Risk Of Neurological Damage Research Articles

Hyperammonemia in the Pediatric Emergency Department.

Hyperammonemia is a serious clinical condition associated with significant morbidity and mortality. In the pediatric population, this is often caused by urea cycle disorders, acute liver failure, or other less common underlying etiologies. Children and teens with hyperammonemia can have a broad range of clinical findings, including vomiting, respiratory distress, and changes in mental status. As ammonia levels worsen, this presentation can progress to respiratory failure, encephalopathy, cerebral edema, seizures, and death. Given the risk of neurologic damage, timely identification and management of hyperammonemia is critical and includes initial resuscitation, early consultation with subspecialists, and initiation of appropriate therapies. It is important for pediatric emergency medicine providers to understand the clinical findings, causes, diagnosis, and management of hyperammonemia because they play a key role in the provision of effective, multidisciplinary care of these patients.

Relationship between Cognitive Impairment and Depressive Symptoms with Somatosensory Functions in Diabetic and Non-Diabetic Older Adults and Its Impact on Quality of Life.

Aging is an inevitable process that impacts the peripheral and central nervous systems and is considered one of the strongest risk factors for neurodegenerative diseases. In addition, when it also presents with diabetes mellitus, the risk of neurological damage may be further increased. This current study aimed to explore the relationships between peripheral sensory system decline and cognitive functions, the symptoms of depression, and quality of life (QoL) as metrics of central nervous system impairment in institutionalized older adults. A total of 95 individuals participated in this case-control study, which included diabetics and non-diabetics. The superficial sensory pathway was assessed in terms of thermal sensation, nociception, and non-discriminative touch, and the deep sensory pathway was evaluated by assessing vibration and light touch-pressure sensations. To assess function at the intellectual level, the Mini-Mental State Examination (MMSE) and Trail Making Test (TMT) cognitive functional tests were used, while the symptoms of depression and QoL were explored by employing the Yesavage Geriatric Depression Scale and EuroQol 5D questionnaire (EQ-5D), respectively. In the overall population analyses, altered thermal sensation was significantly associated with cognitive impairment (CI; p < 0.05). In turn, bivariate analyses and a binary logistic regression showed that the symptoms of depression and QoL were significantly related to altered vibratory sensation when assessed using a medical tuning fork (p < 0.05). In the group of diabetic patients, those with CI also had significantly lower thermal sensation (p < 0.05) and non-discriminative touch sensation, although this was only a trend (p = 0.055). Diabetics with depression had a significantly worse non-discriminative touch (p < 0.05) and vibratory sensation when tested with a tuning fork (p < 0.05). In addition, poorer QoL was associated with reduced sensitivity to heat (p < 0.05), light touch pressure (p < 0.05), and vibrations when assessed either with a tuning fork (p < 0.05) or a biothesiometer (p < 0.05). In contrast, no relationships were found between sensory functions and cognitive assessments in non-diabetic patients. These findings indicate that superficial sensitivity damage was related to CI, while deep sensation alterations were related to depression and poor QoL, with diabetes apparently further strengthening these relationships.

Obstetric Neuropathy in Diabetic Patients: The "Double Hit Hypothesis".

