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Objective. To determine the inciting events leading to the development of sacroiliac joint syndrome (SIJS).Methods. This was a retrospective descriptive cohort series from an academic interdisciplinary spine center. Consecutive patients presenting with low back or buttock pain with or without leg symptoms who met specific inclusion and exclusion criteria for the diagnosis of SIJS were included in the study. Inciting events leading to the development of SIJS in these patients were categorized into traumatic, cumulative, and idiopathic events.Results. Of 194 patients who were included in the study, 54 patients had symptom resolution with one or more therapeutic intraarticular sacroiliac joint injections, following a positive diagnostic injection. Those patients were given the diagnosis of SIJS. Of these, 24 (44%) had had a traumatic event (13 motor vehicle accidents, six falls onto the buttock, three immediately postpartum, one severe football tackle, and one pelvis fracture). Eleven (21%) patients were considered to have a cumulative injury (four lifting, two running, three altered gait due to lower extremity disorder, one crew training injury, and one forceful hip extension injury). Nineteen (35%) patients had spontaneous or idiopathic onset of sacroiliac joint pain.Conclusion. SIJS can occur following a traumatic event or cumulative shear events, or can occur spontaneously. [ABSTRACT FROM AUTHOR]

The development of lithium-sulfur batteries (LSBs) marks a crucial milestone in advancing energy storage solutions essential for sustainable energy transitions. With high theoretical specific capacity, cost-effectiveness, and reduced ecological footprint, LSBs promise to enhance electric vehicle ranges, extend portable electronics' operational times, and stabilize grids integrated with renewable energy. However, challenges like complex processing, electrode instability, and poor cycling stability hinder their commercialization. This study introduces a novel battery design that addresses these issues by coating sulfur directly onto the separator instead of the current collector, demonstrating that active sulfur can be effectively utilized without being incorporated into the electrode structure. Using an interwoven substrate made from carbon nanotube (CNT) fabric adorned with reduced graphene oxide (rGO), this setup enhances manufacturing scalability, supports optimal sulfur utilization, and improves battery performance. The rGO decoration provides multiple highly conductive polysulfide trapping sites, enhancing active material reutilization, while the flexibility and mechanical strength of CNT fabric contribute to electrode integrity. This combination boosts electrical conductivity and polysulfide-capturing capability, effectively managing migrating sulfur species during charge-discharge cycles and mitigating sulfur loss and polysulfide shuttling. The results demonstrate superior cycling stability and efficiency, highlighting the potential of this approach in advancing LSB technology., (© 2024 The Author(s). Small published by Wiley‐VCH GmbH.)

It is uncommon to have additional muscles in the upper limb. Some of them may restrict the movements or compress the nerves and vessels, while others may go unnoticed. During the routine dissection for undergraduate medical students, we observed an additional muscle in the anterior compartment of the forearm in about 60-year-old male cadaver. The muscle had a prominent belly and a long tendon. Distally, it was attached to the flexor retinaculum by a short and thick tendon. Proximally, long tendon of the muscle passed between the flexor carpi ulnaris and palmaris longus and was attached to the common aponeurosis shared by the extensor carpi ulnaris and flexor digitorum profundus muscles. The additional muscle belly was supplied by a branch from the anterior interosseous nerve. The ulnar nerve and artery was passing deep to the fleshy belly of the muscle. The muscle reported here might compress the ulnar nerve and artery and may produce neurovascular symptoms. On the other hand, the tendon and fleshy belly of the muscle could be useful in muscle/tendon grafts. The observations made by us in the present case will supplement our knowledge of variations of the muscles in this region which could be useful for surgeons during the forearm and hand surgeries.

