for capsular contracture (OR, 4.67; 95%CI 1.86–11.71, p &lt; 0.001). Breasts with nanotextured TEs showed a higher rate of seroma, but lower rates of malposition and pain. Predictors for developing postoperative complications included higher mastectomy weight (p = 0.008). Conclusions: Breasts with nanotextured TEs exhibited the lowest rate of capsular contracture compared to micro- and macrotextured TEs. Together with its MRI-compatibility and improved oncologic follow-up, the nanotextured TE seems to be a favorable device for expander-based breast reconstruction.

Umbilical Line Securement Bundle to Reduce Line Loss in the Neonate.

Umbilical line migration not only increases the risks of complications but also results in malposition and, ultimately, loss of the umbilical line. To evaluate the use of an umbilical line securement bundle to reduce unintended line discontinuation after line adjustment in the neonate at a single 40-bed Level IV neonatal intensive care unit. A pre-post design of 75 neonates, preimplementation (n=50) and postimplementation (n=25), was analyzed using data collection from the electronic health record. There was a 37.5% absolute reduction in removal of the umbilical line due to malposition after line adjustment utilizing the umbilical line bundle, standardizing the adjustment order, nursing process, and follow-up x-ray evaluation. This absolute reduction has clinical significance although not statistically significant. Provider compliance rates with line adjustment order bundle were 75%, decreasing with additional adjustments (50%). Nursing staff reported comfort with umbilical line management, ranging from 63% to 87% on different tasks. The use of umbilical line bundles reduces rates of line discontinuation due to malposition. The adoption of umbilical line bundles in neonatal intensive care unit practice may help to prevent unintended line discontinuation. There is a need for continued research regarding the use of secondary securement devices for decreased rate of malposition and the timing and methods for surveillance of umbilical line position.

Beyond the Learning Curve of Robot-Assisted Navigation Spine Surgery: Refinement of Outcomes With Extended Experience.

Objective This study assessed whether robotic-assisted navigation (RAN) spine surgery outcomes, including operative time and pedicle screw accuracy, continue to improve with extended experience beyond 200 cases. Methods This is a retrospective review of 60 patients who underwent lumbosacral transforaminal interbody fusion using RAN. Patients were segmented into three groups of 20 consecutive cases each. The first group represented a surgical performance baseline leading up to the investigating surgeon's 200th RAN case. The subsequent two groups were selected beyond the 200th case with an average of 15 cases between groups. Pedicle screw accuracy and intraoperative outcomes were assessed. Statistical results were significant if p<0.05. Results Measures of surgical efficiency significantly improved beyond the investigating surgeon's 200th RAN case. As case number increased, the following parameters significantly decreased: registration time (group 1: 16.9±6.5, group 2: 12.9±3.0, group 3: 8.7±1.6 minutes; p<0.05), screw insertion time (group 1: 14.9±3.5, group 2: 10.9±2.0, group 3: 8.4±2.7 minutes; p<0.05), and total operative time significantly decreased from group 1 (175.9±58.2 minutes) to group 2 (135.8±23.9 minutes) (p=0.013) with a non-significant decrease to group 3 (121.5±32.3 minutes). Accuracy (Grade = A) significantly increased across groups (group 1: 87%, group 2: 94%, group 3: 98%; p=0.024). Group 1 had the highest misplacement rate of 3.7% (4/108 screws). The overall misplacement rate was 1.4% (4/290 screws) (Grade C-E). There was a higher rate of lateral screw misplacement compared to medial misplacement. Conclusion Even with a small number of initial cases, RAN spine surgery can consistently be performed with high accuracy and acceptable intraoperative outcomes. However, this study demonstrated refined outcomes with extended robotic experience.

Evaluating the Success Rate of Distal Femur Intraosseous Access Attempts in Pediatric Patients in the Prehospital Setting: A Retrospective Analysis