The two-hit model has been proposed to explain the effects of diabetes on mothers who are already in a putative subclinical damaged state and then undergo neuronal damage during the delivery process. However, the anatomical and pathophysiological mechanisms are not well understood. Our overarching hypothesis in this review paper is that pregnant women who are diabetic have a damaged peripheral nervous system, constituting the "first hit" hypothesis. The delivery process itself-the "second hit"-can produce neurological damage to the mother. Women with diabetes mellitus (DM) are at risk for neurological damage during both hits, but the cumulative effects of both "hits" pose a greater risk of neurological damage and pathophysiological changes during delivery. In our analysis, we introduce the different steps of our concept paper. Subsequently, we describe each of the topics. First, we outline the mechanisms by which diabetes acts as a detrimental variable in neuropathy by focusing on the most common form of diabetic neuropathy, diabetic distal symmetrical polyneuropathy, also known as distal sensorimotor neuropathy. The possible role of macrosomia in causing diabetic neuropathy and obstetric neurological injury is discussed. Second, we describe how vaginal delivery can cause various obstetrical neurological syndromes and pathophysiological changes. Third, we highlight the risk of obstetric neuropathy and discuss anatomical sites at which lesions may occur, including lesions during delivery. Fourth, we characterize the pathophysiological pathways involved in the causation of diabetic neuropathy. Finally, we highlight diabetic damage to sensory vs. motor nerves, including how hyperglycemia causes different types of damage depending on the location of nerve cell bodies.

Methods and Principles of the Intraoperative Neurophysiologic Monitoring in Neurosurgery.

Intraoperative neurophysiologic monitoring (IONM) is an innovation introduced in neurosurgery in the past decades. It aims to support and guide the neurosurgeon to obtain the best surgical result possible, preventing the occurrence of neurological deficits. The somatosensory evoked potentials (SSEP) assess the integrity of the sensory pathways monitoring the dorsal column-medial lemniscus pathway during spine and cerebral surgery. Motor evoked potentials (MEPs) provide information on the integrity of the motor pathway monitoring the efferent motor pathways from the motor cortex to the muscle through corticospinal (or corticobulbar) tracts. Free-running EMG is the standard technique to monitor peripheral nerves, roots, or cranial motor nerves during surgery. Intraoperative EMG signals are activated during cranial motor nerves damaging or after an irritative stimulus. The duration, morphology, and persistence of EMG reflects the severity of neural injury. Nerve mapping consists of recording muscle activations given by direct nerve stimulation. This technique makes use of a stimulation probe available to the neurosurgeon which allows administering current directly to the nervous tissue (nerves, roots, etc.). Intraoperative neurophysiological monitoring (IONM) represents the standard of care during many procedures, including spinal, intracranial, and vascular surgeries, where there is a risk of neurological damage. Close communication and collaboration between the surgical team, neurophysiologist, and anesthesiologist is mandatory to obtain high-quality neuromonitoring, thus preventing neurologic injuries and gaining the best surgical "safe" results.

Intramedullary nailing for humeral shaft fractures: Is distal locking necessary?

IntroductionIntramedullary (IM) nailing of humeral shaft fractures is a reliable means to achieve bone union while allowing early motion. The hypothesis was that distal locking is unnecessary due to good primary stability of the impacted nail in the distal, truncated cone portion of the medullary canal. The primary objective of this study was to confirm the success of the procedure without distal locking by identifying failure criteria. The secondary objectives were to compare the outcomes of IM nailing with and without distal locking. Material and methodsThis was a retrospective, single-center, non-randomized study of 128 patients with a humeral shaft fracture between 2012 and 2020 treated surgically with a long IM nail. Proximal locking was done in every case, then the rotational stability of the nail was tested. Stable nails were not locked distally (group A), while unstable nails were locked distally through an anterior approach (group B). All patients were reviewed with at least 12 months’ follow-up. ResultsDistal locking was performed in 30 patients (mean age 63, 17–91) while the fracture in 98 patients (mean age 65, 20–93) did not require distal locking. The average time to union was 4 months (2–6). The average operative time in group B was 87min (35–185) with 90s fluoroscopy time (33–158) versus 52min (20–127) with 44 s fluoroscopy time (12–143) in group A (p<0.05). Four patients in group B suffered postoperative radial nerve palsy and two others had another fracture at the level of the distal locking screws. The union rate did not differ between groups (Group A 94.6%, group B 86.2%, p=0.217) nor did the functional recovery – SSV of 79.5 (10–100) in group A versus 76 (40–100) in group B (p=0.271) – or the range of motion (p>0.05). There were no instances of rotational malunion. DiscussionExcept for certain distal third fractures, distal locking is not necessary to achieve bone union when the nail is impacted into the medullary canal. This reduces the operative time, fluoroscopy time and risk of neurological damage. Level of evidenceIV.