Objectives: To evaluate the results of single-stage new technique of perineal urethroplasty with double breasting of the urethra and bladder neck and sphincteroplasty in female patients with epispadias., Methods: We have treated 4 patients with severe female epispadias (male/female ratio 6:1) since 1991. They presented at the age of 3, 11, 12, and 23 years. Perineal urethroplasty with double breasting, sphincteroplasty, and genitoplasty was done in 3 cases. Cohen's cross-trigonal reimplantation with bladder neck reconstruction was done in the fourth patient who had an ectopic ureter, but the patient required perineal urethroplasty and genitoplasty because of partial incontinence. The urethral plate and bladder neck was mobilized from the surrounding tissue to the bladder neck. A urethral mucosal strip of about 5 to 10 mm was denuded from the bladder neck to the end of urethral plate on one lateral edge, and the urethral plate and urethral mucosa was tubularized over a 12F catheter. Urethroplasty was done with double breasting of the urethral muscle margins starting from inside the bladder neck downward to the neomeatus with corporoplasty, sphincteroplasty, and genital reconstruction., Results: Of the 4 patients, 3 were fully continent during the day with a dry interval of 4 to 5 hours. One of the 3 patients was partially continent and had nocturnal enuresis, which responded to anticholinergic. The fourth patient with bladder neck reconstruction was partially incontinent initially but became continent after perineal urethroplasty., Conclusions: Our technique of one-stage perineal urethroplasty increases the urethral and bladder neck resistance, as well as the bladder capacity, all factors important for continence. This is a simple and effective method for the development of both continence and cosmesis in female epispadias repair.

Objective: To determine the efficacy of the Back Rx program in patients with diskogenic low back pain (LBP)., Design: Prospective, randomized study., Setting: Outpatient setting of a major university teaching hospital., Participants: Subjects with LBP greater than leg pain for at least 3 months duration and magnetic resonance imaging evidence of disk pathology. Fifty of 87 eligible patients consented and were randomized into age- and sex-matched groups., Interventions: Group I participated in the Back Rx program for 15 minutes a day, 3 times a week. All patients, from both groups, received celecoxib (200 mg) and hydrocodone (5 mg) with acetaminophen (500 mg) as needed, and wore a lumbar cryobrace for 15 minutes before bedtime., Main Outcome Measures: Roland-Morris Disability Questionnaire score, numeric pain rating score, patient satisfaction score, measured forward flexion, use of celecoxib, hydrocodone, and acetaminophen, time off work, and rate of symptom recurrence., Results: At minimal 12-month follow-up, 70% of group I reported over 50% pain reduction with good or better patient satisfaction, compared with 33% in group II (P=.001). Average daily hydrocodone and acetaminophen use and time off work were less for group I (all, P<.05). Recurrence of symptoms at the end of the year was less for group I (P=.001)., Conclusions: Back Rx exercises, combined with use of a lumbar cryobrace and oral medications, yielded superior therapeutic results than with use of medications and cryobrace alone. Also significant was the reduced rate of recurrence in these patients.

Objective: To report on the incidence of dysphonia and/or associated throat symptoms after steroid injections in the axial skeleton., Design: A prospective cohort study., Setting: Academic spine center., Participants: Patients (N = 100) undergoing a diagnostic injection followed by a therapeutic injection in the axial skeleton., Interventions: Not applicable., Main Outcome Measure: Presence or absence of dysphonia and/or associated throat symptoms, as determined by completion of a predetermined 10-item questionnaire. This questionnaire was administered before participation in the study and at specific intervals after a diagnostic injection and, again, after a therapeutic spinal injection., Results: There was a 12% incidence of transient dysphonia and/or associated throat symptoms in this study population after a therapeutic injection., Conclusions: Throat symptoms are a potential, albeit transient side effect, after an epidural space corticosteroid injection. The mechanism through which dysphonia or other throat symptoms develop is unknown but appears to be mediated by a systemic steroid effect.

