Abstract:A prospective comparative study conducted on 12 patients with post labor backache (after 3 days of vaginal delivery till the end of puerperium) in Al-Basrah General Hospital, during the period from July 2009 till October 2010. The aim of this study is to compare between the results of manipulation of sacroiliac joint under general anesthesia and other conservative treatment for the management of post labor backache due to sacroiliac subluxation. The 12 patients included were those who met the diagnostic criteria for sacroiliac subluxation [pain in the sacral region, a positive Piedallu's sign (asymmetrical movement of the posterior superior iliac spine upon forward flexion), a positive pelvic compression test, and asymmetry of the anterior superior iliac spine] plus confirmatory signs of sacroiliac subluxation (straight leg raise, flexion block, positive Patrick's test, pain at Baer's point). The patients were divided into two groups A and B, 6 patients in each , those in group A were treated by NSAID, special pelvic belt and physiotherapy while those in group B were treated by manipulation of the sacroiliac joint under general anesthesia. In group A, pain was relieved partially in 4 patients (66.7%) and in 2 patients (33.3%) there was no improvement after 12 weeks of treatment. While in group B, pain was relieved totally in 5 patients (83.4%) and partial pain relieve in one (16.6%). In conclusion, manipulation of the sacroiliac joint under general anesthesia is superior to other conservative options for the management of post labor sacroiliac subluxation.

Objective: The aim of this study is to compare the outcome of endoscopic endonasal verus transcranial approach for cerebrospinal fluid leak repair. Study Design: Comparative study Place and Duration: Conducted at department of Neurosurgery, Mardan Medical Complex/ Bacha Khan Medical College, Mardan during the period from 1st January 2020 to 31st December 2021. Methods: Total eighty patients of both genders were presented in this study. Patients were aged between 20-65 years. Patients’ detailed demographics age, sex and body mass were recorded after taking written consent. Patients had CSF leaks and the history of CSF leak was presented. Patients were equally divided into two groups, I and II. Group I received endonasal technique and group II received transcranial approach. All the patients underwent MRI and CT scan. Complete follow up among both groups were taken in the duration of 8 months for the assessment of efficacy. Complete data was analyzed by SPSS 24.0 version. Results: Mean age of the patients in group I was 33.08±14.90 years with mean BMI28.4±3.12 kg/m2 and in group II mean age was 31.66±4.84 years with mean BMI 27.45±1108 kg/m2. Total 50 (62.5%) patients were males (25 in each group) and 30 (37.5%) patients were females (15 in each group). In group I recurrence rate was found in 3 (7.5%) cases and in group II recurrence rate was 6 (15%). 3 (7.5%) patients in group II developed infection but no infection rate was found in the endoscopic endonasal group. Satisfaction among patients in the endonasal group was greater than that of the transcranial group. Overall efficacy rate among both groups was 71 (88.8%). Conclusion: We concluded in this study that for repair of cerebrospinal fluid leak endoscopic endonasal approach was effective and safe method as compared to transcranial approach. Minimum rate of recurrence and high rate of recovery was fund in endonasal approach. Keywords: CSF, Endoscopic endonasal, Transcranial approach, Complications, Recurrence