Does a preoperative cone beam CT reduce complication rates in the surgical removal of complex lower third molars? A retrospective study including 486 cases

BackroundThis study was designed to analyse the value of preoperative Cone Beam CTs (CBCT) prior to the surgical removal of complex lower third molars. Furthermore, the aim was to assess injuries to the inferior alveolar nerve (IAN) bundle and postoperative neurological disorders depending on the position of the lower third molar and the inferior alveolar nerve bundle.MethodsIn this retrospective examination preoperative Cone Beam CTs and Orthopantomographs (OPT) of 324 patients were analysed concerning the location of the lower third molars in relation to the mandible and the inferior alveolar nerve bundle. Surgery protocols of all patients who underwent the surgical removal of at least one complex lower third molar were analysed concerning patient data, length of surgery, intraoperative haemorrhage, intraoperative exposure of the inferior alveolar nerve bundle, postoperative swelling and postoperative neurological disorders. The data was then compared to data from international studies.ResultsIn all 324 patients a permanent neurological damage was not found. Temporary neurological damage was recorded in 13 cases (2.6%). A caudal nerve position with no measurable distance to the root of the lower third molar was associated with the highest risk of a temporal neurological damage. A vestibular touching nerve route also correlated with postoperative sensitivity impairment. If a mesioangulation (Winter) or a Pell and Gregory Type IIIC appears in the OPT, risk of neurological damage is at its highest.ConclusionsThree-dimensional radiographic imaging, in our patient group, does not significantly affect the risk for complications during the surgical removal of complex lower third molars. Therefore, it should only be utilized for risk assessment, especially in cases of symptom-free lower third molars.A preoperative orthopantomogram still can be accepted as standard for radiographic imaging.An intraoperative exposure of the IAN bundle does not necessarily predict simultaneous neurological damage. Exposure of the IAN bundle is no indication for a discontinuation of the surgery.

Management Of Sacral And Sacroiliac Joint Fractures By Percutaneous Screws

Pelvic ring fractures are serious injuries which have been functionally determined by reduction quality; the objective of this research is to assess the effect of percutaneous fixation of the screw in the treatment of sacred fractures and sacroiliac joint damage. The research included 20 patients with sacral fractures and sacroilia joint injuries, with an average age of 32. Every single xray anteroposterior (AP), inlet and outlet views in the pelvis were radiologically evaluated for all patients. At the conclusion of the follow-up period, the outcomes were evaluated both clinically and radiologically. Overall Majeed outcomes were (clinically) judged to be acceptable among 16 (80%) patients; eight (40%) were excellent and eight (40%) were good and only 4 (20%) were unsatisfactory; 3 (15%) were fair and 1 (5%) were bad; Percutaneous sacroiliac pelvic fracture fixation has less damage, less bleeding, fast recovery, safe and effective minimally invasive operation technique. Percutaneous iliosacral vibrators are very demanding methods of placing highly scalable malpositions that are potentially associated with the risk of neurological damage or inadequate stability.

Giant intradural plexiform schwannoma of the lumbosacral spine - a case report and literature review

