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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 -
The Journal of the American Academy of... Dec 2020Spinopelvic dissociation is a rare injury associated with 2% to 3% of transverse sacral fractures and 3% of sacral fractures associated with pelvic ring injuries. When... (Review)
Review
Spinopelvic dissociation is a rare injury associated with 2% to 3% of transverse sacral fractures and 3% of sacral fractures associated with pelvic ring injuries. When spinopelvic dissociation is expediently identified and treated appropriately, patient outcomes can be maximized, highlighting the importance of early diagnosis and treatment. Because of its rarity and complexity, there remains a paucity of high-level evidence-based guidance on treating this complex issue. No consensus exists on fixation techniques or reduction maneuvers to achieve stability, allowing for early functional rehabilitation. The purpose of this article is to review the current body of literature to better understand this injury pattern to help establish a treatment algorithm that appropriately guides the treating surgeons in the surgical planning and perioperative care of these patients.
Topics: Adolescent; Aged; Algorithms; Bone Screws; Evidence-Based Medicine; Fracture Fixation; Fracture Fixation, Internal; Humans; Lumbar Vertebrae; Male; Patient Care Planning; Patient Care Team; Perioperative Care; Sacrum; Spinal Fractures; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 33009194
DOI: 10.5435/JAAOS-D-19-00863 -
European Spine Journal : Official... Dec 2023Recent studies demonstrated that primary tumor resection (PTR) improves survival of patients with metastatic bone sarcomas. However, it remains quite unclear regarding...
BACKGROUND
Recent studies demonstrated that primary tumor resection (PTR) improves survival of patients with metastatic bone sarcomas. However, it remains quite unclear regarding the role of PTR in the treatment of sarcomas of pelvic bones with synchronous metastasis at diagnosis.
METHODS
Using the Surveillance, Epidemiology, and End Results Program, we enrolled a total of 385 patients with sarcomas of pelvic bones, sacrum, and coccyx who have metastasis at initial diagnosis, including 139 patients with osteosarcoma, 176 with Ewing sarcoma, and 70 with chondrosarcoma. Association between PTR and disease-specific survival (DSS) were investigated using the univariable and multivariable Cox regression models. Hazard ratio (HR) and 95% confidence interval (CI) were reported. Representative institutional PTR strategies and clinical outcomes for patients with metastatic pelvic sarcomas from our cancer center were displayed.
RESULTS
The usage rate of PTR was 28.1% (39/139) in osteosarcoma, 13.6% (24/176) in Ewing sarcoma, and 41.4% (29/70) in chondrosarcoma with synchronous metastatic lesions. PTR was not associated with an improved DSS for metastatic pelvic osteosarcoma (HR = 0.686, 95% CI = 0.430 ~ 1.094, P = 0.113) and Ewing sarcoma (HR = 0.580, 95% CI = 0.291 ~ 1.154, P = 0.121). The use of PTR was associated with an improved DSS for metastatic pelvic chondrosarcoma (HR = 0.464, 95% CI = 0.225 ~ 0.954, P = 0.037).
CONCLUSION
Primary lesion resection may provide a survival benefit for metastatic chondrosarcoma, but not for osteosarcoma and Ewing sarcoma of pelvic bones, sacrum, and coccyx. This population-based study recommends an active surgical intervention for metastatic chondrosarcoma while non-surgical treatment for metastatic osteosarcoma and Ewing sarcoma of the pelvis in terms of survival improvement.
Topics: Humans; Sarcoma, Ewing; Sacrum; Coccyx; Sarcoma; Bone Neoplasms; Osteosarcoma; Pelvic Bones; Pelvis; Chondrosarcoma; Retrospective Studies
PubMed: 37870700
DOI: 10.1007/s00586-023-07985-x -
Injury Jul 2020Vacuum phenomenon (VP) in closed pelvic fracture is a rare disorder. This study aimed to examine the prevalence and clinical findings of VP in closed pelvic fracture.
BACKGROUND
Vacuum phenomenon (VP) in closed pelvic fracture is a rare disorder. This study aimed to examine the prevalence and clinical findings of VP in closed pelvic fracture.
METHODS
We retrospectively reviewed 197 patients with closed pelvic fracture who presented to our institution from January 2012 to December 2018. Pelvic fractures were diagnosed by plain radiography and computed tomography (CT). First, we investigated the prevalence and clinical findings of VP in pelvic fractures. Second, we compared the clinical findings between pelvic fracture with and without VP. Finally, VP in pelvic fracture was evaluated clinically and radiologically.