Objectives Although the proximal tibia is a common site for intraosseous (IO) line placement in pediatric patients, previously published data indicate high malposition rates in infants and children at this location. Although distal femur IO lines generally demonstrate higher flow rates than those at the proximal tibia, to date, there have been no published studies assessing distal femur IO access in pediatric patients. Thus, we aimed to compare the success rates of pediatric IO line insertion attempts between the proximal tibia and the distal femur in a prehospital setting. Methods We conducted a retrospective chart review of prehospital pediatric patients who underwent at least one IO line placement attempt by Palm Beach County Fire Rescue from May 2015 to January 2024. We excluded records lacking specific documentation of IO attempt location. We compared the unadjusted success rates of distal femur to proximal tibia, and we also compared success rates after propensity score matching and multivariable logistic regression. Secondarily, we assessed the prehospital complication rate of the IO lines at each anatomical site. Results We identified 163 pediatric patients who had an IO attempt and were eligible for analysis. Median age was 1.9 years (IQR: 0.46 to 4.2 years). Among those 163 patients, there were 234 vascular access attempts, including 82 IO attempts at the distal femur and 72 at the proximal tibia. The unadjusted success rate of distal femur attempts was 89.0%, compared to 84.7% for proximal tibia attempts, a difference of 4.3% (95% CI −6.4 to 15.0%). After propensity score matching, we found an adjusted odds ratio of 2.0 (95% CI 0.66 to 6.8), favoring the distal femur for successful placement. Prehospital complication rates were similar for distal femur (5.5%) and proximal tibia (4.9%). Conclusions This retrospective analysis of pediatric patients in a prehospital setting suggests that IO line placement at the distal femur might offer a marginally higher success rate compared to the proximal tibia. Despite not reaching statistical significance, these findings support the consideration of distal femur as a viable option for IO placement in the pediatric population.

EFFECTS OF SPRAYING CEMELE PEPPER (Capsicum annuum L.) EXTRACTS ONTO HATCHING EGGS OF ATAK-S LAYER HENS ON HATCHING RESULTS, SERUM GLUTATHIONE AND MALONDIALDEHYDE LEVELS

Alternative natural products have been used in hatching since chemicals used in the incubation of chicken eggs have toxic effects on the embryo, the practitioners and the environment. In this study with completely randomized design (CRD) the effects of a registered local pepper (Cemele) extract at different dosages in the incubation process of hatching eggs was examined. The chloride group disinfectant (T1), ethanol (T2), 2% pepper extract (T3), and 4% pepper extract (T4) were sprayed on to disinfect eggs before the incubation process. On the second, eighth, and eighteenth incubation days of the groups, the total mesophilic aerobic bacteria (TMAB) loads of the eggshell were examined, and the lowest load values were found at T4. In this study, the highest hatching efficiency (H) and the highest fertilised hatching rate (HF) were 87.52±2.88% and 81.66±1.44%, respectively, in T4. Early embryonic mortality (EEM) was not observed at T4, while the highest value was 7.11±1.35% at T2. The highest mid embryonic mortality (MEM) rate was 10.91±0.34% in T3 while the lowest rate was 7.11±1.35% in T4. The late embryonic mortality (LEM) rates were 14.22±2.69% in T2, 12.47±1.17% in T1, 12.66±2.69% in T3 and 5.30±0.17% in T4. The lowest malposition rate 8.92±0.01% and the lowest malformation rate 8.83±0.12% were observed in T4. At the end of this study, body weights, lengths, tona, and pasgar scores of the hatched chicks were calculated. The highest body weight and length values were observed as 43.57±1.37 g and 16.47±0.45 cm in T4 birds, respectively. The highest tona score was 98.10±1.27 in T4 and the lowest tona score was 93.65±1.22 in T1 birds. Pasgar score values of the chicks were 9.69±0.16 in T4, 9.38±0.17 in T2, 9.31±0.18 at T3 and 9.16±0.16 in T1, respectively. The MDA values of birds were 8.63±0.05, 0.70±0.10, 0.28±0.01 and 0.25±0.01 nmol mL-1 in T1, T2, T3 and T4, respectively while the highest GSH value was 32.39±0.66 M in T4, and the lowest value 11.15±1.03M in T2. In conclusion, the use of Cemele pepper extract had positive results in the incubation process of hatching eggs. Key Words: Incubation process, disinfectant, chlorine dioxide, ethanol, cemele pepper.

Does Pedicle Morphology Affect the Safety and Accuracy of Pedicle Screw Placement Using 3D-Printed Guides? A 5-Year, Single-Center Experience With 2210 Screws Placed for Adult Spinal Deformity Reconstruction.

