Purpose: Placement of pedicle screws can be performed using freehand/fluoroscopic technique or intra-operative CT guided navigation. We sought to compare screw malposition and return to OR for pedicle screw malposition for screws placed with and without CT-guided navigation. Methods: This study was a single center retrospective comparative study. All patients under the age of 18 with minimum 2-year follow-up who underwent pedicle screw instrumentation between 2009-2015 were included. IRB-approval was obtained and patient charts were reviewed for patient demographics and surgical outcomes. If available, incidental CTs following the index surgery were reviewed to assess screw position. Results: 217 patients underwent spinal instrumentation. 112 patients had pedicle screws placed using fluoroscopic guidance, while 105 patients had screws placed using lowdose intraoperative CT-guided navigation (O-arm, Medtronics). Of the total cohort, 107 (49.3 %) patients had adolescent idiopathic scoliosis, and the remainder had neuromuscular, tumor, congenital, or other diagnoses. Patients in each group had a similar number of levels fused (fluoroscopic = 10.9 vs. CT navigation = 9.8, p = 0.06). There was no difference in total estimated blood loss (1127 vs. 1179 mL, p = 0.63), or in blood loss per level fused (133.7 vs. 146.6 mL, p = 0.47). Patients with screws placed using fluoroscopic guidance had a shorter total operative time (441 vs. 468 minutes, p = 0.04); however, there was no difference when controlling for number of levels fused (58.3 vs. 61.5 minutes/level, p = 0.63). Postoperative CTs were available in 51 patients representing 526 imaged screws, which showed a significantly higher rate of severely malpositioned (>4mm) screws in the fluoroscopic group than the CT navigation group (3.3% vs. 1.0%, p = 0.027). There was a 3.6% rate of return to OR for pedicle screw malposition in the freehand/fluoroscopic group compared to 0% in the CT-guided navigation group (p=0.048). Including patients with less than 2-year follow

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There exists a dichotomy in regenerative capacity between the PNS and CNS, which poses the question – where do cranial nerves fall? Through the discussion of the various cells and processes involved in axonal regeneration, we will evaluate whether the assumption that cranial nerve regeneration is analogous to peripheral nerve regeneration is valid. It is evident from this review that much remains to be clarified regarding both PNS and CNS regeneration. Furthermore, it is not clear if cranial nerves follow the PNS model, CNS model or possess an alternative novel regenerative process altogether. Future research should continue to focus on elucidating how cranial nerves regenerate; and the various cellular interactions, molecules and pathways involved.

Traditional measures of scholarly impact (i.e., impact factor, citation rate) do not account for the role of social media in knowledge dissemination. The Altmetric Attention Score (AAS) tracks the online sharing activity of articles on platforms such as Twitter and Facebook. All 285 original scientific articles published in Journal of Burn Care & Research and Burns from January to December 2017 were obtained from official journal websites. Article characteristics extracted include: AAS; number of Twitter, Facebook, and news outlet mentions; subject of study and study design; number of citations; number of authors and academic institutions; and others. The average AAS for all articles was 6.1 (SD: 48; Range: 0 to 611) in which 156 (55%) of those had Twitter mentions. The mean AAS for Journal of Burn Care & Research and Burns were 7.7 (SD: 54; Range: 0 to 536) and 5.3 (SD: 45; Range: 0 to 611), respectively. There was a weak, positive correlation between AAS and citation count for all articles (ρ = 0.12; p = 0.049), and this finding was consistent for Journal of Burn Care & Research (ρ = 0.21; p = 0.039) and Burns (ρ = 0.15; p = 0.038) individually. The weak correlation between the two metrics supports that AAS and citation count capture the attention of different audiences. In addition, studies discussing skin grafting were associated with higher average AAS (β: 29 [95% CI: 4.2 to 54]; p = 0.022). Overall, our findings support using both AAS and traditional bibliometrics to assess article impact.