SEARCH · PubMed Health

Results for “SACRUM”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources

PubMed2003

[Clinical application of universal spine system in reconstruction of lumbar sacrum joint after resection of sacrum tumor].

OBJECTIVE: To investigate the operative indications and techniques of the universal spine system (USS) in reconstruction of the stability of the lumbar-sacrum joint after resection of sacrum tumor. METHODS: Nine patients were treated with USS after resection of sacrum tumor. Among them, there were 6 males and 3 females, aged from 34-60 years. The operation could be divided into four main procedures: 1. to resect sacrum tumor; 2. to insert the pedicle screw into the normal pedicle (L3 or L4 or L5) above the region of laminectomy; 3. to insert the lower screw into the iliac plate; 4. to put the rods, bone graft and links. RESULTS: There was no recurrence of sacrum tumor by MRI examination during 7-17 month follow-up. The pains of the lumbar-sacrum joint and the spinal nerve root were relieved obviously. The patients could stand and walked normally. There was no loose screw and no fracture of the screw and the rod. There was no appearance of the enlarged screw passage, the lessened pelvis and lowed L5 spine. CONCLUSION: Reconstruction of the lumbar-sacrum joint by the USS after resection of sacrum tumor is a practical operation clinically. It is characterized by the easy manipulation, few complication and stable fixation.

Adult↗

PubMed2002

The sagittal anatomy of the sacrum among young adults, infants, and spondylolisthesis patients.

The anatomic pelvic parameter "incidence" - the angle between the line perpendicular to the middle of the sacral plate and the line joining the middle of the sacral plate to the center of the bicoxo-femoral axis - has been shown to be strongly correlated with the sacral slope and lumbar lordosis, and ensures the individual an economical standing position. It is important for determining the sagittal curve of the spine. The angle of incidence has also been shown to depend partly on the sagittal anatomy of sacrum, which is established in childhood while learning to stand and walk. The purpose of this study was (1) to define the relationship between the sacrum and the angle of incidence, and (2) to compare these parameters in three populations: young adults, infants before walking, and patients with spondylolisthesis. Forty-four normal young adults, 32 infants not yet walking and 39 patients with spondylolisthesis due to isthmic spondylolysis underwent a sagittal full-spine radiography. A graphic table and the software for bidimensional study of the sacrum developed by J. Hecquet were used to determine various anatomic and positional parameters. Comparison tests of means, and multiple and partial correlation tests were used. A study of the reliability of the measurements using factorial plan methods was performed. The sagittal anatomic parameters of the sacrum were found to have a close relationship with the pelvic parameter of incidence angle, and therefore with the sagittal balance of the spine. The anatomy of the sacrum in spondylolisthesis patients is particular in that some features are much like those of young infants, but it is more curved and the incidence angle is significantly larger. There is a close relationship between angle of incidence and the slip of spondylolisthesis. All the parameters of young infants are significantly smaller than those of adults. It can be concluded that the sagittal anatomy of the sacrum plays a key role in spinal sagittal balance. The sacral bone is an integral a part of the pelvis and constitutes the undistorted part of the spinal curves. Organization of sagittal curves during growth can be followed up by looking at the sacrum. The sacrum in the spondylolisthesis group differs from the normal, and the greater angle of incidence and sacral slope in this group could predispose to vertebral slip.

Adolescent↗

PubMed2000

Internal architecture of the sacrum in the elderly. An anatomic and radiographic study.

STUDY DESIGN: A description of the internal architecture of the sacrum, including its trabecular arrangement, cortical thickness, and overall bone density. OBJECTIVES: To determine the strong and weak areas in the sacrum to understand more clearly the sacral structure and its clinical implications. METHODS: First, seven cadaveric sacral specimens were sectioned in different planes. Horizontal sections were performed at the upper S1, middle S1, S2, S3, and S4. Sagittal sections were made through the median sacral crest, the sacral foramina, and medial to the articular surface. A coronal section through the whole length of a sacral specimen was produced. All sections were studied radiographically, and the trabecular pattern was analyzed. In the second part of the study, axial computed tomography scans of 40 dry sacrum specimens were analyzed by using the National Institutes of Health Image 1.61 program. The cortical thickness and bone density were determined. RESULTS: In the upper sacrum, three distinctive distributions of bony trabeculae were noted, one extending from the center of the sacral body anterolaterally, and the other two extending from the pedicle toward the auricular surface. A condensation zone was observed at the intersection of these trabeculae and was located at the anterior cortex of the foraminal zone. The junction between S2 and S3 represented a weak area with abrupt disappearance of the condensation zone. Analysis of the bone density of the sacrum using the plot analysis demonstrated that, at S1 and S2, the anterior cortex of the foraminal zone (condensation zone) is the most compact part of the sacrum. CONCLUSION: These results suggest that the strongest part of the sacrum is the anterior cortex above the foramina in S1 and S2. The weakest point of the sacrum was found to lie at the level of the junction of S2 and S3.