Adult spinal deformity (ASD) surgery often involves the placement of pedicle screws using various methods, including freehand technique, fluoroscopic guidance, and computer-assisted intraoperative navigation, each with distinct limitations. Particularly challenging is the instrumentation of pedicles with small or absent cancellous channels (Watanabe types C and D pedicles), commonly found at the apex of large curves where precise screw placement is crucial for effective deformity correction. 3D-printed pedicle screw drill guides (3DPSG) may assist in accurately placing pedicle screws while minimally disrupting the standard ASD surgery workflow. This study aims to evaluate the safety and efficacy of 3DPSG in ASD patients with Watanabe types C and D pedicles, where the safe corridor for screw placement is limited. 3DPSG were designed using fine cut (≤1.25 mm) computed tomography scans. Preoperative screw trajectory planning and guide manufacturing were conducted using computer-aided design software (Mighty Oak Medical, Englewood, CO). Four ASD surgeons with varying experience levels placed the guides. Data on patient demographics, pedicle morphology, number of levels instrumented, and implant-related complications were collected. The study included 115 patients (median age 67, range 18-81 years) with 2210 screws placed from T1 to L5. The median number of levels instrumented per case was 11 (range 7-12). Diagnoses included adult degenerative scoliosis (n = 62), adult idiopathic scoliosis (n = 30), Scheuermann's kyphosis (n = 2), and other complex conditions (n = 21). The overall accuracy rate for pedicle screw placement was 99.5%, with a 0% malposition rate in type C and D pedicles. No vascular or neurological complications or reoperations related to screw placement were reported. 3DPSG facilitates safe and accurate pedicle screw placement regardless of pedicle morphology in ASD surgeries. This includes the challenging Watanabe types C and D pedicles, typically found at curve apices, enabling surgeons to achieve high implant density and optimal spinal fixation in ASD patients.

Transcatheter Valve-in-Valve Replacement With Balloon- Versus Self-Expanding Valves in Patients With Degenerated Stentless Aortic Bioprosthesis

Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has been associated with favorable outcomes in patients with degenerated stentless bioprosthesis. However, whether the outcomes after ViV TAVR for failed stentless bioprosthesis differ between balloon-expandable valves (BEVs) and self-expanding valves (SEVs) remains unknown. Therefore, we retrospectively analyzed 59 consecutive patients who underwent ViV TAVR for failed stentless bioprsothesis with BEVs (n = 42) versus SEVs (n = 17) in a single-health care system between 2013 and 2022. Overall, the mean age was 70.8 years and 74.6% were men. The mean transcatheter valve size was 26.3 ± 2.2 mm for BEVs and 26.4 ± 4 mm for SEVs (p = 0.93). The mean Society of Thoracic Surgeons score was 6.0 ± 3.6 for BEVs and 7.5 ± 5.5 for SEVs (p = 0.22). Compared with patients who received BEVs, those who received SEVs had higher rates of device malposition (2.4% vs 23.5%, p <0.01), postdeployment balloon dilation (11.9% vs 35.5%, p = 0.04) and need for a second transcatheter device (2.4% vs 35.5%, p <0.01). However, both groups showed similar improvement in aortic valve function at 30-day and 1-year follow-up (incidence of 1-year severe patient-prosthesis mismatch in BEVs: 17.6% vs 14.3% in SEVs, p = 0.78). The 1- and 3-year mortality did not differ between BEVs and SEVs (11.9% vs 11.8% and 25% vs 30%, respectively, Log rank p = 0.9). In conclusion, performing ViV TAVR for failed stentless bioprsothesis is technically challenging, especially when using SEVs; however, satisfactory positioning is possible in most cases, with excellent hemodynamic and clinical outcomes with BEVs and SEVs.

Assessment of Cardiac Anomalies in Pediatric Patients with Pectus Carinatum

Background: Pectus carinatum (PC) is an anterior thoracic visible deformity manifested by protrusion of the sternum. It can be an isolated chest deformity or it can be seen together with genetic pathologies. Methods: We analyzed the cardiac findings of 40 children who were diagnosed with pectus carinatum at Kahramanmaras Sutcu Imam University’s Thoracic Surgery Outpatient Clinic between 1 February 2021 and 1 February 2022 and 97 healthy controls in similar age groups. Results: The Pectus Carinatum patients had higher rates of cardiac malposition, MVP (Mitral valve prolapse), MI (mitral insufficiency), TVP (tricuspid valve prolapse), CHD (congenital heart disease), and aortic valve pathology. Conclusıons: Our study showed that the prevalence of cardiac pathologies in the pediatric PC patients was higher than that in the control group consisting of healthy children. Thus, it may be recommend the referral of pediatric PC patients to cardiology outpatient clinics for the early diagnosis of potential cardiac pathologies.