BackgroundPlexiform schwannoma (PS), variant of schwannoma, often involves multiple fascicles as plexiform neurofibroma, and is usually located superficially on the dermis and subcutaneous layers. Spinal PS is extremely rare, and there is insufficient information on its natural course and treatment strategy. We describe the clinical features and treatment of giant intradural PS at the lumbosacral spine.Case presentationA 66-year-old man presented with leg pain, paresthesia, and weakness for 2 years. Magnetic resonance imaging demonstrated a large mass lesion involving a continuous multi-lobulated bead-like mass and a cystic portion from L1 to S3. The lesion was iso-intense on T2-weighted images (WI), iso- to slightly low-intense on T1-WI, and heterogeneous enhancement on contrast-enhanced T1-WI. The large mass lesion had three portions, including a cystic mass at L1, continuous multi-lobulated bead-like mass with a cystic portion from L2 to S1, and multi-lobulated mass from S2 to S3, which were identified with severe adhesions with cauda equina on operative assessment. Grossly total extirpation was achieved at the lumbar spine, and remained three round shaped small masses at the lumbar area and a multi-lobulated round masses from S2 to S3 involving nerves related with motor function of the lower extremities and anal sphincter, respectively. Histological examination revealed multinodular or plexiform growth pattern composed of spindle-shaped tumor cells, which were diffusely and strongly positive for S100 protein with KI67 < 1%. There were no recurrence of preoperative symptoms and changes of the remained masses over a 2-year follow-up period.ConclusionSubtotal extirpation to minimize neural deficits and close observation can be considered an appropriate treatment strategy for a giant spinal PS considering its benign prognosis and histological features, with a high risk of neurological damage during surgery.

Penetrating spine injury bisecting thoracic spinal canal with no significant neurological deficits-The midline cord syndrome.

In India, the incidence of penetrating spine injury (PSI) is increasing because of the increased use of advanced ballistics (missile PSI) among military personnel and sophisticated tools and construction instruments like nail-guns or drills (non-missile PSI) among civilians. These injuries are associated with a risk of neurological damage, central nervous system infections, vascular injury, dural tear followed by CSF leakage, and spinal instability. A 35-year-old male presented with a non-missile PSI with retained iron nail bisecting his dorsal spinal cord, without any motor deficits. Patient presented with only left lower limb proprioceptive loss and L1-L3 paresthesia. Nail removal was done on emergent basis without any further neurological damage. To the best of our knowledge, this presentation of a non-missile PSI and has not been previously reported. The specific clinical presentation of this distinct type of injury to the midline structures of the spinal cord is hence named "midline cord syndrome".

Risk of neurological damage when placing implants in the pterygomaxillary area: a CBCT study

Risk of neurological damage when placing implants in the pterygomaxillary area: a CBCT study

What is the importance of the spinal canal encroachment in the management of thoracolumbar burst fracture without neurological deficit?

Introduction: The relevant features in the treatment of thoracolumbar fractures vary in the literature. The classical surgical indications of burst fractures are loss of vertebral body height, kyphosis, neurological deficit and canal encroachment. Recent papers have attributed less importance to canal impingement as a surgical indicator in intact patients, irrespectively of the degree of encroachment. The several thoracolumbar fracture classifications have prompted efforts to guide the surgical indications. We analyzed the relevance attributed to the canal encroachment by thoracolumbar fracture classifications in the management of burst fractures without neurological deficit. Objective: To evaluate the relevance attributed by the thoracolumbar fractures classifications to the canal encroachment in the management of burst fractures without posterior ligamentous complex disruptions or neurological deficits. Methods: A literature search was performed by tracking the related articles of thoracolumbar fractures classifications from Vaccaro’s to Holdsworth’s study. We analyzed the role of canal impingement in the management of burst fractures without posterior ligament complex injury or neurological deficits in each classification. Results: Seven classifications were included. Holdsworth considered the burst fractures as stable, irrespectively of the amount of canal impingement or neurological deficit. Denis considered that the burst fracture carried a neurological instability criterion, therefore, in these cases he suggested surgical treatment because of the riskof new neurological damage. McAffee postulated that there is no reliable predictor to correlate the severity of canal encroachment with the risk of neurological damage. Ferguson and Allen discussed the possibility of anterior decompression, stabilization and anterior fusion of the spine in certain cases of burst fractures. The classifications of McCormack, Karaikovic and Gaines, Magerl and Vaccaro did not include canal encroachment in their considerations. Conclusion: The thoracolumbar fractures classifications did not directly consider the severity of canal encroachment in the treatment decision making of burst fractures without neurological damage. It is not possible to predict which patients will deteriorate if not operated. It remains unclear what is the risk of neurological deterioration in a SCE greater than 50%.