Background: Low back pain is fairly prevalent among golfers; however, its precise biomechanical mechanism is often debated., Hypothesis: There is a positive correlation between decreased lead hip rotation and lumbar range of motion with a prior history of low back pain in professional golfers., Study Design: A cross-sectional study., Methods: Forty-two consecutive professional male golfers were categorized as group 1 (history of low back pain greater than 2 weeks affecting quality of play within past 1 year) and group 2 (no previous such history). All underwent measurements of hip and lumbar range of motion, FABERE's distance, and finger-to-floor distance. Differences in measurements were analyzed using the Wilcoxon signed rank test., Results: 33% of golfers had previously experienced low back pain. A statistically significant correlation (P <.05) was observed between a history of low back pain with decreased lead hip internal rotation, FABERE's distance, and lumbar extension. No statistically significant difference was noted in nonlead hip range of motion or finger-to-floor distance with history of low back pain., Conclusions: Range-of-motion deficits in the lead hip rotation and lumbar spine extension correlated with a history of low back pain in golfers.

Lumbar zygapophyseal joints have long been considered a source of low back pain with or without leg pain. The objective of this prospective study was to investigate the therapeutic effectiveness of lumbar zygapophyseal joint radiofrequency denervation (RFD) followed by physical therapy, for the treatment of refractory lumbar zygapophyseal joint mediated low back pain secondary to lumbar zygapophyseal joint synovitis, in baseball pitchers. Participants included twelve male baseball pitchers with a diagnosis of lumbar zygapophyseal joint synovitis mediated low back pain and a subsequent difficulty in pitching. These athletes underwent a trial of treatment, including oral anti-inflammatory medication, physical therapy, osteopathic manipulations, and fluoroscopically guided intra-articular zygapophyseal joint injection utilizing steroid and local anesthetic agent. Failure to progress led to these athletes receiving percutaneous, fluoroscopically-guided, radiofrequency denervation of the bilateral L 4-L5 and L5-S1 zygapophyseal joints. A good response to a diagnostic medial branch block was a prerequisite for RFD treatment. In all cases, the medial branch above and below the involved level was treated. Post procedure, all athletes participated in a phased physical therapy program followed by a progressive return to pitching. Success was defined as the ability to return to pre-procedure level of baseball pitching combined with greater than 50% low back pain reduction. Pre- and post-RFD, Visual Analog (Numeric) Scale (VAS) and Roland-Morris (R-M) tests were administered. Ten out of 12 (83%) athletes were able to return to pitching at a level attained prior to RFD. All 12 patients, experienced statistically significant low back pain relief, with a mean pre-RFD VAS of 8.4; mean post-RFD VAS of 1.7; mean pre-RFD R-M score of 12.3; and mean post-RFD R-M score of 22.3. In conclusion, athletes, experiencing lumbar zygapophyseal joint mediated low back pain secondary to zygapophyseal joint synovitis and have failed more conservative management may benefit from radiofrequency zygapophyseal joint denervation followed by a formal rehabilitation program.

Background Context: Lumbar zygapophysial joints are currently believed to be a cause of axial low back pain. Once this diagnosis is made, decisions about when to institute a particular intervention and which treatment to offer is regionally and specialty dependent., Purpose: To perform a critical review of prior published studies assessing the use of interventional treatment options for the treatment of lumbar zygapophysial joint syndrome., Study Design: Evidence-based medicine analysis of current literature., Methods: A database search of Medline (PubMed, Ovid and MDConsult), Embase and the Cochrane database was conducted. The keywords used were low back pain, lumbar zygapophysial joint, lumbar facet joint, radiofrequency denervation, medial branch block, and intraarticular injection. After identifying all relevant literature, each article was reviewed. Data from the following categories were compiled: inclusion criteria, randomization of subjects, total number of subjects involved at enrollment and at final analysis. statistical analysis used, intervention performed, outcome measures, follow-up intervals and results. Guidelines described by the Agency for Health Care Policy and Research were then applied to these data., Results: This review determined that the evidence for the treatment of lumbar zygapophysial joint syndrome with intraarticular injections should be rated as level III (moderate) to IV (limited) evidence, whereas that for radiofrequency denervation is at a level III., Conclusions: Current studies fail to give more than sparse evidence to support the use of interventional techniques in the treatment of lumbar zygapophysial joint-mediated low back pain. This review emphasizes the need for larger, prospective, randomized controlled trials with uniform inclusion and exclusion criteria, standardized treatment, uniform outcome measures and an adequate duration of follow-up period so that definitive recommendations for the treatment of lumbar zygapophysial joint-mediated pain can be made.

