No abstract

The benefits of exercise and physical activity, im- No. 2, pp. 197-203, 1993. It is widely acknowledged that musculoskeletal injuries occur as a result public health officials in the United States to promote of vigorous physical activity and exercise, but little quantitative greater activity and fitness levels in the population as documentation exists on the incidence of or risk factors for these major health objectives for the nation (32).injuries. This study was conducted to assess the incidence, types, and risk factors for training-related injuries among young men undergoing For some populations, such as the military, however, Army infantry basic training. Prior to training we evaluated 303 men there is a strong need to know not oniy the mcnefits.(median age 19 yr), utilizing questionnaires and measurements of but also the short-term risks of exercise. Even relatively physical fitness. Subjects were followed over 12 wk of training. Physical training was documented on a daily basis, and injuries were benign injuries, such as sprained ankles, can be costly ascertained by review of medical records for every trainee. We perin terms of lost training time and reduced "combat formed univariate and multivariate analyses of the data. Cumulative readiness" of soldiers. Because physical fitness is conincidence of subjects with one or more lower extremity trainingrelated injury was 37% (80% of all injuries). The most common sidered to be an essential element of readiness. the injuries were muscle strains, sprains, and overuse knee conditions. A Army places great emphasis on physical training. As a number of risk factors were identified, including: older age, smoking.

SINS demonstrated near-perfect inter- and intraobserver reliability in determining three clinically relevant categories of stability. The sensitivity and specificity of SINS for potentially unstable or unstable lesions were 95.7% and 79.5%, respectively.

Ninety-nine percent of screws were fully contained or were inserted with either < or =2 mm of medial cortical perforation or an acceptable lateral breech using the "in-out-in" technique. Anterior cortical penetration occurred significantly more often with lateral pedicle perforation and with a smaller mean TSA. The incidence of fully contained screws was directly correlated with the region of instrumented thoracic spine.

For patients presenting to a spine surgeon's clinic for LBP, up to 25% of patients may have significant pain contribution from the hip or SI joints, and an additional 10% will still have an undefined pain source even after diagnostic workup. This underscores the need for clinicians to be aware of nonspinal pain generators and to appropriately pursue alternative diagnoses.

The Spine Instability Neoplastic Score is a comprehensive classification system with content validity that can guide clinicians in identifying when patients with neoplastic disease of the spine may benefit from surgical consultation. It can also aid surgeons in assessing the key components of spinal instability due to neoplasia and may become a prognostic tool for surgical decision-making when put in context with other key elements such as neurologic symptoms, extent of disease, prognosis, patient health factors, oncologic subtype, and radiosensitivity of the tumor.

We believe that thresholds of substantial clinical benefit for commonly used health-related quality-of-life measures following lumbar spine arthrodesis are important as they describe a magnitude of change that the patient recognizes as a major improvement.

Background Sacroiliac joint (SIJ) dysfunction is an important and underappreciated cause of chronic low back pain. Objective To prospectively and concurrently compare outcomes after surgical and non-surgical treatment for chronic SIJ dysfunction. Methods One hundred and forty-eight subjects with SIJ dysfunction were randomly assigned to minimally invasive SIJ fusion with triangular titanium implants (SIJF, n=102) or non-surgical management (NSM, n=46). SIJ pain (measured with a 100-point visual analog scale, VAS), disability (measured with Oswestry Disability Index, ODI) and quality of life scores were collected at baseline and at scheduled visits to 24 months. Crossover from non-surgical to surgical care was allowed after the 6-month study visit was complete. Improvements in continuous measures were compared using repeated measures analysis of variance. The proportions of subjects with clinical improvement (SIJ pain improvement ≥20 points, ODI ≥15 points) and substantial clinical benefit (SIJ pain improvement ≥25 points or SIJ pain rating ≤35, ODI ≥18.8 points) were compared. Results In the SIJF group, mean SIJ pain improved rapidly and was sustained (mean improvement of 55.4 points) at month 24. The 6-month mean change in the NSM group (12.2 points) was substantially smaller than that in the SIJF group (by 38.3 points, p<.0001 for superiority). By month 24, 83.1% and 82.0% received either clinical improvement or substantial clinical benefit in VAS SIJ pain score. Similarly, 68.2% and 65.9% had received clinical improvement or substantial clinical benefit in ODI score at month 24. In the NSM group, these proportions were <10% with non-surgical treatment only. Parallel changes were seen for EQ-5D and SF-36, with larger changes in the surgery group at 6 months compared to NSM. The rate of adverse events related to SIJF was low and only 3 subjects assigned to SIJF underwent revision surgery within the 24-month follow-up period. Conclusions In this Level 1 multicenter prospective randomized controlled trial, minimally invasive SIJF with triangular titanium implants provided larger improvements in pain, disability and quality of life compared to NSM. Improvements after SIJF persisted to 24 months. This study was approved by a local or central IRB before any subjects were enrolled. All patients provided studyspecific informed consent prior to participation.