Ten Tips to Improve Iliosacral Screw Placement

Sacroiliac screw fixation has become the most common procedure for iliosacral joint fracture-dislocations and sacral fractures in the last decade. At present, the standard technique is the percutaneous iliosacral screw fixation under conventional C-arm fluoroscopy. This technique is considered to be a highly demanding operative technique with a high rate of screw malpositions, which may be associated with the risk of neurologic damage or inefficient stability. The surgical steps have been carefully described but, according to our experience, several tricks may be added to those descriptions. The purpose of this review is to summarize ten simple tips to help minimize failures and improve outcomes when positioning iliosacral screws.

An Interprofessional Approach to Hypothermia Prevention in the Perioperative Setting

While hypothermia may be intentionally induced in some perioperative patients (e.g., risk of neurological damage following cardiac arrest), maintenance of normothermia is more commonplace to diminish negative sequelae like prolonged recovery times, altered drug metabolism, and wound infections. Inadvertent perioperative hypothermia (IPH) can result from low ambient room temperature, general anesthesia resulting in peripheral vasoconstriction, and patient factors (e.g., elderly, very young, major trauma or burns). Variations in IPH prevention practices, financial impacts, and a commitment to improving patient outcomes prompted the development of an IPH awareness campaign.

Evaluation of functional performance assessment in preterm infants with Infant Neurological International Battery

Context: Many studies have found that there is an increased risk of neurodevelopmental impairments in preterm and low birth weight (LBW) infants, so it is desirable to make early predictions with regard to outcome. This is important for the family, for the researchers designing appropriate follow-up and intervention programs, and for the pediatric neurologist who has to give meaningful feedback to obstetricians and neonatologists. Several studies have tried to identify infants at particularly high risk of neurological damage. In 1972, Drillien described transitory dystonia of the LBW premature infant as a common developmental deviation of motor function during the 1 st year of life. Aims: To evaluate the functional performance (age specific motor development) in preterm infants using Infant Neurological International Battery (INFANIB). Settings and Design: Observational study design conducted at physiotherapy OPD. Subjects and Methods: An observational study was carried out in 100 infants who were born at 24-31 weeks gestation with age group from 4 to 9 months with a mean age of 4.3 months. The sample selection was based on convenient sampling method. The infants were evaluated according to their gestational age. The study was approved by Institutional Ethical Committee. The guardians signed an informed consent form allowing the infant's participation. INFANIB was administered on 100 preterm infants, and collected data were compared with standard values of INFANIB. Statistical Analysis Used: Unpaired t-test was used for between group comparisons. Results: The present study shows that premature infants have high risk of delayed pattern of motor development which is different from those infants born at term. Conclusions: The premature infants show delayed pattern of motor development that is different from those born at term.

Le lesioni vascolo-nervose nei trattamenti ortopedici a livello di braccio e gomito

Despite advances in instrumentation and technology, complications still exist in orthopaedic practice and neurologic and vascular injuries remain an inherent part of many procedures. At arm and elbow level one of the most severe, even if unfrequent, complications is a iatrogenic nerve injury, for the relevant impairment to the upper limb function in terms of motility but also of sensibility. Various surgical procedures around the elbow and arm are known to involve a risk of vascular and/or peripheral nerve lesions. At arm level one of the major risks is a radial nerve palsy during the treatment of humerus fractures. The decision on nerve exploration and its timing is still controversial. At elbow level the development of sophisticated arthroscopic procedures and the more and more frequent implant of elbow prosthesis augment the risks of neurological damage in a surgical region difficult for the proximity of important nerve structures to the surgical approaches.