Aged↗

PubMed2001

Complications and results of long adult deformity fusions down to l4, l5, and the sacrum.

STUDY DESIGN: This is a consecutive study of patients having undergone surgical treatment of adult lumbar scoliosis. Follow-up ranged from 2 to 13 years (average 5 years). OBJECTIVES: To assess the complications and outcomes of patients with long fusions to L4 (n=23), L5 (n=21), or the sacrum (n=15) and determine if a "deeply seated" L5 segment is protective. SUMMARY OF BACKGROUND DATA: Few studies assess outcomes and complications in adults fused from the thoracic spine to L4, L5, or the sacrum with minimum 2-year follow-up. METHODS: Fifty-eight patients (59 cases; average age 43 years; range 21 to 60) with minimum 2-year follow-up were analyzed for subsequent spinal degeneration and complications. Outcomes were assessed from questionnaires administered at latest follow-up. RESULTS: Sixteen percent of cases (7 of 44) fused short of the sacrum displayed subsequent postoperative distal spinal degeneration, although only three patients were symptomatic. Compared with the group with no subsequent degeneration, this group had a lower improvement in function and pain relief. Other complications for patients fused short of the sacrum included two cases with crosslink breakage, one with neurologic deficit, three with pseudarthroses, one with hook pullout, and one with L5 screw pullout. For cases fused to the sacrum, two cases with deep wound infections and one with loose iliac screw requiring removal were observed. Because two of four cases fused to L5 with subsequent degeneration at L5-S1 were observed to have "deeply seated" L5 segments and two of the four did not, the authors could conclude only that "deep seating" of L5 is not absolute protection. CONCLUSIONS: Fusions short of the sacrum did not have predictable long-term results. Those fused short of the sacrum who developed distal spinal degeneration had worse outcomes. Patients fused to the sacrum did not have a higher complication rate. A "deeply seated" L5 segment does not necessarily protect the L5-S1 disc.

Adult↗

PubMedDate not supplied

The sacrum: pathologic spectrum, multimodality imaging, and subspecialty approach.

The sacrum is a structure that is imaged by both general and subspecialty radiologists. A wide variety of disease processes can involve the sacrum either focally or as part of a systemic process. Plain radiographs, although limited in evaluation of the sacrum, should be carefully examined when abnormalities of the sacrum are suspected. Cross-sectional imaging, particularly computed tomography and magnetic resonance (MR) imaging, plays a crucial role in identification, localization, and characterization of sacral lesions. Congenital lesions of the sacrum, including sacral agenesis and meningocele, are optimally imaged with MR. The most common sacral neoplasm is metastatic disease. Primary neoplasms of the sacrum, which include giant cell tumor, chordoma, and teratoma, are infrequent. Infection of the sacrum or sacroiliac joint is most often due to contiguous spread from a suppurative focus. A wide variety of arthritic disorders such as ankylosing spondylitis and osteoarthritis can involve the sacroiliac joints as part of a localized or systemic process. Sacral fractures related to acute trauma or repetitive stress are difficult to diagnose and treat. Knowledge of these abnormalities and familiarity with the imaging of these processes will allow radiologists of all subspecialties to contribute to the diagnosis and management of sacral disorders.

Diagnosis, Differential↗

PubMed1992

[The problem of the sacrum fracture. Clinical analysis of 377 cases].

