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Neuroimaging Clinics of North America Aug 2023Three-dimensional (3D) printing technology has proven to have many advantages in spine and sacrum surgery. 3D printing allows the manufacturing of life-size... (Review)
Review
Three-dimensional (3D) printing technology has proven to have many advantages in spine and sacrum surgery. 3D printing allows the manufacturing of life-size patient-specific anatomic and pathologic models to improve preoperative understanding of patient anatomy and pathology. Additionally, virtual surgical planning using medical computer-aided design software has enabled surgeons to create patient-specific surgical plans and simulate procedures in a virtual environment. This has resulted in reduced operative times, decreased complications, and improved patient outcomes. Combined with new surgical techniques, 3D-printed custom medical devices and instruments using titanium and biocompatible resins and polyamides have allowed innovative reconstructions.
Topics: Humans; Printing, Three-Dimensional; Computer-Aided Design; Sacrum; Neoplasms
PubMed: 37356866
DOI: 10.1016/j.nic.2023.05.001 -
Experimental Oncology Dec 2021Surgical treatment of recurrent rectal tumors is a challenge for cancer surgeons. Due to the high risk of intraoperative and postoperative complications, such tumors are...
Surgical treatment of recurrent rectal tumors is a challenge for cancer surgeons. Due to the high risk of intraoperative and postoperative complications, such tumors are often considered inoperable. We present a clinical case of 56-years-old male patient with local recurrence and pathological fracture of the sacrum at S5 level to whom en-bloc distal sacrectomy was performed. Such surgical technique for recurrence of rectal cancer provides significant improvement in local and general condition and creates a favorable prognosis for the patient's survival, which is demonstrated by the described clinical case.
Topics: Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Postoperative Complications; Prognosis; Rectal Neoplasms; Sacrum; Treatment Outcome
PubMed: 34967550
DOI: 10.32471/exp-oncology.2312-8852.vol-43-no-4.16794 -
Pediatric Radiology Sep 2021The sacral ratio has been used as a tool for evaluating sacral development in patients with anorectal malformations. Sacral ratios can be calculated by obtaining sacral...
BACKGROUND
The sacral ratio has been used as a tool for evaluating sacral development in patients with anorectal malformations. Sacral ratios can be calculated by obtaining sacral radiographs in the anteroposterior (AP) and lateral planes.
OBJECTIVE
The objective of the study was to determine the correlation and agreement in sacral ratio calculations.
MATERIALS AND METHODS
In this single institution retrospective cohort study, we reviewed medical charts of all pediatric anorectal malformation patients treated between March 2014 and September 2018 who had both AP and lateral images of their sacrum. All sacral ratios were measured by three radiologists. Pearson's correlation coefficients and corresponding 95% confidence intervals (CIs) were used to assess the correlation between the AP and lateral radiographs. A weighted Kappa statistic was used to measure the agreement between how the AP and lateral sacral ratios categorized observations into risk groups.
RESULTS
Our initial cohort consisted of 646 observations from patients with anorectal malformations who had radiographs obtained in both AP and lateral planes. We excluded all observations (n=76) where the radiographs were deemed to be inadequate or not appropriately centered to measure sacral ratio. For a given pair of measurements, the mean lateral sacral ratio was 0.07 units greater than the AP plane (95% CI 0.06-0.09, paired t-test P-value <0.0001). AP and lateral images had a moderate positive correlation (Pearson's r=0.76, 95% CI 0.73-0.79, P<0.0001) and moderate agreement in risk categorization (unweighted kappa = 0.60, P<0.0001). AP and lateral readings conducted by all three radiologists had excellent inter-rater reliability with intraclass correlations for AP and lateral sacral ratios of 0.88 and 0.84, respectively.
CONCLUSION
Even though the AP and lateral sacral ratios had moderate positive correlation, the mean sacral ratio determined by images in the lateral plane was 0.07 units greater than the AP plane. AP and lateral sacral ratios concluded different risk categories relatively often. Future studies are needed to determine whether AP or lateral sacral ratios correlate better with continence in patients with anorectal malformations.
Topics: Anorectal Malformations; Child; Humans; Radiography; Reproducibility of Results; Retrospective Studies; Sacrum
PubMed: 33991195
DOI: 10.1007/s00247-021-05094-9 -
Journal of Neurosurgery. Spine Aug 2023The objective was to describe an intraoperative method that accurately predicts postoperative coronal alignment for up to 2 years of follow-up. The authors hypothesized...