Background Context: Perineural cysts are commonly found in the sacral region and are incidently discovered on imaging studies performed for the evaluation of low back and/or leg pain., Purpose: To report on a patient presenting with abdominal pain secondary to a large sacral perineural cyst., Study Design/setting: Case report. METHODS/PATIENT SAMPLE: A 47-year-old woman was referred to a specialized multidisciplinary spine center with complaints of left lower quadrant abdominal pain and left leg pain. Of significant note was the presence of constipation and urinary frequency over the preceding 8 months. Physical examination was normal. Magnetic resonance imaging of the lumbosacral spine revealed large perineural cysts eroding the sacrum and extending to the pelvis. The presence of abdominal symptoms prompted a neurosurgical consultation. However, after considering the possible risks associated with the surgical procedure, the patient opted to follow the nonsurgical route., Result and Conclusions: Although commonly visualized, sacral perineural cysts are rarely symptomatic. When symptomatic, it may be secondary to its size and location. Presence of abdominal pain in a patient with back and/or leg pain should prompt the evaluation of the lumbosacral spine.

Objective: To assess the difference in efficacy between knee lavage plus the standard hylan G-F 20 (a derivative of hyaluronan) protocol and the standard hylan G-F 20 as per standard usage protocol alone for the treatment of knee osteoarthritis (OA)., Design: Nonrandomized prospective study in which patients chose their treatment group. Follow-up averaged 1.1 years., Setting: Faculty practice of a single physician at a major teaching hospital., Participants: Eighty-one patients with documented knee OA on magnetic resonance imaging., Interventions: Group 1 (n=44) received a single-needle lavage 1 week before the standard hylan G-F 20 protocol; group 2 (n=37) received the standard hylan G-F 20 protocol alone., Main Outcome Measures: Pre- and posttreatment scores on the Lysholm-II Questionnaire and a visual analog scale (VAS) were documented for each patient. The Wilcoxon signed-rank test was used for statistical analysis., Results: A successful outcome was noted in 79.5% of group 1 patients and in 54% of group 2 patients (P<.05)., Conclusions: In the management of knee OA, the use of knee lavage before viscosupplementation with hylan G-F 20 yields better results than using hylan G-F 20 alone. The presence of radiologic grade IV knee OA or moderate to severe patellofemoral arthritis are negative prognostic factors.

Understanding the innervation of the lumbar spine can be a daunting task. Until recently, only macroscopic visualization and crude histological techniques were available to document the presence of nerve fibers in the anterior spinal canal. Using newer immunohistochemical techniques, studies have been able to more thoroughly investigate the innervation of the anterior spinal canal. The presence of sensory nerve fibers has been definitively identified in all anterior spinal structures. These sensory fibers enable any of the spinal structures the capability of being a pain generator. These sensory nerve fibers tend to form dense interwoven plexuses on the posterior longitudinal ligament and ventral surface of the dura mater. The plexuses allow for anastamoses to take place between nerve fibers from multiple segmental levels. This polysegmental formation causes the expression of low back pain to be diffuse, rather than focal. It is these diffuse pain symptoms that create great difficulty in diagnosing and treating spinal canal structures.

