Object Several retrospective studies have demonstrated higher accuracy rates and increased safety for navigated pedicle screw placement than for free-hand techniques; however, the accuracy differences between navigation systems has not been extensively studied. In some instances, 3D fluoroscopic navigation methods have been reported to not be more accurate than 2D navigation methods for pedicle screw placement. The authors of this study endeavored to identify if 3D fluoroscopic navigation methods resulted in a higher placement accuracy of pedicle screws. Methods A systematic analysis was conducted to examine pedicle screw insertion accuracy based on the use of 2D, 3D, and conventional fluoroscopic image guidance systems. A PubMed and MEDLINE database search was conducted to review the published literature that focused on the accuracy of pedicle screw placement using intraoperative, real-time fluoroscopic image guidance in spine fusion surgeries. The pedicle screw accuracy rates were segregated according to spinal level because each spinal region has individual anatomical and morphological variations. Descriptive statistics were used to compare the pedicle screw insertion accuracy rate differences among the navigation methods. Results A total of 30 studies were included in the analysis. The data were abstracted and analyzed for the following groups: 12 data sets that used conventional fluoroscopy, 8 data sets that used 2D fluoroscopic navigation, and 20 data sets that used 3D fluoroscopic navigation. These studies included 1973 patients in whom 9310 pedicle screws were inserted. With conventional fluoroscopy, 2532 of 3719 screws were inserted accurately (68.1% accuracy); with 2D fluoroscopic navigation, 1031 of 1223 screws were inserted accurately (84.3% accuracy); and with 3D fluoroscopic navigation, 4170 of 4368 screws were inserted accurately (95.5% accuracy). The accuracy rates when 3D was compared with 2D fluoroscopic navigation were also consistently higher throughout all individual spinal levels. Conclusions Three-dimensional fluoroscopic image guidance systems demonstrated a significantly higher pedicle screw placement accuracy than conventional fluoroscopy or 2D fluoroscopic image guidance methods.

Background: Altered Cl -homeostasis and GABAergic function are associated with nociceptive input hypersensitivity. This study investigated the role of two major intracellular Cl -regulatory proteins, Na + -K + -Cl -cotransporter 1 (NKCC1) and K + -Cl -cotransporter 2 (KCC2), in neuropathic pain following spinal cord injury (SCI).

Of 35 patients with metastatic ocular melanoma, 71.4% manifested liver involvement either initially (45.7%) or later in the course of the disease (25.7%). With liver involvement, the median survival was 2.2 months, whereas with pulmonary involvement it was 19.2 months after the first evidence of metastatic disease (P < 0.01). Survival after recurrence varied also with age, those younger than 50 years having median survival of 14 months, with those 50 years or older having median survival 3.5 months (P < 0.01). It also varied with the patient's sex, males having median survival 3 months after recurrence, and females 10.4 months (P < 0.05). Younger patients and females had also longer disease‐free intervals prior to recurrence. Surgical removal of metastases, when feasible, in combination with chemotherapy, seems to offer improved palliation, since a subsequent median survival thus of 18.4 months was observed with 3/15 patients alive disease‐free 1 to 3 years later, while the median survival of 20 patients not treated with surgery was 2.5 months. Most of this difference in survival, however, is due to a difference in tumor load between the two groups, with patients subjected to surgery having lesser amounts of tumor and/or more favorable sites. Cancer 52:334‐336, 1983.

Background: The optimal treatment for hepatic metastases from neuroendocrine tumors remains controversial because of the often indolent nature of these tumors. We sought to determine the effect of 3 major treatment modalities including medical therapy, hepatic artery embolization, and surgical resection, ablation, or both in patients with liver-only neuroendocrine metastases, with the hypothesis that surgical treatment is associated with improvement in survival.Design: Retrospective study.Setting: Tertiary care center.Patients: Patients with metastatic liver-only neuroendocrine tumors were identified from hospital records.Interventions: Patients were subdivided into those receiving medical therapy, hepatic artery embolization, or surgical management. Main Outcome Measures:Effect of treatment on survival and palliation of symptoms was analyzed.

This quality improvement study shows some safety and significant advantages of a multimodal perioperative oral analgesic regimen compared with standard IV PCA after spine surgery.