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Background Data: Coccydynia is defined as pain in the coccyx or tailbone area, usually caused by sitting acutely on a hard object. Because it often runs a chronic course, the management of this medical problem remains controversial. Different therapeutic options are available for the treatment of this condition. Purpose: To evaluate the effectiveness of a local betamethasone-17α,21-dipropionate and 21-disodium phosphate injections versus NSAIDs and physiotherapy in its management. Study Design: Prospective clinical cases study. Materials and Methods: Forty-eight patients who presented with pain in the tailbone area for more than four weeks were recruited for the study. They were subdivided randomly into two groups:Group I patients were treated with a local injection with betamethasone-17α,21-dipropionate and 21-disodium phosphate (n = 24), whereas Group II were treated with oral NSAIDs and physiotherapy (n = 24). Oral diclofenac sodium (150 mg/day) with physiotherapy program was given to patients in Group II for six weeks. Clinical evaluation was based on the severity of the coccyx pain by Visual Analog Scales (VAS) at 1-, 3-, 6-, and 12-month follow-up and comparison to the baseline pain at presentation. Results: The incidence was more in the third decade (52%, n = 25), with female overbalance (85%, n = 40). In Group I, the mean of VAS was 8.1 before treatment and after one month of treatment, the score reached 3.9 and improved to 0.2 at the end of one year. However, in Group II, the mean of VAS was 7.5 before treatment; then after one month, it changed to 6.6 and improved to 2.5 at the end of one year. Conclusion: The reported outcome in this study suggests that local betamethasone-17α,21-dipropionate and betamethasone 21-disodium phosphate injections are more effective than NSAIDs and physiotherapy for the treatment of coccydynia. (2020ESJ224)

Background Data: Povidone-iodine is very effective broad spectrum antiseptic solution against different types of pathogens including methicillin-resistant Staphylococcus aureus and some strains of Enterococcus faecium based on the antiseptic properties of iodine. Purpose: To evaluate the effect of intraoperative 3.35 % povidone-iodine irrigation in lumbar spine fusion surgeries. Study Design: Retrospective clinical case study. Patients and Methods: 93 spine fusion surgeries in 2016 (Group I) and 112 fusion surgeries in 2017 (Group II). Both groups were retrospectively compared regarding infection rate, fusion rate, and Oswestry Disability Index (ODI) score. Group I had intraoperative saline irrigation and Group II was irrigated with 3.35 % povidone-iodine. Results: There were no reported infections in Group II. Two superficial and two deep wound infections were observed in Group I. Complete wound dehiscence was found in one patient with deep wound infection. The pathogens were methicillin-resistant Staphylococcus aureus in two cases, Klebsiella pneumonia in one case, and combination of methicillin-sensitive Staphylococcus aureus and Staphylococcus epidermidis in the last case. There was insignificant difference between the two groups in fusion rates and with no linear correlation relationship between povidone-iodine soaking time and the fusion rate in Group II. There was significant postoperative ODI improvement in the two groups relative to the preoperative scores with insignificant statistical difference when comparing this improvement of the two groups. Conclusion: Povidone-iodine 3.35% irrigation in lumbar spine fusion surgery is effective in decreasing postoperative infection with no negative influence on the fusion rate or clinical outcome. (2019ESJ177)

Background Data: Muscle dissection associated with posterior approach to cervical spine usually results in local pain, muscle wasting and temporarily restricted neck movement. Use of muscle sparing spinous process splitting approach for cervical laminectomy allows decompression of the spinal cord and neural foramen if needed. Meanwhile, it does not require instrumentation, fusion and it preserves cervical spine stability. Purpose: To assess the effectiveness of spinous process splitting approach for cervical laminectomy in cervical spondylotic myelopathy. Study Design: Prospective clinical case study. Patients and Methods: Patient Sample: Fifteen patients with cervical spondylotic myelopathy, eleven males and 4 females with mean age 66.4±6.6 (Range 44-71) years. All patients underwent muscle sparing spinous process splitting cervical laminectomy. Outcome Measures: Operative time and blood loss were recorded. Clinical outcome was assessed by the JOA score and VAS. MRI was done 6 months postoperative to assess decompression. Spinal stability and curvature index were assessed on plain cervical radiographs. Results: No case of wound dehiscence was recorded. There was significant improvement of JOA scores and brachialgia and neck pain VAS scores at 6 months, the mean JOA recovery rate was 56.2%. No patient had postoperative kyphosis or instability and 66.6% of patients had improved modified Ishihara cervical curvature index. No neurological deterioration was recorded in the follow-up. No patient had newly developed axial pain. MRI revealed adequate decompression of the spinal cord in all patients. Conclusion: The spinous process splitting cervical laminectomy allows good spinal cord decompression and preserves spine curvature and stability. The mini open approach and preservation of interspinous ligaments could play a role in wound dehiscence prevention. (2017ESJ133)

Background Data: Ligamentum flavum cysts have rarely been reported, it is believed to be a result of degenerative process. Complete excision of the cyst leads to excellent results. Ligamentum flavum cysts have rarely been reported worldwide and never published as an Egyptian case. Purpose: To report a case of ligamentum flavum cysts in the lumbar spine. Study Design: Case Report. Patients and Methods: We reported a case of ligamentum flavum cyst at the level of L4-5 in a 45 year old Egyptian woman, meticulous complete excision of the cyst without any durotomy or CSF leakage. Histopathological examination reported myxoid degeneration of the ligamentum flavum with no synovial cells. Results: the patient was satisfied and all her symptoms were completely resolved with 1 year follow up. Conclusion: ligamentum flavum cyst should be put in mind when reading the MRI. Complete surgical excision should be carried meticulously. (2016ESJ123)