Study Design: A prospective study randomized by patient choice from the private practice of a single physician affiliated with a major teaching hospital was conducted., Objectives: To compare transforaminal epidural steroid injections with saline trigger-point injections used in the treatment of lumbosacral radiculopathy secondary to a herniated nucleus pulposus., Summary of Background Data: Epidural steroid injections have been used for more than half a century in the management of lumbosacral radicular pain. At this writing, however, there have been no controlled prospective trials of transforaminal epidural steroid injections in the treatment of lumbar radiculopathy secondary to a herniated nucleus pulposus., Methods: Randomized by patient choice, patients received either a transforaminal epidural steroid injection or a saline trigger-point injection. Treatment outcome was measured using a patient satisfaction scale with choice options of 0 (poor), 1 (fair), 2 (good), 3 (very good), and 4 (excellent); a Roland-Morris low back pain questionnaire that showed improvement by an increase in score; a measurement of finger-to-floor distance with the patient in fully tolerated hip flexion; and a visual numeric pain scale ranging from 0 to 10. A successful outcome required a patient satisfaction score of 2 (good) or 3 (very good), improvement on the Roland-Morris score of 5 or more, and pain reduction greater than 50% at least 1 year after treatment. The final analysis included 48 patients with an average follow-up period of 16 months (range, 12-21 months)., Results: After an average follow-up period of 1.4 years, the group receiving transforaminal epidural steroid injections had a success rate of 84%, as compared with 48% for the group receiving trigger-point injections (P < 0.005)., Conclusion: Fluoroscopically guided transforaminal injections serve as an important tool in the nonsurgical management of lumbosacral radiculopathy secondary to a herniated nucleus pulposus.

Prostate cancer is the most commonly diagnosed cancer and the second most common cause of cancer death among American men. To our knowledge, the highest reported prostate specific antigen (PSA) level on initial presentation is 3280 ng/mL. In this case report, we discuss a 46-year-old African-American man with back pain of 1-month's duration. A magnetic resonance imaging study of the lumbar spine revealed numerous osseous metastatic lesions, and the PSA level was found to be 5666 ng/mL. He was treated with oral narcotics and a Duragesic patch to achieve analgesia and bicalutamide (Casodex) and leuprolide acetate (Lupron) therapy for androgen blockade. Later in his course, he required chemotherapy due to hormone-refractory prostate cancer. The patient has done well as shown at his latest follow-up at 48 months. The objective of this report is to discuss the first patient with metastatic prostate cancer to the spine with PSA level greater than 3,500 ng/mL.

Back injury is one of the most frequently encountered injuries in the collegiate rower. The differential diagnosis of back pain in the competitive rower includes muscle strain, ligament/tendon injury, stress reaction, stress fracture, and a tear in the annulus fibrosis. Endurance sports, such as rowing, have an increased frequency of stress injury The diagnosis of stress reaction cannot be made with plain radiographs. Many studies have firmly established the efficacy of single photon emission computed tomography (SPECT) bone scans and magnetic resonance imaging in establishing the diagnosis of a stress reaction We present a case of a collegiate rower with mid back pain secondary to a stress reaction of the endplates of the costotransverse articulation at the T8 level diagnosed by a positive positron emission tomogram study in the setting of a negative SPECT scan.

Foreign body on penis is usually put himself or by his female partner by adults for sexual gratification and in children as an innocent childish play. We have managed a 10 years shepherd who put on a bark of tree with successful outcome which is not being reported in literature.

Athletes participating in contact sports or activities, such as excessive running, are at higher risk for the development of knee osteoarthritis. Newer minimally invasive, nonsurgical treatment options, and medications in the management of knee osteoarthritis, have enabled many athletes with knee osteoarthritis to regain most of their mobility. These new treatments have no down time and, when combined with proper rehabilitation protocol, have helped patients to regain and maintain their mobility gains and overall quality of their life. In the years to come newer technologies, such as autologous cultured chondrocyte implantation, tissue engineered cartilage, growth factors, and acellular matrices, may play an important role in the management of knee osteoarthritis.

