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Neurosurgical Focus Aug 2003One of the basic tenets of performing surgery is knowledge of the relevant anatomy. Surgeons incorporate this knowledge along with factors, such as biomechanics and... (Review)
Review
One of the basic tenets of performing surgery is knowledge of the relevant anatomy. Surgeons incorporate this knowledge along with factors, such as biomechanics and physiology, to develop their operative approaches and procedures. In the diagnosis and management of sacral tumors, the need to be familiar with the anatomy of the sacrum is no less important than knowledge of the pathological entity involved. This article will provide an overview of the embryology and anatomy of the sacrum, along with concepts as applied to surgical intervention.
Topics: Adult; Female; Genetic Variation; Humans; Infant, Newborn; Male; Morphogenesis; Osteogenesis; Sacrum; Sex Characteristics; Spine
PubMed: 15350034
DOI: 10.3171/foc.2003.15.2.3 -
American Journal of Orthopedics (Belle... Oct 2008Treatment in spinal disorders, sacroiliac joint disruption, and sacral fractures may involve instrumentation of the sacrum. Proper screw placement is essential for... (Review)
Review
Treatment in spinal disorders, sacroiliac joint disruption, and sacral fractures may involve instrumentation of the sacrum. Proper screw placement is essential for obtaining adequate bony purchase for solid fixation. Injury to adjacent vital structures during screw placement remains a major concern because of the complex anatomy of the sacrum. This article reviews the bony anatomy of the sacrum.
Topics: Humans; Radiography; Sacrum
PubMed: 19081888
DOI: No ID Found -
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 -
Neurocirugia (English Edition) 2022Our objective is to share our experience in neurogenic tumors of the sacral area, an uncommon disease, and assess approaches, intraoperative techniques, complications...
OBJECTIVES
Our objective is to share our experience in neurogenic tumors of the sacral area, an uncommon disease, and assess approaches, intraoperative techniques, complications and clinical course of patients in a case series.
METHODS
We conducted a retrospective analysis of 19 cases of patients with neurogenic tumors in the sacral area who were diagnosed and underwent surgery at our center. Of them, 8 were male and 11 were female. They had a mean age at diagnosis of 51 years (with an age range of 25-78 years). Six patients were asymptomatic and were diagnosed incidentally, while the majority (11 patients) presented with lumbar pain accompanied by other symptoms: pain radiating to the legs, pelvic pain, sensory alterations and loss of strength in the legs. Two patients presented with another primary symptom on diagnosis: pain in the pelvic region and in the left leg. All patients underwent a least one imaging test (MRI/CT scan). Nine patients had tumors limited to the sacrum or with subsequent spread, with surgery via the posterior route. In 6 cases, an exclusively anterior approach was employed owing to the pre-sacral location of the tumor; 4 cases required both an anterior and posterior approach.
RESULTS
The 6 patients who were asymptomatic at diagnosis continued to have no symptoms after surgery. In 8 patients, symptoms resolved after surgery, and at discharge 4 had pain in the lumbar region or legs, which improved in subsequent consultations. One patient had symptoms consistent with motor and sensory deficit in the right leg deriving from impairment of the external popliteal sciatic nerve. The mean follow-up period was 69 months (6-178 months). Histologically, 17 cases were classified as schwannomas, one case was classified as neurofibroma, and one case was classified as neurofibrosarcoma, which received radiotherapy. Three patients with benign histologies had further surgery for local recurrences.
CONCLUSIONS
When selecting the approach, the large size that these tumors can reach, their relationship with structures, and their anterior or posterior spread should be taken in to account. Resecting the tumor mass as much as possible provides greater benefit to the patient, as this decreases the odds of tumor recurrence without increasing intraoperative and postoperative complications when multidisciplinary teams are also used.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvis; Retrospective Studies; Sacrum; Treatment Outcome
PubMed: 35248299
DOI: 10.1016/j.neucie.2020.11.001 -
Orthopaedic Surgery Feb 2023Melanotic schwannoma is a rare tumor when it occurs in the sacrum. Though it is mostly classified as benign, the prognosis is unpredictable due to the possibility of... (Review)
Review
BACKGROUND
Melanotic schwannoma is a rare tumor when it occurs in the sacrum. Though it is mostly classified as benign, the prognosis is unpredictable due to the possibility of recurrence and metastasis. Here, we reported a case of intraosseous of sacrum with good results and reviewed the literature.
CASE PRESENTATION
A 33-year-old male patient complained of low back pain and was discovered to have an obstruction at S2. Following the necessary imaging diagnosis, we treated the patient with piecemeal excision in conjunction with extended curettage, and the frozen biopsy revealed that the tumor was melanotic schwannoma. The intraosseous portion of the lesion was curettaged using high-speed drill to enlarge the edge of curettage, and piecemeal excision for lesion within the sacral canal. After surgery, the patient received total 56Gy radiotherapy and frequent follow-up. After 15 months follow-up, there was no evidence of recurrence, and the nerve function was normal.
CONCLUSION
Melanotic schwannoma that occurs intraosseous of the sacrum is extremely rare and lacks typical clinical manifestations; however it can be identified through careful pathological and imaging diagnosis. Intralesional extended curettage combined with radiotherapy can achieve a good local control with a satisfactory clinical effect in this rare disease.