OBJECTIVE
The objective was to describe an intraoperative method that accurately predicts postoperative coronal alignment for up to 2 years of follow-up. The authors hypothesized that the intraoperative coronal target for adult spinal deformity (ASD) surgery should account for lower-extremity parameters, including pelvic obliquity (PO), leg length discrepancy (LLD), lower-extremity mechanical axis difference (MAD), and asymmetrical knee bending.
METHODS
Two lines were drawn on intraoperative prone radiographs: the central sacral pelvic line (CSPL) (the line bisecting the sacrum and perpendicular to the line touching the acetabular sourcil of both hips) and the intraoperative central sacral vertical line (iCSVL) (which is drawn relative to CSPL based on the preoperative erect PO). The distance from the C7 spinous process to CSPL (C7-CSPL) and the distance from the C7 spinous process to iCSVL (iCVA) were compared with immediate and 2-year postoperative CVA. To account for LLD and preoperative lower-extremity compensation, patients were categorized into four preoperative groups: type 1, no LLD (< 1 cm) and no lower-extremity compensation; type 2, no LLD with lower-extremity compensation (PO > 1°, asymmetrical knee bending, and MAD > 2°); type 3, LLD and no lower-extremity compensation; and type 4, LLD with lower-extremity compensation (asymmetrical knee bending and MAD > 4°). A retrospective review of a consecutively collected cohort with ASD who underwent minimum 6-level fusion with pelvic fixation was performed for validation.
RESULTS
In total, 108 patients (mean ± SD age 57.7 ± 13.7 years, 14.0 ± 3.9 levels fused) were reviewed. Mean preoperative/2-year postoperative CVA was 5.0 ± 2.0/2.2 ± 1.8 cm. For patients with type 1, both C7-CSPL and iCVA had similar error margins for immediate postoperative CVA (0.5 ± 0.6 vs 0.5 ± 0.6 cm, p = 0.900) and 2-year postoperative CVA (0.3 ± 0.4 vs 0.4 ± 0.5 cm, p = 0.185). For patients with type 2, C7-CSPL was more accurate for immediate postoperative CVA (0.8 ± 1.2 vs 1.7 ± 1.8 cm, p = 0.006) and 2-year postoperative CVA (0.7 ± 1.1 vs 2.1 ± 2.2 cm, p < 0.001). For patients with type 3, iCVA was more accurate for immediate postoperative CVA (0.3 ± 0.4 vs 1.7 ± 0.8 cm, p < 0.001) and 2-year postoperative CVA (0.3 ± 0.2 vs 1.9 ± 0.8 cm, p < 0.001). For patients with type 4, iCVA was more accurate for immediate postoperative CVA (0.6 ± 0.7 vs 3.0 ± 1.3 cm, p < 0.001) and 2-year postoperative CVA (0.5 ± 0.6 vs 3.0 ± 1.6 cm, p < 0.001).
CONCLUSIONS
This system, which accounted for lower-extremity factors, provided an intraoperative guide to determine both immediate and 2-year postoperative CVA with high accuracy. For patients with type 1 and 2 (no LLD, with or without lower-extremity compensation), C7-intraoperative CSPL accurately predicted postoperative CVA up to 2-year follow-up (mean error 0.5 cm). For patients with type 3 and 4 (LLD, with or without lower-extremity compensation), iCVA accurately predicted postoperative CVA up to 2-year follow-up (mean error 0.4 cm).
Topics: Humans; Adult; Middle Aged; Aged; Sacrum; Retrospective Studies; Radiography; Lower Extremity; Pelvis; Spinal Fusion
PubMed: 37148236
DOI: 10.3171/2023.3.SPINE221364 -
International Urogynecology Journal Sep 2021To develop an instructional video that correlates cadaveric anatomy with fluoroscopic images to assist in conceptualization of optimal placement of the foramen needle...
INTRODUCTION AND HYPOSTHESIS
To develop an instructional video that correlates cadaveric anatomy with fluoroscopic images to assist in conceptualization of optimal placement of the foramen needle and lead to complete an efficient and successful sacral neuromodulation (SNM) procedure.
METHODS
A SNM procedure was performed and recorded on a fresh female cadaver. Fluoroscopic images were obtained during the procedure to highlight the bony relationships to the S3 foramen and nerve. Dissection of the anterior and posterior sacrum was completed to highlight the tract of the S3 nerve. Techniques to increase the likelihood of optimal foramen needle and thus lead placement were highlighted.
CONCLUSIONS
This video demonstrates how achieving optimal foramen needle placement within the S3 foramen is key to optimal lead placement. Understanding the relationship of the bony landmarks on fluoroscopy to the S3 nerve and foramen, seen in the cadaveric dissections, are important in understanding how to achieve optimal lead placement. This optimization should lead to decreased operating room time, maximization of programming options, and decreased amplitude requirements.