Comparison of Catheter Malposition Between Left and Right Ultrasound-Guided Infraclavicular Subclavian Venous Catheterizations: A Randomized Controlled Trial.

Catheter malposition after subclavian venous catheterization (SVC) is not uncommon and can lead to serious complications. This study hypothesized that the left access is superior to the right access in terms of catheter malposition after ultrasound-guided infraclavicular SVC due to the asymmetry of the bilateral brachiocephalic veins. Parallel-armed randomized controlled trial. A tertiary referral hospital in Korea. Patients 20-79 years old who were scheduled to undergo SVC under general anesthesia. Patients were randomly assigned to either the left ( n = 224) or right ( n = 225) SVC group. The primary outcome measure was the overall catheter malposition rate. The secondary outcome measures included catheter malposition rates into the ipsilateral internal jugular and contralateral brachiocephalic veins, other catheterization-related complications, and catheterization performance. The catheter malposition rate was lower (10 [4.5%] vs. 31 [13.8%], p = 0.001), especially in the ipsilateral internal jugular vein (9 [4.0%] vs. 24 [10.7%], p = 0.007), in the left SVC group than in the right SVC group. In the left SVC group, catheterization success rates on the first pass (88 [39.3%] vs. 65 [28.9%], p = 0.020) and first-catheterization attempt (198 [88.4%] vs. 181 [80.4%], p = 0.020) were higher whereas times for vein visualization (30 s [18-50] vs. 20 s [13-38], p < 0.001) and total catheterization (134 s [113-182] vs. 132 s [103-170], p = 0.034) were longer. There were no significant differences in other catheterization performance and catheterization-related complications between the two groups. These findings strengthen the rationale for choosing the left access over the right access for ultrasound-guided infraclavicular SVC.

Real-Time Ultrasound Tip Location Reduces Malposition and Radiation Exposure during Umbilical Venous Catheter Placement in Neonates: A Retrospective, Observational Study

Introduction: The umbilical venous catheter is a vital access device in neonatal intensive care units for preterm and critically ill infants. Correct positioning is crucial, as malpositioning can lead to severe complications. According to international guidelines, the position of the umbilical venous catheter tip must be assessed in real time; traditionally, the catheter is visualized with a thoracoabdominal X-ray, but one of the most effective and safest methods is therefore real-time ultrasound. Methods: This study compares real-time ultrasound and traditional X-ray methods for assessing umbilical venous catheter tip location in 461 cases. The rate of tip malposition was analyzed retrospectively. The secondary aim was to assess indwelling time of umbilical venous catheters and reasons of removal. Results: Real-time ultrasound tip location, found to be more reliable and efficient, demonstrated a significantly lower incidence of primary malpositioning compared to X-ray assessments (9.6 vs. 75.9%). The study also highlighted the association of real-time ultrasound with reduced catheter manipulation, fewer radiographs, and higher indwelling times of umbilical venous catheter. The multiple logistic regression showed a high probability of the central safe position of the umbilical venous catheter tip using real-time ultrasound tip location (odds ratio 29.5, 95% confidence interval: 17.4–49.4). Conclusion: The findings support the adoption of real-time ultrasound in clinical settings to enhance umbilical venous catheter placement accuracy and minimize associated risks. A minimal training investment is needed to attain the proficiency to visualize the umbilical venous catheters, offering a substantial advantage in terms of both cost-effectiveness for the procedure and enhanced patient safety.

In idiopathic scoliosis distances of spinal cord to thoracic pedicle are within 2 mm in a large region of the thoracic apex

Despite a 15% misplacement rate of screws in idiopathic scoliosis surgery, little is known about the relationship between pedicles and nerve structures in the entire thoracic curve. This study aimed to explore the spinal cord’s proximity to the pedicle wall at each thoracic vertebra in the entire thoracic curve, while considering different anatomical changes. Spinal cord to medial pedicle distances were measured on magnetic resonance imaging in 73 patients who underwent posterior spinal fusion with pedicle screw instrumentation. Associations with different variables were examined. A total of 51 patients (69.9%) showed a distance within 2 mm at the apex vertebra on the concave side, more than 50% had a distance within 2 mm in the next thoracic vertebra level above and below, and more than 25% two levels above and below. Weak correlations were found between proximity of the spinal cord at the apex vertebra and vertebra’s level and Cobb angle on the concave side (r = − 0.310, P = 0.008, r = 0.380, P = 0.001, respectively). These results emphasize the importance of thorough assessment when placing thoracic pedicle screws in idiopathic scoliosis patients. Further research is warranted to develop surgical strategies aimed at preventing potentially neurological complications resulting from screw misplacement.