RESULTS
VP in pelvic fractures was detected by CT in 9 (3.6%) of the 197 patients with pelvic fractures. Patients with VP had a significantly greater proportion of fracture progression than those without VP (42.9% vs. 11.3%, P = 0.02). Patients with VP had a greater proportion of fragility fractures of the pelvis (FFP), and a lesser proportion of bone union than those without VP, although the differences were not significant. In nine pelvic fractures with VP, all sacral fractures were classified as type 1 according to the Denis classification, and all pubic fractures were classified as type 1 according to the Nakatani classification. Two (22.2%) nonunion in nine pelvic fractures with VP occurred at the pubic fracture site alone.
CONCLUSIONS
Orthopedic clinicians should be aware of the potential of CT for detecting VP in pelvic fractures, especially in the course of FFP progression.
Topics: Aged; Aged, 80 and over; Female; Fractures, Bone; Gases; Hospitals, General; Humans; Japan; Male; Middle Aged; Pelvic Bones; Pubic Bone; Radiography; Retrospective Studies; Sacrum; Tomography, X-Ray Computed; Vacuum
PubMed: 32386839
DOI: 10.1016/j.injury.2020.03.051 -
JBJS Reviews Dec 2022Chordomas account for 1% to 4% of primary tumors of the spine and sacrum.
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Chordomas account for 1% to 4% of primary tumors of the spine and sacrum.
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En bloc resection is the preferred surgical treatment for the management of chordomas.
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Proton beam radiation is increasingly being used as a postoperative radiation modality for the treatment of chordomas.
Topics: Humans; Sacrum; Chordoma; Treatment Outcome; Spinal Neoplasms; Neoplasm Recurrence, Local
PubMed: 36639876
DOI: 10.2106/JBJS.RVW.22.00162 -
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 -
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 -
Clinical Spine Surgery Jul 2024Surgical technique video.
STUDY DESIGN
Surgical technique video.
OBJECTIVE
To report a surgical technique to revise patients with previous fusions at L4-S1 leading to an iatrogenic flat back and sagittal imbalance using L5-S1 transforaminal interbody fusion combined with a small S1 corner osteotomy.
BACKGROUND
This is a case of a woman (51 y old) with a history of multiple lumbar surgeries, severe back pain, sagittal imbalance, and loss of lordosis.
METHODS
We describe a feasible revision technique in a complex patient with the goal of attaining optimal distribution of lumbar lordosis and sagittal balance through a modified S1 pedicle subtraction osteotomy, and the use of an interbody cage to enhance the fusion rate and facilitate closure of the 3-column osteotomy.
RESULTS
The preoperative patient lordosis angle of 31 degrees at L1-L4 and 16 degrees at L4-S1 became 12 degrees at L1-L4 and 44 degrees at L4-S1 postoperatively.
CONCLUSION
The combination of L5-S1 transforaminal interbody fusion and S1 corner osteotomy is a feasible technique for the restoration of lumbar lordosis in patients with previous fusion and consequent loss of lordosis.
Topics: Humans; Osteotomy; Female; Middle Aged; Spinal Fusion; Lumbar Vertebrae; Lordosis; Sacrum
PubMed: 38637935
DOI: 10.1097/BSD.0000000000001620 -
Acta Neurochirurgica Oct 2021Symptomatic midline sacral meningeal cysts (MSMC) are rare, and, as a consequence, so are reports on the surgical techniques to address these lesions. Here we provide a...
BACKGROUND
Symptomatic midline sacral meningeal cysts (MSMC) are rare, and, as a consequence, so are reports on the surgical techniques to address these lesions. Here we provide a description of the senior author's (ATC) technique.
METHOD
A sacral laminectomy is performed. The cyst's relation with the dural sac and sacral nerves is inspected; it is then opened and drained. Its lumen is explored for its point of communication with the dural sac, and this ostium is closed off with non-penetrating clips. A lumbar drain is inserted in select cases.
CONCLUSION
Cyst wall resection is unnecessary and closing the ostium is sufficient to treat MSMC.
Topics: Central Nervous System Cysts; Cysts; Decompression; Humans; Laminectomy; Magnetic Resonance Imaging; Meningocele; Sacrum
PubMed: 34417877
DOI: 10.1007/s00701-021-04948-3