Various conditions such as fracture, dislocation, tumor, or infection adversely affect the vertebral body and lead to instability. Restoration of a stable anterior column is essential for normal spinal biomechanics. Various biological and mechanical spacers have been used to reconstruct the anterior column after corpectomy. In this retrospective review, the authors evaluated clinical charts and radiographs of 13 patients receiving titanium surgical mesh (TSM)-bone graft composite to reconstruct the anterior spinal column in the thoracic or lumbar region. The objective of this review was to evaluate the stability and efficacy of the TSM-bone graft composite in the anterior spine after a complete or partial corpectomy. Sixteen patients with involvement of the thoracic or lumbar vertebral column after trauma, tumor, or infection underwent partial or complete corpectomy. In all patients the anterior defect was reconstructed using a TSM-bone graft composite. Three patients died within 12 months postoperatively due to primary malignant process. Thirteen of 16 patient charts and radiographs were evaluated for anterior fusion status, settling of the TSM-bone graft composite, and hardware failure. No pseudoarthroses were noted. Evidence of solid anterior fusion was noted in all patients. The average settling of the TSM-bone graft construct was 3 mm. All patients presenting with only pain and no neurological symptoms (n = 9) experienced early pain relief. For patients presenting with neurological symptoms (n = 4), the recovery was complete in three and partial in one. No patient was made neurologically worse, and there were no vascular injuries intra- or postoperatively. The study suggests that TSM-bone graft composite offers excellent biomechanical stability in the immediate postoperative period, permitting progressive maturation of the fusion mass.

Chylous leakage is an unusual complication following anterior spinal surgery. This leakage can occur as a result of traumatic injury to the thoracic duct, the cisterna chyli, or the retroperitoneal lymphatic vessels. The authors present case reports of three patients who underwent anterior spinal surgical procedures inadvertently complicated by an injury to the lymphatic system. All patients were managed nonoperatively with tube drainage and hyperalimentation and had uneventful recoveries.

This retrospective study evaluated a single surgeon's series of patients treated by multilevel cervical disc excision (two or three levels), allograft tricortical iliac crest arthrodesis, and anterior instrumentation. The objective of this retrospective study was to compare fusion success and clinical outcome between multilevel Smith-Robinson interbody grafting and tricortical iliac strut graft reconstruction, both supplemented with anterior instrumentation in the cervical spine. The incidence of nonunion for cervical discectomy and fusion varies widely depending on the number of disc levels involved, type of bone graft used, and whether the anterior grafting is supplemented with instrumentation. An alternative to multilevel interbody fusion is corpectomy and strut grafting, in which the incidence of nonunion has been reported to be 27% with autograft and 41% with allograft. Sixty-four consecutive patients who underwent allograft tricortical iliac crest reconstruction and anterior cervical plating were studied. The average follow-up was 39 months. There were 38 patients in the discectomy and interbody grafting group and 26 patients in the corpectomy and strut graft reconstruction group. Pseudoarthrosis occurred in 42% of the anterior cervical interbody fusion patients and 31% of the corpectomy patients. Nonunion in two-level interbody fusions occurred in 36% of the patients as compared to 10% for patients with one-level corpectomies; while 54% of patients with three-level interbody fusions and 44% of patients with two-level corpectomies were noted to have pseudoarthrosis. Higher percentages of nonunion were noted in multilevel interbody grafting than in corpectomy with strut grafting and when more vertebral levels were involved. These radiographic and clinical findings underscore the shortcomings of multilevel anterior cervical allograft reconstruction with plating. Corpectomy may be the preferred method when multiple disc levels are fused. In addition, anterior corpectomy affords decompression of significant osteophytes in a safer and quicker manner. In retrospective studies, there is a need for long-term follow-up before accurate statements can be made about the study population.

Penile strangulation is a rare injury that requires urgent management. Non-metallic, thin objects are easy to remove but can cause severe injury. Metallic objects are difficult to remove but the injuries are usually less severe. Penile ulceration and oedema in children may well indicate the presence of a strangulation object. We describe a new hammer and chisel method for removing such objects.

Human amniotic membrane is a readily available biological dressing material used to treat burns. It not only prevents oozing of plasma from burn wounds but also relieves pain and controls sepsis. We used human amniotic membrane to treat fifteen burn patients, and this material was effective. The application of this cost-free dressing material warrants further study as it can be made use of in areas where expensive and specialized equipment is not available.