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European Spine Journal : Official... Feb 2010
Topics: Activities of Daily Living; Adolescent; Anesthetics, Local; Bone Screws; Bone Transplantation; Braces; Humans; Low Back Pain; Lumbar Vertebrae; Male; Nerve Block; Neurosurgical Procedures; Postoperative Complications; Radiography; Range of Motion, Articular; Sacrum; Spinal Fusion; Spondylolysis; Stress, Mechanical; Treatment Outcome; Weight-Bearing
PubMed: 20130927
DOI: 10.1007/s00586-010-1308-y -
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 -
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 Neuroradiology Journal Oct 2018Background and purpose Sacral intraosseous schwannomas represent a rare subset of schwannomas. The existing literature detailing the radiographic appearance of... (Review)
Review
Background and purpose Sacral intraosseous schwannomas represent a rare subset of schwannomas. The existing literature detailing the radiographic appearance of intraosseous schwannomas is limited. The aim of this study is to formally characterize the radiological appearance of sacral intraosseous schwannomas to differentiate them from other lytic lesions. Materials and methods Imaging studies of 13 pathologically proven intraosseous schwannomas were reviewed from multiple institutions by fellowship-trained radiologists. A PubMed search was performed and identified four papers pertaining to the imaging characteristics of sacral intraosseous schwannomas. The results of these papers were compared to findings from our cases. Results All tumors had heterogeneous signals and were predominately solid but cystic components with fluid-fluid levels were present. The tumors caused a mass effect but none infiltrated the surrounding soft tissues. Post-contrast T1-weighted images revealed heterogeneous enhancement in all 13 tumors and four possessed non-enhancing cysts. A literature review identified 16 other cases of sacral intraosseous schwannomas forming a total of 29 cases examined. Conclusions Sacral intraosseous schwannomas should be considered in the differential diagnosis for both radiologists and pathologists when dealing with large expansile, lytic lesions, with well-defined sclerotic margins involving the sacrum. This is particularly important in middle-aged adults presenting with pathology centered around S2-3.
Topics: Humans; Magnetic Resonance Imaging; Neurilemmoma; Sacrum; Spinal Neoplasms
PubMed: 29890877
DOI: 10.1177/1971400918782321 -
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 -
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 -
Journal of Orthopaedic Surgery and... Aug 2021To explore the feasibility of sacral-2-alar (S2-alar) screw placement by measuring the length, diameter, and angle of the screw trajectory on computed tomography (CT).
PURPOSE
To explore the feasibility of sacral-2-alar (S2-alar) screw placement by measuring the length, diameter, and angle of the screw trajectory on computed tomography (CT).
METHODS
This study selected 100 Han-nationality adults in northern China with a normal spine and pelvis. CT data were imported into PHILIPS software for reconstructing the 3D digital images. The optimal S2-alar screw trajectory was imitated on CT. Parameters including the length of the screw trajectory, sagittal angle, coronal angle, distance between the entry point and the spinous process, and minimum diameter of the screw trajectory were measured to evaluate the application of S2-alar screws.
RESULTS
In total, 48 males and 52 females were included. The average length of the left screw trajectory was 47.18 ± 3.91 mm. The sagittal angle was 29.06 ± 4.00°. The coronal angle was 13.31 ± 6.95°. The distance between the entry point and the spinous process was 21.0 (3.7) mm. The minimum diameter of the screw trajectory was 17.1 (2.3) mm. The average length of the right screw trajectory was 45.46 ± 4.37 mm. The sagittal angle was 23.33 ± 4.26°. The coronal angle was 14.88 ± 6.84°. The distance between the entry point and the spinous process was 22.8 (2.9) mm. The minimum diameter of the screw trajectory was 16.9 (3.1) mm. In women, the average length of the left screw trajectory was 44.80 ± 3.66 mm. The sagittal angle was 32.14 ± 5.48°. The coronal angle was 16.04 ± 7.74°. The distance between the entry point and the spinous process was 21.8 (2.8) mm. The minimum diameter of the screw trajectory was 17.1 (5) mm. The average length of the right screw trajectory was 44.01 ± 3.72 mm. The sagittal angle was 25.12 ± 5.19. The coronal angle was 16.67 ± 8.34°. The distance between the entry point and the spinous process was 21.6 (2.7) mm. The minimum diameter of the screw trajectory was 17 (4.5) mm. As seen from the data, there were significant differences in the minimum diameter of the screw trajectory in both males and females. In females, there were also significant differences between the left and right sides in the coronal angle. Between males and females, there were statistically significant differences in the length of the screw trajectory. There were no statistically significant differences in the other parameters between males and females.