Complicanze vascolari o neurologiche nella chirurgia multisettoriale della colonna

Spine surgery for correction of scoliosis and kyphosis is insidious. It involves operating on different segments of the spine at the same time and this may create peculiar problems to the surgeon. The positioning of patients on the surgical table is important; the potential risks of neurological damage and of vascular injuries we can observe during such kind of operation are then discussed.

Intra- and postoperative complications of navigated and conventional techniques in percutaneous iliosacral screw fixation after pelvic fractures: Results from the German Pelvic Trauma Registry

BackgroundPercutaneous iliosacral screw placement following pelvic trauma is a very demanding technique involving a high rate of screw malpositions possibly associated with the risk of neurological damage or inadequate stability. In the conventional technique, the screw's correct entry point and the small target corridor for the iliosacral screw may be difficult to visualise using an image intensifier. 2D and 3D navigation techniques may therefore be helpful tools.The aim of this multicentre study was to evaluate the intra- and postoperative complications after percutaneous screw implantation by classifying the fractures using data from a prospective pelvic trauma registry. The a priori hypothesis was that the navigation techniques have lower rates of intraoperative and postoperative complications. MethodsThis study is based on data from the prospective pelvic trauma registry introduced by the German Society of Traumatology and the German Section of the AO/ASIF International in 1991. The registry provides data on all patients with pelvic fractures treated between July 2008 and June 2011 at any one of the 23 Level I trauma centres contributing to the registry. ResultsA total of 2615 patients were identified. Out of these a further analysis was performed in 597 patients suffering injuries of the SI joint (187×with surgical interventions) and 597 patients with sacral fractures (334×with surgical interventions).The rate of intraoperative complications was not significantly different, with 10/114 patients undergoing navigated techniques (8.8%) and 14/239 patients in the conventional group (5.9%) for percutaneous screw implantation (p=0.4242).Postoperative complications were analysed in 30/114 patients in the navigated group (26.3%) and in 70/239 patients (29.3%) in the conventional group (p=0.6542). Patients who underwent no surgery had with 66/197 cases (33.5%) a relatively high rate of complications during their hospital stay. The rate of surgically-treated fractures was higher in the group with more unstable Type-C fractures, but the fracture classification had no significant influence on the rate of complications. DiscussionIn this prospective multicentre study, the 2D/3D navigation techniques revealed similar results for the rate of intraoperative and postoperative complications compared to the conventional technique. The rate of neurological complications was significantly higher in the navigated group.

Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis

Percutaneous iliosacral screw placement following pelvic trauma is associated with high rates of revisions, screw malpositioning, the risk of neurological damage and inefficient stability. The correct entry point and the small target corridor may be difficult to visualize using only an image intensifier. Therefore, 2D and 3D image-based navigation and reconstruction techniques could be helpful tools. The aim of this systematic review and meta-analysis was to evaluate the best available evidence regarding the rate of malpositioning and revisions using different techniques for screw implantation, i.e., conventional, 2D and 3D image-based navigation and reconstruction techniques, CT navigation. A systematic review and meta-analysis were performed using the data available on Ovid Medline. 430 studies published between 1/1948 and 2/2011 were identified by two independent investigators. Inclusion criteria were percutaneous iliosacral screw fixation after traumatic pelvic fractures with included revision rate or positioning of the screw, language of the article English or German. Exclusion criteria were osteoporotic fracture, tumor, reviews, epidemiological studies, biomechanical/cadaveric studies, studies about operative technique. For statistical analysis the random effect model was used. A total of 51 studies fulfilled the inclusion requirements describing 2,353 percutaneous screw implantations following pelvic trauma in 1,731 patients. The estimated rate of malposition was 0.1% for 262 screws using CT navigation. This rate was significantly lower (p<0.0001) than for the conventional technique with malposition rate of 2.6% (total 1,832 screws). Using 2D and 3D image-based navigation and reconstruction techniques, the malposition rate was 1.3% (total 445 screws). No significance was observed between the conventional and the 2D and 3D image-based navigation and reconstruction techniques. The rates of revision were not statistically significant with 2.7% (1,832 implantations) in the conventional group, 1.3% (445 implantations) in the group of 2D and 3D image-based navigation and reconstruction techniques and 0.8% (262 implantations) using the CT navigation. CT navigation has the lowest rate of screw malposition, but on the other hand it could not be used for all type of fractures where surgical procedures (reduction maneuvers, additional osteosynthetic procedures) are necessary. The 2D and 3D image-based navigation and reconstruction techniques provide encouraging results with slightly lower rate of complications compared to the conventional technique and are additional tools to enhance the precision and decrease the rate of revision.