Sacral fractures are rare injuries that are often neglected because of the general severity of the patient's injuries. They are typical injuries in patients with polytraumata. A "hidden" injury, they are often diagnosed late or are even missed. In a well-documented consecutive series of 1,350 patients with pelvic fractures treated in the trauma department of the Hannover Medical School between 1972 and 1991, a total of 377 sacrum fractures were evaluated in a retrospective study. The cause of the accident, mechanism of injury, concomitant injuries, diagnostic procedures, classification of the pelvic injury (TILE), as well as the classification of the sacrum injury (DENIS), treatment and outcome were analyzed in all cases. Observed complications with special attention to injuries to the lumbosacral plexus were correlated with the classification of the sacrum and pelvis, as well as with a detailed analysis of the fracture pattern and fracture characteristics. In 89.4% at least one additional body region was injured in these patients. PTS (Hannover Polytrauma Score) groups III and IV included 42.5% of the patients. With an improved diagnostic protocol (radiological a.p. views, oblique views and CT scan), the observed rate of sacrum fractures was 33%. Neurological deficits occurred in 15.1% of the patients. In contrast to the literature, the rate of neurological deficits was related more to the degree of pelvic instability (TILE) than to the specific fracture pattern in the sacrum. In stable injuries (TILE A) neurological deficits were only seen in exceptions. In type B injuries the maximum rate was 10%, whereas in unstable fractures (TILE C) the rate of neurological deficits was 32.6% in transalar fractures (DENIS zone I), 42.9% in transforaminal fractures (DENIS zone II), and 63.6% in central fracture types (DENIS zone III). Additional risk indicators for neurological impairment are avulsion fractures of the sacrum, comminuted and bilateral fracture lines. The fracture classification should thus be modified. Our own experience with operative therapy for sacral fractures (open revision of the sacral plexus together with internal stabilization of the fracture) is still limited, but based on the experience presented, further development of the treatment protocol for sacrum fractures should be considered.

Adolescent↗

PubMed1998

The internal bony architecture of the sacrum.

STUDY DESIGN: Radiographic and direct quantitative measurements were made of the cortical and the trabecular anatomy of the sacrum. OBJECTIVES: To define the trabecular patterns and the cortical thickness of the sacrum. SUMMARY OF BACKGROUND DATA: The sacrum is a frequent site of internal fixation. In previous anatomic studies, investigators have focused on specific dimensional measurements of the sacrum, whereas others have described the anatomic course of the anterior sacral neurovascular or visceral structures. Computed tomographic imaging also has been used to quantify the sacral trabecular bone density. The internal architecture of the sacrum has yet to be described in detail. METHODS: Seventeen cadaveric sacra were studied by computed tomographic imaging and then were sectioned at 3-mm intervals in the axial or sagittal plane. The cortical thickness of each section was measured under microscopic visualization. The sections were radiographed with high-resolution imaging to delineate their trabecular patterns. RESULTS: The trabecular bone was densest adjacent to the endplates. The sacral body trabeculae were arranged in a cruciate pattern, and bony atrophy occurred in a systematic fashion. An alar void was a consistent finding in all specimens with definable boundaries. The cortical thickness was uniform throughout the surface of each specimen. The computed tomographic images correlated with the anatomy observed in the cadaveric sections. CONCLUSION: The internal bony architecture of the sacrum has several consistent features. The relatively uniform cortical thickness seen in each sacral specimen may have clinical significance in the internal fixation of this region.

Aged↗

PubMed2002

Multimodality management of a giant cell tumor arising in the proximal sacrum: case report.

STUDY DESIGN: Descriptive. OBJECTIVE: To outline a novel multimodality approach for a difficult surgical resection of a giant cell tumor in the cephalad portion of the sacrum. SUMMARY OF BACKGROUND DATA: Giant cell tumors of the sacrum are rare primary bone tumors. Recent reports have demonstrated diminished giant cell tumor recurrence with cryosurgery by using a "direct pour" technique with liquid nitrogen. Although successful in decreasing tumor recurrence, this technique is accompanied by a 4%-8% rate of skin necrosis and high rates of pathologic fracture. The authors describe resection and a novel, controlled method of argon-based cryotherapy (followed by a unique pelvic reconstruction) for a large, difficult giant cell tumor of the sacrum. METHODS: A 29-year-old woman presented with complaints of right foot drop and decreased sensation of the right buttock, posterior thigh, posterior calf, and lateral aspect of the right foot. Radiographic evaluation revealed a mass in the right sacrum; histologic examination of CT-guided biopsy revealed a giant cell tumor. A combined anterior abdominal and posterior sacral approach was performed, the tumor was resected, and the margin of the cavity was treated with controlled argon-based cryotherapy. The combination of thermocouples, electromyographic monitoring, and rapid freeze-thaw cycles allowed a controlled ablation of the tumor margin while ensuring that surrounding structures, such as the rectal wall, sacral nerves, and gluteal muscles, were not damaged. Posterior spinal fusion L4 to sacrum, posterior spinal instrumentation L4 to pelvis, and allograft reconstruction of the right sacrum were performed. RESULTS: The patient recovered well without skin necrosis or pathologic fracture. Urinary and fecal continence were preserved. At the 20-month follow-up the patient has no evidence of local tumor recurrence and is fully ambulatory without a brace or narcotic medication. CONCLUSION: A novel multimodality approach, consisting of resection, controlled cryosurgery, and a unique lumbopelvic reconstruction, was safe and successful in managing a challenging proximal sacral giant cell tumor. Twenty months after surgery the patient has excellent bowel and bladder control, no tumor recurrence, and functional ambulation without a brace or pain.

