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Journal of Anatomy Dec 2020The sacrum is a key piece of the vertebrate skeleton, since it connects the caudal region with the presacral region of the vertebral column and the hind limbs through...
The sacrum is a key piece of the vertebrate skeleton, since it connects the caudal region with the presacral region of the vertebral column and the hind limbs through the pelvis. Therefore, understanding its form and function is of great relevance in vertebrate ecomorphology. However, it is striking that morphometric studies that quantify its morphological evolution in relation to function are scarce. The main goal of this study is to investigate the morphological evolution of the sacrum in relation to its function in the mammalian order Carnivora, using three-dimensional (3D) geometric morphometrics. Principal component analysis under a phylogenetic background indicated that changes in sacrum morphology are mainly focused on the joint areas where it articulates with other parts of the skeleton allowing resistance to stress at these joints caused by increasing muscle loadings. In addition, we demonstrated that sacrum morphology is related to both the length of the tail relativised to the length of the body, and the length of the body relativised to body mass. We conclude that the sacrum in carnivores has evolved in response to the locomotor requirements of the species analysed, but in locomotion, each family has followed alternative morphological solutions to address the same functional demands.
Topics: Animals; Biological Evolution; Body Size; Carnivora; Locomotion; Osteology; Phylogeny; Sacrum
PubMed: 32654137
DOI: 10.1111/joa.13272 -
Journal of Neurosurgery. Spine Dec 2022The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading... (Review)
Review
OBJECTIVE
The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading systems.
METHODS
A systematic search of MEDLINE, EMBASE, Google Scholar, and Cochrane databases was performed consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all existing sacral and pelvic fracture classification systems.
RESULTS
A total of 49 articles were included in this review, comprising 23 pelvic classification systems and 17 sacral grading schemes. The AO Spine Sacral and Pelvic Classification System represents both the evolutionary product of these historical systems and a reinvention of classic concepts in 5 ways. First, the classification introduces fracture types in a graduated order of biomechanical stability while also taking into consideration the neurological status of patients. Second, the traditional belief that Denis central zone III fractures have the highest rate of neurological deficit is not supported because this subgroup often includes a broad spectrum of injuries ranging from a benign sagittally oriented undisplaced fracture to an unstable "U-type" fracture. Third, the 1990 Isler lumbosacral system is adopted in its original format to divide injuries based on their likelihood of affecting posterior pelvic or spinopelvic stability. Fourth, new discrete fracture subtypes are introduced and the importance of bilateral injuries is acknowledged. Last, this is the first integrated sacral and pelvic classification to date.
CONCLUSIONS
The AO Spine Sacral and Pelvic Classification is a universally applicable system that redefines and reorders historical fracture morphologies into a rational hierarchy. This is the first classification to simultaneously address the biomechanical stability of the posterior pelvic complex and spinopelvic stability, while also taking into consideration neurological status. Further high-quality controlled trials are required prior to the inclusion of this novel classification within a validated scoring system to guide the management of sacral and pelvic injuries.
Topics: Humans; Retrospective Studies; Sacrum; Pelvic Bones; Fractures, Bone; Pelvis; Spinal Fractures
PubMed: 35907199
DOI: 10.3171/2022.5.SPINE211468 -
Der Unfallchirurg Apr 2019Geriatric sacral fractures represent an independent fracture entity of increasing incidence and growing socioeconomic relevance. The goals of treatment are very... (Review)
Review
BACKGROUND
Geriatric sacral fractures represent an independent fracture entity of increasing incidence and growing socioeconomic relevance. The goals of treatment are very different to those in younger patients with high-energy pelvic fractures. Hence, new outcome measurement instruments are required in order to assess the success of treatment.
OBJECTIVE
Literature review summarizing existing concepts and providing an overview of outcome measurement instruments for geriatric sacral fractures.
METHODS
Narrative review article based on an analysis of the German and English-speaking literature from the last 10 years.
RESULTS
Geriatric sacral fractures result in impaired mobility, increased physical and social loss of dependency and increased morbidity and mortality rates. There is a lack of standardized specific assessment procedures for functional outcome measurement after geriatric sacral fractures. Until these are developed and validated, a parallel acquisition of mortality, the timed up and go test, the Oswestry disability index (ODI) and a generic healthcare questionnaire score (SF-36, EQ-5D) seem to be most suitable.
CONCLUSION
At present our knowledge about the natural course of geriatric sacral fractures is limited by the lack of well-validated instruments to measure functional and radiographic outcomes. This has to be considered when evaluating the success of new treatment options for these patients. Future studies should validate existing scores for this population and develop new specific outcome instruments.