Topics: Male; Humans; Adult; Sacrum; Prognosis; Pelvis; Curettage; Neurilemmoma
PubMed: 36453472
DOI: 10.1111/os.13606 -
European Journal of Pediatric Surgery :... Feb 2021The aim of this study was to compare the compliance of sacrum ultrasonography with radiography for the measuring of sacral ratio in infants. (Comparative Study)
Comparative Study
INTRODUCTION
The aim of this study was to compare the compliance of sacrum ultrasonography with radiography for the measuring of sacral ratio in infants.
MATERIALS AND METHODS
A total of 129 infants under the age of 6 months, who were a candidate for abdominal and/or pelvic radiographs, were assessed. Sacrum ultrasonography and radiography were performed by a single radiologist using the same device. The sacral ratio was calculated for all patients undergoing ultrasonography and radiography. Agreement between two methods was calculated by Bland-Altman's chart.
RESULTS
The mean of sacral ratio was 0.70 ± 0.11 radiographically and 0.72 ± 0.05 ultrasonographically. Based on Bland-Altman's chart, the mean difference between ultrasonography and radiology was 4.6 mm (confidence intervals of 8.18 ± 5.6).
CONCLUSION
Sacrum ultrasonography could be safely used in the investigation of sacral ratio to detect sacrum abnormalities in infants.
Topics: Cross-Sectional Studies; Female; Humans; Infant; Infant, Newborn; Male; Pilot Projects; Prospective Studies; Radiography; Sacrum; Ultrasonography
PubMed: 33027838
DOI: 10.1055/s-0040-1716879 -
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 -
Orthopaedics & Traumatology, Surgery &... Oct 2020Some clinical situations, such as great sagittal imbalance, high-grade isthmic spondylolisthesis or sacral malunion could require a sacral osteotomy to decrease pelvic...
PURPOSE
Some clinical situations, such as great sagittal imbalance, high-grade isthmic spondylolisthesis or sacral malunion could require a sacral osteotomy to decrease pelvic parameters, horizontalize the sacrum or correct sacral malunion. Here is described a novel technique to perform a sacral osteotomy to decrease pelvic parameters with a lumbo-pelvic construct, with first a sacral slope decrease, then a pelvic tilt decrease.
METHODS
Simulations have been performed using tridimensional reconstructions of the lumbar spine and pelvis, made from CT-scan images of a healthy individual. A cadaveric study has then been performed.
RESULTS
3D modeling exhibited linear relationship between osteotomy angle and pelvic incidence correction, through multiple simulations with 1° increment. Cadaveric study demonstrated feasibility.
CONCLUSION
This preliminary work shows that this technique is efficient to decrease pelvic parameters. A linear relationship has been exhibited between osteotomy angle and PI decrease, as per the following formula: osteotomy angle=PI change/0.84.
Topics: Humans; Lumbar Vertebrae; Osteotomy; Pelvis; Sacrum; Spondylolisthesis
PubMed: 32893167
DOI: 10.1016/j.otsr.2020.05.010 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Apr 2016To summarize the research progress of surgical treatment for primary sacrum tumor. (Review)
Review
OBJECTIVE
To summarize the research progress of surgical treatment for primary sacrum tumor.
METHODS
The domestic and foreign related literature about surgical treatment of primary sacrum tumor, and many aspects of its surgical procedures, intraoperative hemostasis, pelvic reconstruction, protection of sacral nerve, complications, and prognosis was summarized and analyzed.
RESULTS
The operation is the major therapy for primary sacrum tumor. However, surgical procedures, protection of sacral nerve, and the way of intraoperative hemostasis remain controversial. Meanwhile, the complexity of pelvic reconstruction, the diversity of complications, and prognosis related with many factors bring difficulties and challenges to the surgical treatment.
CONCLUSION
It is urgent need to develop an effective unified standard to conduct diagnosis and treatment of primary sacrum tumor.
Topics: Bone Neoplasms; Humans; Pelvis; Plastic Surgery Procedures; Sacrum; Spinal Neoplasms; Treatment Outcome
PubMed: 27411285
DOI: No ID Found -
Skeletal Radiology Jul 2008We describe herein a rare case of primary rhabdomyosarcoma (RMS) occurring in the sacrum. A 16-year-old woman presented with a 2-month history of pain in bilateral... (Review)
Review
We describe herein a rare case of primary rhabdomyosarcoma (RMS) occurring in the sacrum. A 16-year-old woman presented with a 2-month history of pain in bilateral buttocks and posterior thighs. Computed tomography showed a primary tumor with bone destruction in the 2nd sacral vertebra and invasion to the 1st to 3rd vertebrae and retroperitoneal space. Histological examination of the tumor showed proliferation of spindle-shaped cells intermingled with rhabdomyoblasts in a fascicular and storiform growth pattern. Tumor cells showed immunoreactivity for vimentin, desmin, muscle-specific actin, sarcomeric actin, alpha-smooth muscle actin and CD99, and partial immunoreactivity for myoD1, myf-4, myogenin and myoglobin. Reverse transcription polymerase chain reaction demonstrated expression of myoD1. On the basis of the aforementioned findings, a poorly differentiated spindle cell variant of embryonal RMS was diagnosed. The patient underwent combined therapy with chemotherapy and radiotherapy, but died 17 months after incisional biopsy. The present case is instructive in differential diagnosis of primary bone tumors, and the possibility of skeletal RMS needs to be considered.
Topics: Adolescent; Female; Humans; Magnetic Resonance Imaging; Rhabdomyosarcoma; Sacrum; Spinal Neoplasms; Tomography, X-Ray Computed
PubMed: 18421456
DOI: 10.1007/s00256-008-0472-1