Adult↗

PubMed1989

Weight transmission through the sacrum in man.

An attempt has been made to find the route and relative magnitude of weight passing through different components of the sacrum. In 44 adult male dry sacra, the combined surface area of the body and the two facets was compared with the combined surface area of the two auricular surfaces. It was found that the forces acting on the body and articular facets, at the upper end of the sacrum, are ultimately transmitted through the two auricular surfaces with an appreciable part of the load passing directly from the transverse process of the fifth lumbar vertebra to the ala of the sacrum through the lumbosacral ligament. The direction of the trabecular bone indicates the route of load transmission in the sacrum. From the various parts of the sacrum (body, facets, alae and laminae) distinct sets of trabeculae extend towards the auricular surface. Observations on the sacra with the anomalous articular processes provided strong evidence for the role of the neural arch elements in the load transmission. In specimens where the articular facet was absent on one or both sides, there was always an accessory facet on the ala of the sacrum so that the load was transmitted to this facet from the transverse process of the fifth lumbar vertebra.

Adult↗

PubMed1987

Evolution of the sacrum in hominoids.

In order to study the formation of the sacrum during the primate evolution, a new way of numbering mammalian vertebrae is presented; this demonstrates that the thoracolumbosacral complex is fixed at 22 vertebrae in 80% and at 22 +/- 1 in 100% of the cases. The shift of a vertebra from one type to another occurs either at the thoracolumbar or at the lumbosacral junction and not at the cervicothoracic junction. Rarely does the shift take place at the sacrococcygeal junction. Data from 318 primates reveal that the seven original lumbar vertebrae of the Old World monkeys are reduced in the great apes by a caudad "thoracization" of one to two lumbar vertebrae and a cephalad sacralization of one to four lumbar vertebrae. In the apes, sacralization is not total and different stages that are intermediate between lumbar and sacral are described. In Homo sapiens there is a total sacralization of the last two original lumbar vertebrae. In addition, development of the sacral wings (alae) is minimal in apes and reaches its maximum in hominids. The tendency of the hominoid sacrum to incorporate the last lumbar vertebrae and to widen markedly provides for an enhanced articulation of the sacrum with the ilium and offers a firm base of support for the trunk during erect posture. This is necessary for the support of the weight of the trunk above the sacrum and for the stabilization of the body during bipedal posture and locomotion. Encephalization did not play any major role in the widening of the sacrum since the former by far preceded the latter.

Animals↗

PubMed1995

Normal bone marrow in the sacrum of young adults: differences between the sexes seen on chemical-shift MR imaging.

OBJECTIVE: Age-related changes in the distribution of fatty and nonfatty bone marrow in the pelvis and femur are well recognized. However, mapping not only of age-related MR appearance of normal bone marrow but also of potential variations in females versus males is necessary to differentiate normal findings from marrow disease. Accordingly, we studied possible sex-related differences in the MR imaging appearance of sacral bone marrow in young adults. SUBJECTS AND METHODS: A population of 21 healthy men and 21 healthy women (17-42 years old) was prospectively studied with chemical-shift pulse sequences. MR imaging (1.5 T) of the sacrum was done with frequency-selective fat images (SENEX [selective nonexcitation] 300/27) and water images (SENEX 1000/27) by using an elliptical surface coil. Two independent observers compared the signal intensity of sacral marrow with the signal of fatty tissue planes adjacent to the sacrum (fat images) and the signal of gluteus muscle (water images). T2 relaxation times were estimated by using a two-parametric monoexponential fit on SENEX 1000/27 and SENEX 1000/54 images. RESULTS: In both sexes, fat MR images showed a higher fat content and greater heterogeneity in the bone marrow of the lateral masses than in the vertebral bodies of the sacrum (p < .05). Yellow marrow in the lateral masses of the sacrum appeared brighter in men than in women (p < .05). The heterogeneity of fatty marrow did not differ significantly between the sexes. On water MR images, the signal intensity of the sacrum was higher in women (p < .05). T2 relaxation times were longer in nonfatty marrow with a high water signal intensity (41.8 +/- 5.5 msec versus 33.4 +/- 2.6 msec p < .01). CONCLUSION: Our findings show that the normal appearance of the sacral bone marrow depicted on chemical-shift MR imaging differs between young men and women. Awareness of these differences is important to avoid misinterpretation of normal MR findings seen in patients in this age group.