Topics: Age Factors; Aged; Health Status; Health Status Indicators; Humans; Sacrum; Spinal Fractures; Treatment Outcome
PubMed: 29797033
DOI: 10.1007/s00113-018-0511-x -
Neurourology and Urodynamics Nov 2021Sacral neuromodulation (SNM) has successfully treated patients with functional urinary and/or bowel disorders for more than two decades. Historically, patients with the...
AIMS
Sacral neuromodulation (SNM) has successfully treated patients with functional urinary and/or bowel disorders for more than two decades. Historically, patients with the InterStim system (Medtronic) were contraindicated for Magnetic Resonance Imaging (MRI) scans. In 2012, Medtronic obtained Food and Drug Administration (FDA) approval for allowing 1.5 Tesla (T) MRI head scans. In September 2019, the Axonics System (Axonics) received FDA approval for 1.5 T full-body MR Conditional labeling and then 3 T full-body MR Conditional labeling in July 2020. In August 2020, Medtronic received 1.5 and 3 T full-body MR Conditional labeling from the FDA for their new SNM systems (InterStim II and Micro devices with SureScan leads). With the advancements in MRI technology and availability of full-body MRI eligible SNM systems, it is important for physicians to better understand MRI safety for these systems.
METHODS
This paper explains the fundamentals of MRI physics, its interactions with active implantable medical devices (AIMDs), the subsequent potential safety hazards with emphasis on radio frequency (RF)-related safety, and the risks associated with "Off-label" scans, including abandoned and broken leads.
RESULTS
MRI guidelines provided by the AIMD device manufacturer should be followed to ensure MRI scan safety and avoid any unnecessary risk to patients.
CONCLUSIONS
MRI guidelines provided by the device manufacturer are the best resource for guidance for performing safe MRI scanning. Specific conditions should be fully understood and generalizations on MRI safety claims based on partial analysis or case studies should be avoided.
Topics: Electric Stimulation Therapy; Humans; Magnetic Resonance Imaging; Radio Waves; Sacrococcygeal Region; Sacrum
PubMed: 34487571
DOI: 10.1002/nau.24756 -
The Israel Medical Association Journal... Dec 2021The current approach to performing sacral neuromodulation consists of a two-stage procedure, the first of which includes insertion of the sacral electrode under...
BACKGROUND
The current approach to performing sacral neuromodulation consists of a two-stage procedure, the first of which includes insertion of the sacral electrode under fluoroscopic visualization of the S3 foramen. Alternatively, in certain situations computed tomography (CT)-guided insertion can be used.
OBJECTIVES
To evaluate the use of CT in cases of reinsertion of the electrode due to infection, dislocation, or rupture.
METHODS
Medical records of patients who underwent neuromodulation device reinsertion between 2005 and 2016 for fecal incontinence were reviewed. Study outcomes included procedure course, successful placement, and long-term treatment success.
RESULTS
During the study period, we inserted a neuromodulation device in 67 patients. A CT-guided insertion of a sacral electrode was performed in 10 patients. In nine patients, the insertion and the final location of the electrode were successful. In one patient, the electrode migrated upward due to a malformation of the S3 foramen on both sides and had to be placed in S4. In a mean follow-up of 68.4 ± 30.0 months following the re-insertion, there was a significant reduction in the number of incontinence episodes per day (P < 0.001) and the number of pads used per day (P = 0.002).
CONCLUSIONS
CT-guided insertion of a sacral electrode is a safe and promising option, especially in recurrent and or selected cases.
Topics: Adolescent; Aged; Electric Stimulation Therapy; Electrodes, Implanted; Fecal Incontinence; Female; Follow-Up Studies; Humans; Male; Middle Aged; Sacrum; Tomography, X-Ray Computed
PubMed: 34954915
DOI: No ID Found -
The Malaysian Journal of Pathology Apr 2022Solitary fibrous tumour (SFT) of the sacrum is a very rare disease. So far, there have been few reports on this disease. Here, we reported 2 such cases and reviewed the... (Review)
Review
INTRODUCTION
Solitary fibrous tumour (SFT) of the sacrum is a very rare disease. So far, there have been few reports on this disease. Here, we reported 2 such cases and reviewed the other 7 reports in the literature.
CASE SERIES
Case 1, a 48-year-old man presented with lumbosacral pain for 2 months and numbness in the left plantar region for more than 1 month. The report of CT scan indicated that the sacrum was destroyed and the soft tissue mass projected into the pelvis. Histopathology showed that the cells were fusiform or short fusiform, arranged in strips, sheets, and wavy patterns. Case 2, a 40-year-old woman presented with hip joint pain and lower extremity dyskinesia for more than 2 months. The result of the MRI examination demonstrated a mass on the right sacral foramen and anterior sacrum. The characteristics of histopathology are ovoid or spindle-shaped cells with focal nuclear pleomorphism and prominently branched, hemangiopericytoma-like vascular patterns. In addition, immunohistochemical showed that CD34, Bcl-2, CD99, STAT6 and vimentin were positive, while Desmin, MSA, EMA, S100 were negative in both cases.