Sacropelvic Fixation with Porous Fusion/Fixation Screws: A Technical Note and Retrospective Review

ObjectiveThe goal of this study was to analyze our initial experience using a novel porous fusion/fixation screw (PFFS) for pelvic fixation, and to determine our rate of screw malposition requiring intraoperative repositioning. MethodsWe reviewed 83 consecutive patients who underwent sacropelvic fixation with PFFS at our institution from 6/1/2022-6/30/2023 using intraoperative CT-based computer-assisted navigation (CAN) via an open posterior approach. Following PFFS insertion, intraoperative CT scans were obtained to assess screw positioning. Demographic data was collected, and operative reports and patient images were reviewed to determine what implants were used and if any PFFS required repositioning. Results74 patients (26M:48F) were included, and 57 (77.0%) had a prior sacroiliac joint or lumbar spine surgery. A stacked screw configuration was used in 62/74 cases (83.8%). A total of 235 PFFS were used and six (2.6%) were malpositioned. Of 88 cephalic screws placed in stacked configuration, 4 were malpositioned (4.5%); and 1/123 caudal screws were malpositioned (0.8%). One of 24 SAI screws placed in a stand-alone configuration was malpositioned (4.2%). Malpositions included four medial, one lateral, and one inferior; and all were revised intraoperatively without major sequela. ConclusionsAlthough PFFS are larger than traditional sacropelvic fixation screws, stacked SAI instrumentation can be done safely with CAN. We found a low malposition rate in our initial series of patients, the majority being the cephalad screw in a stacked configuration. This isn’t surprising, as these are placed after the caudal screws which reduces the available corridor size and increases the placement difficulty.

Clinical application of intracavitary electrocardiogram localization combined with ultrasound in central venous catheterization in critically ill patients: An observational study.

To explore the clinical application value of intracavitary electrocardiogram (ECG) localization combined with ultrasound in central venous catheterization in critically ill patients. A total of 103 patients who were treated in the intensive care unit of our hospital from October 2020 to June 2023 were selected as the study subjects, and according to the differences in their central venous catheter placement methods, they were divided into study group (n = 52, receiving ultrasound combined with intracavitary ECG localization for catheterization) and control group (n = 51, receiving routine catheterization). The differences in the catheter placement accuracy, catheter depth, catheter placement duration, incidence of catheter-related complications, length of stay, and hospitalization expenses between the 2 groups were compared. The analysis utilizing X-ray for catheter tip positioning indicated that the catheter tip placement rate was higher in the study group than in the control group, and the catheter tip malposition rate was lower than in the control group (P < .05). There was no statistical significance in the catheter depth between study group and control group (P > .05), and the catheter placement duration of study group was significantly lower than that of control group, with statistical significance (P < .05). One case of partial catheter blockage, one case of catheter-related bloodstream infection, and one case of phlebitis were observed in study group, with an overall incidence of complications of 5.77% (3/52), which was significantly lower than 21.57% (11/51) of control group (P < .05). The length of stay and hospitalization expenses in study group were significantly lower than those in control group, with statistical significance (P < .05). The combined use of ultrasound and intracavitary ECG localization in critically ill patients undergoing central venous catheterization can help increase the success rate of catheter placement, shorten the catheter placement duration, reduce the incidence of various catheter-related complications, and also reduce the length of stay and hospitalization expenses.