Effect of the adjunct of carbon dioxide during cardiopulmonary bypass on cerebral oxygenation

Over the last few years, near-infrared spectroscopy (NIRS) has been introduced to study cerebral haemodynamics and oxygenation. This paper points out how the use of an external source of CO2 effects on the absolute value of cerebral NIRS during cardiac surgery on cardiopulmonary bypass. Between January 2010 and September 2011, 368 patients underwent congenital heart disease correction on cardiopulmonary bypass (CPB). Nineteen patients, with a mean age of 26 days (range 6-120 days), required an external source of CO2 to correct hypocarbia during cardiopulmonary bypass. Different parameters were monitored: NIRS value, oxygen saturation, oxygen partial pressure, CO2 partial pressure, haematocrit, mean arterial pressure and pH. They were analyzed during different phases of the surgical procedure: before, during and after CO2 infusion. There were no deaths during the hospital stay. The NIRS value increased significantly (p<0.05) after the addition of CO2, from a starting value of 52.9 to a final value of 63.4. PaCO2 was found to increase too: from 31.3 mmHg to 40.6 mmHg. On the other hand, both values decreased when the CO2 was removed, to respective final values of 55.8 and 34.4 mmHg. Mean arterial pressure, haematocrit and PaO2 didn't modify significantly during this period. Nowadays, NIRS is usually used in cardiac surgery to reduce possible risks of neurological damage. The importance of the role of pCO2 in the cerebral vascular resistance and in cerebral blood flow has already been proven. This research demonstrates a relationship between pCO2 and the NIRS value. This paper could introduce an important correcting tool when an inadequate NIRS value occurs although the level of oxygenation, haematocrit and mean arterial pressure are acceptable and the arterial line is accurately positioned.

Percutaneous Iliosacral Screw Insertion: Malpositioning and Revision Rate of Screws With Regards to Application Technique (Navigated Vs. Conventional)

Conventional percutaneous iliosacral screw placement in pelvic surgery is considered to be a highly demanding operative technique with a high rate of screw malpositions, which may be associated with the risk of neurologic damage or inefficient stability. In the conventional technique, the correct entry point for the screw and the small target corridor for the iliosacral screw may be difficult to visualize using an image intensifier. We tried to find out in this study whether the positioning of percutaneous screw implantations could be optimized by evaluating the rate and grade of malpositions and whether the needed revisions could be reduced by using computer navigation and three-dimensional (3D) image intensifier. A group of 54 patients with 63 screws implanted using computer navigation was compared with 87 patients with 131 screws implanted using the conventional fluoroscopic technique. The exact screw position was controlled in a postoperative computed tomography scan, and the grade of malposition of every screw was investigated and compared. A complete intraosseous screw position was found in 42% of cases using the conventional technique and was significantly less compared with 81% using a 3D image intensifier in combination with a navigation system. Moreover, the revision rate of 1.6% was significantly less in the navigated group compared with 19% in the conventional group. The results indicate that 3D-computer navigation of the percutaneous iliosacral screw insertion can facilitate surgical performance in respect to reducing screw malposition and revision rates.