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Objectives Ventriculoperitoneal (VP) shunting is commonly used to treat pediatric hydrocephalus, but failure rates are high. VP shunt failure in children is mostly caused by infection and/or proximal/distal shunt obstruction. However, to our knowledge, no previous reviews have discussed this topic using only clinical studies when age-related data could be obtained. This systematic review aimed at reevaluating what is already known as the most common causes of shunt failure and to determine the incidence and causes of VP shunt failure during the first 2 years of life as a step to establish solid evidence-based guidelines to avoid VP shunt failure in infants. Methods We performed a search using the search terms “Cerebrospinal Fluid Shunts” (Medical Subject Headings [MeSH]) AND failure [All Fields] AND (“humans” [MeSH] AND English [lang] AND “infant” [MeSH]). Only articles that specifically discussed VP shunt complications in children < 2 years were included. Results We found that the most common causes of VP shunt failure in children < 2 years were shunt obstruction and infection, both observed in a range. Conclusion VP shunt failure is very common in infants, mostly resulting from obstruction and infection. Future studies should focus on methods designed to avoid these complications or on alternative treatments for hydrocephalus.

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BACKGROUND: Sacroiliac joint (SIJ) pain is a commonly encountered problem following spine surgery. Therefore, its accurate diagnosis and proper management is mandatory for improving the quality of life following spine surgery. OBJECT:The aim of the study was to determine the incidence of SIJ dysfunction following lumbar fixation and to identify the possible risk factors and the treatment options. METHODS:A prospective study was conducted on 40 patients who were subjected to lumbar fixation by transpedicular screws. We included patients undergoing surgical lumbar fixation with no preoperative sacroiliac pain, while patients who had sacroiliac pain preoperatively or after surgeries other than fixation were excluded. All cases were operated upon in Cairo University Hospitals between March 2020 and October 2020. Sacroiliac joint pain was assessed post operatively using the Visual Analogue Scale (VAS). Estimated odds ratio (OR) with 95% confidence intervals (95% CI) and p values were used to evaluate the statistical significance of the associations and correlations between variables. A p value < 0.05 was considered statistically significant. RESULTS:Sacroiliac joint dysfunction occurred in 25 patients (62.5%). Increased body mass index (BMI), sacral fusion and multi-level fixation were regarded as important risk factors that lead to increased incidence of sacroiliac joint dysfunction post operatively (p value =0.034, 0.033 and 0.046, respectively). Eight patients were successfully managed conservatively, while 17 patients needed SIJ injection with 71% improvement. CONCLUSION:The lumbar fixation surgery disrupts the biomechanics of the lumbar spine increasing the incidence of sacroiliac joint dysfunction. Possible risk factors include increased body mass index, sacral fusion and multilevel fixation. Conservative treatment is the initial management of choice and it is effective in several cases. Sacroiliac joint injection with methylprednisolone and local anesthetics is an important line of treatment that gives excellent temporary relief of pain.