CONCLUSION
Previous literatures have revealed that SFTs of the sacrum are rare neoplasms. Case 1 and a part of these lesions previously reported seem to be malignant and should be treated with surgery. Radiation or chemotherapy was adopted if necessary. Since SFT of the sacrum is prone to recur and metastasis, long-term follow-up should be considered. To a certain extent, new risk stratification models can predict prognosis more accurately.
Topics: Adult; Female; Hemangiopericytoma; Humans; Male; Middle Aged; Pelvis; Prognosis; Sacrum; Solitary Fibrous Tumors
PubMed: 35484892
DOI: No ID Found -
Turkish Neurosurgery 2023To outline the variations in morphology and a few clinically relevant morphometric parameters of the sacral hiatus.
AIM
To outline the variations in morphology and a few clinically relevant morphometric parameters of the sacral hiatus.
MATERIAL AND METHODS
The study included 50 dry human sacra, of unspecified sex, in the Department of Anatomy at a medical college in South India. The sex was determined using the sacral, auricular and curvature index. The variations and morphometry of the sacra were documented and tabulated.
RESULTS
It was observed that the inverted U shape of sacral hiatus was common in both males (n=24) and females (n=26). There was one female sacrum with complete dorsal wall agenesis. In males, the length of the apex of sacral hiatus from 1st sacral spine was 5.82 cm ± 1.27 and in females, it was 6.02 cm ± 1.08. Sacral hiatus depth in males was 0.56 cm ± 0.16 and in females 0.54 cm ± 0.14. The width of sacral hiatus at the cornua in males was 1.42 cm ± 0.29 and in females, it was 1.46 cm ± 0.38 CONCLUSION: Knowledge of incidences of variations in the morphology and morphometry of the sacral hiatus across various population groups is paramount for the success and reliability of epidural anesthesia. The success rate of such procedures depends on the clinicians' understanding of the discrepancy in the sacral hiatus.
Topics: Male; Female; Humans; Sacrum; Reproducibility of Results; Pelvis; Anesthesia, Epidural; India
PubMed: 37222010
DOI: 10.5137/1019-5149.JTN.35322-21.4 -
PloS One 2016To investigate the impact of surgery on local control and quality of life for patients with sacral metastases and to determine whether the complications of surgery were...
OBJECTIVE
To investigate the impact of surgery on local control and quality of life for patients with sacral metastases and to determine whether the complications of surgery were acceptable.
METHODS
Curettage for metastatic lesions of the sacrum was performed in 154 patients with obvious sacral nerve compression symptoms between July 1997 and July 2014. Potential risk factors were evaluated in univariate analysis for associations with local control; multivariate conditional logistic regression was used to identify the combined effects. Complications were recorded. The pre- and postoperative visual analogue scale of pain, Eastern Cooperative Oncology Group (ECOG) scores, and quality of life scores were collected to evaluate the impact of surgery.
RESULTS
The cumulative survival rates were 71.8%, 41.1%, and 22.5% and the local control rates were 95.4%, 90.9%, and 79.4% at 6, 12, and 24 months, respectively. Tumors with rapid growth, the lack of preoperative radiotherapy, and application of aortic balloon occlusion were significantly associated with good local control. There were 29 (18.8%) complications related to surgery. The mean pain scores were 7.04 preoperatively, 1.66 at 1 month postoperatively (p = 0.003), and 1.51 at 3 months postoperatively (p = 0.002). The mean ECOG scores were 2.82 preoperatively and 1.47 3 months postoperatively (p < 0.001). There were significant improvements from preoperatively to 3 months postoperatively in global health status (43.3 vs. 52.1), pain (62.0 vs. 33.2), and constipation (51.4 vs. 30.3) (p < 0.001).
CONCLUSIONS
Surgery for sacral metastasis is effective to palliate pain rapidly and improve constipation and quality of life and has a low rate of complications.
Topics: Curettage; Female; Humans; Logistic Models; Male; Pain Measurement; Quality of Life; Retrospective Studies; Risk Factors; Sacrum; Spinal Neoplasms; Survival Rate; Treatment Outcome
PubMed: 27992502
DOI: 10.1371/journal.pone.0168313 -
BMC Veterinary Research Jan 2022Computed tomography (CT) is used to evaluate body composition and limb osteochondrosis in selection of breeding boars. Pigs also develop heritably predisposed abnormal...
Osteochondrosis and other lesions in all intervertebral, articular process and rib joints from occiput to sacrum in pigs with poor back conformation, and relationship to juvenile kyphosis.