Topics: Cadaver; Electric Stimulation Therapy; Female; Humans; Lumbosacral Plexus; Sacrum
PubMed: 33237358
DOI: 10.1007/s00192-020-04615-8 -
World Neurosurgery Oct 2022A Stereotaxic Atlas of the Human Lumbar-Sacral Spinal Cord has been created to provide an anatomical basis for radiologic and ultrasonic imaging and electrophysiological...
OBJECTIVE
A Stereotaxic Atlas of the Human Lumbar-Sacral Spinal Cord has been created to provide an anatomical basis for radiologic and ultrasonic imaging and electrophysiological examination, which are used to target the placement of lumbar-sacral epidural stimulating electrodes and cellular transplantation in order to restore movement in individuals with sustained spinal cord injury or a degenerative disorder of the spinal cord. Through the availability of an atlas that exhibits axial images of the cytoarchitecture of each cord segment with a stereotaxic millimeter grid of dorsal-ventral depth from the midline dorsal surface of the cord and right-left distances from the midline of the cord, neuromodulation, and cellular therapy would undoubtedly be made not only more precise but also safer for patients.
METHODS
The atlas is based upon dimension measurements and subsequent serial sectioning, staining and high-resolution digital imaging of the lumbar-sacral enlargement of 20 adult human spinal cords.
RESULTS
Nissl stained cross-sections from cord segments L1-S3 illustrate the cytoarchitecture and stereotactic coordinates.
CONCLUSIONS
The atlas provides an anatomical basis for radiologic and physiologic confirmation of target localization in the lumbar-sacral spinal cord.
Topics: Adult; Humans; Lumbosacral Region; Sacrococcygeal Region; Sacrum; Spinal Cord; Spinal Cord Injuries
PubMed: 35840094
DOI: 10.1016/j.wneu.2022.07.017 -
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 -
Current Medical Imaging 2022The diagnosis of sacral neoplasms is often delayed because they tend to remain clinically silent for a long time. Imaging is useful at all stages of the management of...
The diagnosis of sacral neoplasms is often delayed because they tend to remain clinically silent for a long time. Imaging is useful at all stages of the management of sacral bone tumors, i.e., from the detection of the neoplasm to the long-term follow-up. Radiographs are recommended as the modality of choice to begin the imaging workup of a patient with known or suspected sacral pathology. More sensitive examinations, such as Computerized Tomography (CT), magnetic resonance (MRI), or scintigraphy, are often necessary. The morphological features of the lesions on CT and MRI help orientate the diagnosis. Although some imaging characteristics are helpful to limit the differential diagnosis, an imaging-guided biopsy is often ultimately required to establish a specific diagnosis. Imaging is of paramount importance even in the long-term follow-up, in order to assess any residual tumor when surgical resection remains incomplete, to assess the efficacy of adjuvant chemotherapy and radiotherapy, and to detect recurrence.
Topics: Bone Neoplasms; Humans; Magnetic Resonance Imaging; Radiography; Sacrum; Tomography, X-Ray Computed
PubMed: 33982654
DOI: 10.2174/1573405617666210512011923 -
Journal of Gynecology Obstetrics and... May 2023
Topics: Humans; Robotic Surgical Procedures; Neurilemmoma; Sacrococcygeal Region; Sacrum
PubMed: 37028549
DOI: 10.1016/j.jogoh.2023.102585 -
Clinical Spine Surgery Mar 2023The Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification hierarchically separates fractures based on their injury severity with A-type... (Review)
Review
The Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification hierarchically separates fractures based on their injury severity with A-type fractures representing less severe injuries and C-type fractures representing the most severe fracture types. C0 fractures represent moderately severe injuries and have historically been referred to as nondisplaced "U-type" fractures. Injury management of these fractures can be controversial. Therefore, the purpose of this narrative review is to first discuss the Arbeitsgemeinschaft fur Osteosynthese fragen Spine Sacral Injury Classification System and describe the different fracture types and classification modifiers, with particular emphasis on C0 fracture types. The narrative review will then focus on the epidemiology and etiology of C0 fractures with subsequent discussion focused on the clinical presentation for patients with these injuries. Next, we will describe the imaging findings associated with these injuries and discuss the injury management of these injuries with particular emphasis on operative management. Finally, we will outline the outcomes and complications that can be expected during the treatment of these injuries.
Topics: Humans; Spinal Fractures; Spinal Injuries; Sacrum; Fractures, Bone; Retrospective Studies
PubMed: 36006406
DOI: 10.1097/BSD.0000000000001384