Neonatal Endotracheal Intubation: Comparison of Existing Formulae for Accuracy

Background There are several formulae proposed to calculate the ideal depth of insertion of the endotracheal tube (ETT) in neonates, none of which are universally accurate. Our objective is to identify the most accurate of these formulae and to determine the most suitable formula for babies weighing less than 1 kg. Methods This is a retro-prospective observational study conducted in a tertiary neonatal intensive care unit. All intubated babies, irrespective of their gestational age, were included in this study. Those with congenital airway anomalies or syndromes with involvement of the upper airway and those who required short-term ventilation restricted to the theatre complex were excluded. The ideal insertion depth was determined via a chest X-ray (CXR) with the ETT projecting between thoracic vertebrae 2 and 3. Predictions from eight formulae investigated in the Indian population were analysed using paired Wilcoxon tests and Bland–Altman plots. Results The sample size was 83, of which 16 weighed less than 1 kg. Neither weight-based nor naso-tragal length (NTL)-based formulae were universally accurate in the prediction of the ideal depth of insertion, and using either of the formulae resulted in a high rate of malpositioning. Amongst the NTL-based formulae, Tatwavedi and Singh’s adjustments worked better than the original. Conclusion The currently available formulae remain inaccurate in the prediction of the ideal length of insertion of ETT, more so in babies less than 1 kg in our study population.

Effect of cranial entry site on the rate of proximal catheter misplacement in ventriculoperitoneal shunt insertion.

The insertion of a ventriculoperitoneal shunt (VPS) is a common neurosurgical procedure, but the optimal entry site of the ventricular catheter is still under debate. In this study, the authors compare the parietal (Keen's) and frontal (Kocher's) entry sites in terms of the rate of revision surgery due to ventricular catheter misplacement, VPS dysfunction, and VPS infection. The authors retrospectively analyzed the data on consecutive adults (age ≥ 18 years) who had undergone primary VPS insertion between 2010 and 2020 at two neurosurgical centers. One center regularly inserts the ventricular catheter frontally (frontal group); the other center, parietally (parietal group). The primary outcome of interest was the rate of ventricular catheter misplacement necessitating revision surgery. Secondary outcomes were functional outcome as measured by the modified Rankin Scale (mRS), rate of revision surgery for VPS dysfunction and infection, as well as early (≤ 30 days) and late (> 30 days) mortality rates. Propensity score matching was performed based on baseline variables, such as normal pressure hydrocephalus, postinfectious hydrocephalus, and idiopathic intracranial hypertension, which were identified as predictors of ventricular catheter misplacement using logistic regression analysis. Among 539 consecutive patients, 301 (55.8%) were in the frontal group and 238 (44.2%) in the parietal group. Postoperative rates of revision surgery due to misplacement were comparable in the two catheter entry site groups (frontal 14 [4.7%] vs parietal 11 [4.6%], p = 0.987). Rates of revision surgery for VPS dysfunction (14 [4.7%] vs 10 [4.2%], respectively, p = 0.802) and infection (22 [7.3%] vs 10 [4.2%], p = 0.13) exhibited no significant differences. Favorable functional outcomes (mRS score ≤ 2; 164 [76.3%] vs 174 [79.5%], respectively, p = 0.058) and early mortality rates (5 [1.7%] vs 6 [2.5%], p = 0.483) were similar between the groups. After propensity score matching, the primary and secondary outcome measures remained comparable between the groups. The entry site of the ventricular catheter in VPS surgery does not seem to affect proximal revision rates. Further, revision rates due to VPS dysfunction, VPS infection, and morbidity were comparable as well.

Correlation of Medical Specialty With Malpositioned Intrauterine Devices [ID 2683518

INTRODUCTION: Intrauterine devices (IUDs) are an effective method of long-acting reversible contraception (LARC) and essential for preventing unintended pregnancies, as well as controlling abnormal uterine bleeding (AUB). Intrauterine devices are placed by both obstetrician−gynecologists and primary care providers. As an academic institution, our objective was to determine if training specialty of inserting provider correlated with the rate of malpositioned IUDs. METHODS: All ultrasounds from 2017 to 2020 in which an IUD was documented at SIU School of Medicine Department of Obstetrics and Gynecology, an American Institute of Ultrasound Medicine-certified center, were reviewed (IRB# 21-834). Association between specialty of inserting provider and malposition rate was assessed using chi-squared test. RESULTS: A total of 602 ultrasound reports documenting an IUD were reviewed; 109 malpositioned IUDs were identified (18.1%). Body mass index, age, and gravidity/parity were not significantly different in participants with malpositioned IUDs from those with a properly placed IUD. Indications for ultrasound included pelvic pain, bleeding, and lost strings. Intrauterine devices placed by primary care providers were malpositioned at a significantly higher rate than those placed by obstetrician−gynecologists, 30.0% versus 17.3%, respectively (P=.043). Obstetrician−gynecologists placed 1,961 IUDs and primary care providers placed 276 IUDs between 2017 and 2020. CONCLUSION: Intrauterine devices are a safe and reliable choice for LARC to prevent unwanted pregnancies and to control AUB. Training providers on proper techniques for IUD insertion is imperative for good clinical practice and patient satisfaction. Primary care providers are often seen for contraception management; therefore, the significantly higher malpositioned rate indicates the need to implement an enhanced simulation/education curriculum for IUD insertion.