BACKGROUND
Computed tomography (CT) is used to evaluate body composition and limb osteochondrosis in selection of breeding boars. Pigs also develop heritably predisposed abnormal curvature of the spine including juvenile kyphosis. It has been suggested that osteochondrosis-like changes cause vertebral wedging and kyphosis, both of which are identifiable by CT. The aim of the current study was to examine the spine from occiput to sacrum to map changes and evaluate relationships, especially whether osteochondrosis caused juvenile kyphosis, in which case CT could be used in selection against it. Whole-body CT scans were collected retrospectively from 37 Landrace or Duroc boars with poor back conformation scores. Spine curvature and vertebral shape were evaluated, and all inter-vertebral, articular process and rib joints from the occiput to the sacrum were assessed for osteochondrosis and other lesions.
RESULTS
Twenty-seven of the 37 (73%) pigs had normal spine curvature, whereas 10/37 (27%) pigs had abnormal curvature and all of them had wedge vertebrae. The 37 pigs had 875 focal lesions in articular process and rib joints, 98.5% of which represented stages of osteochondrosis. Five of the 37 pigs had focal lesions in other parts of vertebrae, mainly consisting of vertebral body osteochondrosis. The 10 pigs with abnormal curvature had 21 wedge vertebrae, comprising 10 vertebrae without focal lesions, six ventral wedge vertebrae with ventral osteochondrosis lesions and five dorsal wedge vertebrae with lesions in the neuro-central synchondrosis, articular process or rib joints.
CONCLUSIONS
Computed tomography was suited for identification of wedge vertebrae, and kyphosis was due to ventral wedge vertebrae compatible with heritably predisposed vertebral body osteochondrosis. Articular process and rib joint osteochondrosis may represent incidental findings in wedge vertebrae. The role of the neuro-central synchondrosis in the pathogenesis of vertebral wedging warrants further investigation.
Topics: Animals; Male; Osteochondrosis; Retrospective Studies; Ribs; Sacrum; Scheuermann Disease; Spine; Swine; Swine Diseases; Tomography, X-Ray Computed
PubMed: 35042517
DOI: 10.1186/s12917-021-03091-6 -
Orthopaedic Surgery Jan 2023Posterior pelvic ring sacroiliac screws are preferred by clinicians for their good biomechanical performance. However, there are few studies on mechanical analysis and...
OBJECTIVE
Posterior pelvic ring sacroiliac screws are preferred by clinicians for their good biomechanical performance. However, there are few studies on mechanical analysis and intraoperative screw insertion of the dysplastic sacrum and sacroiliac screw. This study investigated the biomechanical performance of oblique sacroiliac screws (OSS) in S1 combined with transiliac-transsacral screws (TTSs) in S2 for pelvic fracture or sacroiliac dislocation with dysplastic sacrum and evaluated the safety of screw placement assisted by the navigation template.
METHODS
Six models were established, including one OSS fixation in the S2 segment, one transverse sacroiliac screw (TSS) fixation in the S2 segment, one TTS fixation in the S2 segment, one OSS fixation in the S1 and S2 segments, one OSS fixation in the S1 segment and one TSS fixation in the S2 segment, one OSS fixation in the S1 segment and one TTS fixation in the S2 segment. Then, finite element analysis (FEA) was performed. Twelve dysplastic sacrum patients with pelvis fracture or sacroiliac dislocation underwent OSS insertion in the S1 combined with TTS insertion in the S2 under the assistance of the patient-specific locked navigation template. Grading and Matta scores were evaluated after surgery.
RESULTS
In the one-screw fixation group, the vertical displacements of the sacrum surface of S2 OSS, S2 TSS and S2 TTS were 1.23, 1.42, and 1.22 mm, respectively, and the maximum stress of screw were 139.45 MPa, 144.81 MPa, 126.14 MPa, respectively. In the two-screw fixation group, the vertical displacements of the sacrum surface of the S1 OSS + S2 OSS, S1 OSS + S2 TSS and S1 OSS + S2 TTS were 0.91, 1.06, and 0.75 mm, respectively, and the maximum stress of screw were 149.26 MPa, 167.13 Pa, 136.76 MPa, respectively. Clinically, a total of 12 TTS and OSS were inserted under the assistance of navigation templates, with a surgical time of 55 ± 7.69 min, bleeding of 57.5 ± 18.15 ml and radiation times of 14.5 ± 4.95. One of the TTS and one of the OSS were grade 1, and the other screws were grade 0. The Matta scores of nine patients were excellent, and three patents were good.
CONCLUSION
OSS in the S1 combined with TTS in the S2 had the best mechanical stability in six models, and it is safe for screw insertion assisted by the patient-specific locked navigation template.
Topics: Humans; Sacrum; Fracture Fixation, Internal; Finite Element Analysis; Bone Screws; Pelvic Bones; Fractures, Bone; Pelvis; Joint Dislocations; Ilium
PubMed: 36424734
DOI: 10.1111/os.13585