Adolescent↗

PubMed2002

Use of routine ventrodorsal radiographic views of the pelvis to assess inclination of the wings of the sacrum in dogs.

OBJECTIVE: To determine the ratio of ventral-to-dorsal transverse diameters between the wings of the sacrum on ventrodorsal radiographic views of the pelvis in large dogs and to validate the reliability of this morphometric analysis for functional interpretation. SAMPLE POPULATION: Pelvic specimens from 40 large-breed dogs and radiographs of 113 large-breed dogs. PROCEDURE: In an anatomic and radiographic evaluation, the transverse dorsal diameter (TVDS) and transverse ventral diameter (TVV) between the wings of the sacrum were evaluated in sacrum specimens and on corresponding radiographs of the pelvis and sacrum. The ratio between TVV and TVDS (VD ratio) was calculated. Intraobserver reliability was determined by calculation of the coefficient of variation. In a retrospective radiographic evaluation, the VD ratio was determined in Rottweilers, Golden Retrievers, and German Shepherd Dogs. Correlations between VD ratio and breed, age, and sex were tested. RESULTS: The VD ratio was significantly higher in Rottweilers than in Golden Retrievers and German Shepherd Dogs, denoting an oblique alignment of the sacral wings in Rottweilers (ie, the dorsal aspects of the sacral wings were located more medially than the ventral aspects) and an almost sagittal alignment in the other breeds. The VD ratio was significantly associated with age but not with sex. CONCLUSIONS AND CLINICAL RELEVANCE: Sagittal alignment of the wings of the sacrum is considered to be biomechanically less efficient. These results provide a basis for further studies to evaluate radiographic assessment of the sacroiliac joints similar to the evaluation for hip dysplasia.

Aging↗

PubMedDate not supplied

Intraexaminer and interexaminer reliability for palpation of the cranial rhythmic impulse at the head and sacrum.

BACKGROUND: A range of health care practitioners use cranial techniques. Palpation of a cranial rhythmic impulse (CRI) is a fundamental clinical skill used in diagnosis and treatment with these techniques. There has been little research establishing the reliability of CRI rate palpation. OBJECTIVE: This study aimed to establish the intraexaminer and interexaminer reliability of CRI rate palpation and to investigate the "core-link" hypothesis of craniosacral interaction that is used to explain simultaneous motion at the cranium and sacrum. DESIGN: Within-subjects, repeated-measures design. SUBJECTS: Two registered osteopaths, both with postgraduate training in diagnosis and treatment, using cranial techniques, palpated 11 normal healthy subjects. METHODS: Examiners simultaneously palpated for the CRI at the head and the sacrum of each subject. Examiners indicated the "full flexion" phase of the CRI by activating silent foot switches that were interfaced with a computer. Subject arousal was monitored using heart rate. Examiners were blind to each other's results and could not communicate during data collection. RESULTS: Reliability was estimated from calculation of intraclass correlation coefficients (2,1). Intrarater reliability for examiners at either the head or the sacrum was fair to good, significant intraclass correlation coefficients ranging from +0.52 to +0.73. Interexaminer reliability for simultaneous palpation at the head and the sacrum was poor to nonexistent, ICCs ranging from -0.09 to +0.31. There were significant differences between rates of CRI palpated simultaneously at the head and the sacrum. CONCLUSIONS: The results fail to support the construct validity of the "core-link" hypothesis as it is traditionally held by proponents of craniosacral therapy and osteopathy in the cranial field.

Adult↗

PubMed1994

Conservative surgery for giant cell tumors of the sacrum. The role of cryosurgery as a supplement to curettage and partial excision.