CONCLUSION
The optimal screw trajectory of the S2-alar screw can be found on CT. The length and deflection angle of the screw meet the clinical requirements. This method is easy to perform and feasible for clinical application.
Topics: Bone Screws; Female; Humans; Imaging, Three-Dimensional; Male; Pelvis; Sacrum; Tomography, X-Ray Computed
PubMed: 34425863
DOI: 10.1186/s13018-021-02626-9 -
Sensors (Basel, Switzerland) Nov 2022With the prevalence of degenerative diseases due to the increase in the aging population, we have encountered many spine-related disorders. Since the spine is a crucial...
With the prevalence of degenerative diseases due to the increase in the aging population, we have encountered many spine-related disorders. Since the spine is a crucial part of the body, fast and accurate diagnosis is critically important. Generally, clinicians use X-ray images to diagnose the spine, but X-ray images are commonly occluded by the shadows of some bones, making it hard to identify the whole spine. Therefore, recently, various deep-learning-based spinal X-ray image analysis approaches have been proposed to help diagnose the spine. However, these approaches did not consider the characteristics of frequent occlusion in the X-ray image and the properties of the vertebra shape. Therefore, based on the X-ray image properties and vertebra shape, we present a novel landmark detection network specialized in lumbar X-ray images. The proposed network consists of two stages: The first step detects the centers of the lumbar vertebrae and the upper end plate of the first sacral vertebra (S1), and the second step detects the four corner points of each lumbar vertebra and two corner points of S1 from the image obtained in the first step. We used random spine cutout augmentation in the first step to robustify the network against the commonly obscured X-ray images. Furthermore, in the second step, we used CoordConv to make the network recognize the location distribution of landmarks and part affinity fields to understand the morphological features of the vertebrae, resulting in more accurate landmark detection. The proposed network was evaluated using 304 X-ray images, and it achieved 98.02% accuracy in center detection and 8.34% relative distance error in corner detection. This indicates that our network can detect spinal landmarks reliably enough to support radiologists in analyzing the lumbar X-ray images.
Topics: Lumbar Vertebrae; Sacrum; X-Rays; Pelvis; Radiography
PubMed: 36433225
DOI: 10.3390/s22228628 -
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 -
JNMA; Journal of the Nepal Medical... Nov 2020Chordoma is a rare and locally aggressive tumor that arises from the notochordal remnants and has an incidence of 0.1/100000 per year. It has a predilection for the...
Chordoma is a rare and locally aggressive tumor that arises from the notochordal remnants and has an incidence of 0.1/100000 per year. It has a predilection for the axial skeleton and is the most common primary malignant tumor of sacrum. The mainstay of treatment is wide surgical excision but there is a risk of recurrence due to the infiltrating nature of the tumor. Here, we report a case of a 56-years male who complained of pain over his sacral region for the past two years along with episodic urinary symptoms, constipation, and weakness of both legs. Seven years after undergoing surgery and radiotherapy for his sacral chordoma, he was diagnosed with recurrent sacral chordoma and planned for reoperation. Subtotal excision of the chordoma was done which significantly alleviated his symptoms postoperatively. Timely intervention helps to improve the quality of life in patients with either primary or recurrent sacral chordomas.
Topics: Chordoma; Humans; Male; Neoplasm Recurrence, Local; Quality of Life; Sacrococcygeal Region; Sacrum
PubMed: 34506409
DOI: 10.31729/jnma.5401