Accurate placement of thoracolumbar pedicle screws using a handheld iOS-based navigation device: a prospective intra-patient agreement study

BACKGROUNDAccurate pedicle screw placement is a challenge with reported misplacement rates of 10% and higher. A handheld navigation device (HND) may provide accuracy equal to CT-based navigation (CT-Nav) but without the cost and complexity. OBJECTIVETo study the accuracy of a handheld navigation device for pedicle screw placement. STUDY DESIGNThis prospective cross-sectional study with consistently applied reference standard enrolled 20 patients undergoing 92 pedicle screw placements. PATIENTSPatients who underwent pedicle screw placement between May 2022 and September 2022. OUTCOME MEASURESPedicle screw placement accuracy per Gertzbein–Robbins. METHODSOnce the screw pilot hole was established, the proposed trajectory of the HND was compared with that proposed by CT-Nav. Postoperatively, screw accuracy was graded according to Gertzbein–Robbins by a blinded radiologist based on CT scans. Accuracy was compared between the two systems and published control for fluoroscopy assisted and CT-Nav placement using Bayesian posterior distribution. RESULTSThe trajectory proposed by the HND and CT-Nav were in agreement in 98.9% (95% Exact CI; 94.09%–99.97%). The HND accuracy was 98.9% with 91 screws rated “A” and 1 rated “C”. Noninferiority to fluoroscopic placement was achieved because the one-sided normal-approximation 95% CI Lower Bound (LB) of 95.3% is greater than the Performance Goal (PG) of 83.4%. Posthoc analysis demonstrated that the probability of superiority of the HND relative to the historical accuracy rate of 91.5% for fluoroscopy assisted procedures is >0.999 and that the HND's accuracy rate is within 4.5% of CT-Nav of 95.5% is >0.999. No adverse events or intra-operative complications associated with HND were observed. There was 1 (1.1%) intra-operative repositioning and no reoperations for any reason. CONCLUSIONSThe accuracy rate of the HND was 98.9%, and the proposed trajectory matched with CT-Nav in 98.9% of the time. This is superior to the historical published accuracy rate for fluoroscopy-assisted procedures and equivalent to the historical published accuracy rate for CT-Nav. Clinical Trial Registration NumberDutch trial register NL74268.058.20.

Mixed Reality-Based Navigation for Pedicle Screw Placement: A Preliminary Study Using a 3D-Printed Spine Model.

Background and objectives Mixed reality (MR) is one of the image processing technologies that allows the user to manipulate three-dimensional (3D) virtual images (hologram). The aim of this study was to evaluate the accuracy of MR-based pedicle screw (PS) placement using 3D spine models. Materials and methods Using the preoperative CT data of a patient with adolescent idiopathic scoliosis (AIS) who had undergone posterior spinal fusion in our hospital, a 3D-printed spine model was created. On the other hand, a 3D hologram of the same patient was automatically created using the preoperative CT data uploaded to the Holoeyes MD service website (Holoeyes Inc., Tokyo, Japan). Using a Magic Leap One® headset (Magic LeapInc., Plantation, FL), the 3D hologram with lines of predetermined PS trajectories was superimposed onto the 3D-printed spine model and PS were inserted bilaterally along with the trajectory lines from T5 to L3. As a control, we used a readymade 3D spine model of AIS and inserted PS bilaterally with a freehand technique from T4 to L3. The rate of pedicle violation was compared between the MR-based and freehand techniques. Results A total of 22 and 24 PS were placed into the 3D-printed spine model of our patient and the readymade 3D spine model, respectively. The rate of pedicle violation was 4.5% (1/22 screws) in the MR-based technique and 29.2% (7/24 screws) in the freehand technique (P = 0.049). Conclusions We demonstrated a significantly lower rate of PS misplacement in the MR-based technique than in the freehand technique. Therefore, an MR-assisted system is a promising tool for PS placement in terms of feasibility, safety, and accuracy, warranting further studies including cadaveric and clinical studies.