BACKGROUND: Giant cell tumors (GCTs) of the sacrum are a difficult clinical problem. Wide excision (total sacrectomy) is associated with high morbidity and pelvic/spinal instability. Curettage with or without supplemental radiotherapy is associated with a high recurrence rate. In view of the proven effectiveness of cryosurgery as an adjunct to curettage for extremity GCT, cryosurgery was used for treatment of GCTs of the sacrum. METHODS: Seven patients with GCTs of the sacrum were treated at our institution by conservative surgery from 1973 to 1992. Four patients presented with recurrent tumors after failing previous radiation treatment (dose, 5040 cGy). Four patients were treated with curettage with cryosurgery and three with limited excision with cryosurgery. In the latter procedure after limited excision of the caudal (below S2) part of the tumor, the upper sacral segments were treated with curettage and cryosurgery. This spared the important upper sacral roots and maintained the skeletal integrity. RESULTS: At a median follow-up of 12.25 years (range, 2-14.2 years), all patients were disease free. Local recurrence developed in two patients. Both of these underwent repeat curettage and cryosurgery and have since remained disease free. Two patients had positive second look biopsy with microscopic tumor. Both of these were treated with repeat cryosurgery and have remained disease free. Two patient who developed solitary pulmonary metastases, underwent wedge resection and are alive without disease. No patient suffered neurologic deterioration. CONCLUSION: Conservative surgery (curettage or partial excision) with adjunct of cryosurgery is our preferred technique for the treatment of GCT of the sacrum. Satisfactory local control could be obtained by close observation, second look biopsy and repeat cryosurgery. The chief advantages of this method include preservation of pelvic and spinal continuity, speed and ease of surgical procedure and less potential blood loss. We recommend it over more radical sacrectomy due to low morbidity and less resultant neurologic deficits.

Adolescent↗

PubMed2001

Computer-assisted percutaneous transiliac approach to tumorous malformation of the sacrum.

The object of this article is to present a new, minimally invasive, percutaneous image-guided technique for surgery of tumorous malformation of the sacrum. Using one of the available CAS systems, we developed a navigable working tube through which various surgical tools may be very precisely introduced into the tumorous malformation. The tube allows us to obtain histological samples and also perform tumor resections. For sacral procedures, the working tube was introduced percutaneously into the affected area of the sacrum through the sacroiliac joint with computer assistance. For successful matching, small titanium screws were inserted into the sacrum and pelvis percutaneously before CT examination to give precise landmark points. We have used the method in 12 cases. The aim of the surgery in biopsy cases was to obtain samples for histological diagnoses of unknown tumors. In the cases of tumor resection (all were metastatic), the indication was to obtain neurological decompression and decreased local pain. The pain response was very effective in all cases. The transiliac percutaneous approach to the sacrum has proven to be a safe and well-designed procedure. It can even be performed under local anesthesia, and is thus a very effective minimally invasive tool for obtaining pain relief in cases of sacral metastasis involving the first, second, and third segments.

Humans↗

PubMed1995

Vacuum phenomena in insufficiency fractures of the sacrum.

OBJECTIVE: Insufficiency fractures of the sacrum are found in women who have undergone radiation therapy to the lower abdomen as well as those suffering from osteoporosis of postmenopausal, steroid-induced, or primary biliary cirrhosis-related origin. Increased uptake in bone scintigraphy and osteolytic changes in these fractures can be misinterpreted as bone metastases, leading to unnecessary biopsies and other procedures in the ensuing search for non-existent primary tumor. PATIENTS: In eight female patients averaging 69.4 years of age, insufficiency fracture of the sacrum was diagnosed by computed tomography (CT) and bone scintigraphy. Three underwent a total of five MRI examinations. Malignancy was excluded by histology in two patients and follow-up of at least 6 months in the remainder. Retrospective analysis of CT scans of 13 patients with metastases in the sacrum revealed no vacuum phenomena. RESULTS: In seven of eight patients with insufficiency fracture of the sacrum, vacuum phenomena were shown on CT examination. The gas was localized centrally within the ventral part of the fracture in three patients; gas was located in ten adjacent sacro-iliac joints of six patients. CONCLUSIONS: The vacuum phenomenon may be an incidental finding in osteoarthritis of the sacro-iliac joint, but it has not been previously recognized in IFS. The presence of intra-articular vacuum phenomena in the sacro-iliac joints in combination with a sacral fracture and vacuum phenomena located within the sacral fracture supports a diagnosis of insufficiency fracture or may indeed be the clue by which this diagnosis is established.

Aged↗

PubMedDate not supplied

[CT in the surgical planning in tumorous processes of the sacrum].

The value of CT in the preoperative management of tumors of the sacrum is demonstrated. Essential informations for treatment planning are: involved sacral segment, infiltration of sacral foramina and nerve roots, involvement of the sacroiliac joints, ingression of the lumbar spine, infiltration of the pelvic organs and vessels, sciatic nerve and the dorsal soft tissues. In order to prove the competence of the CT in answering these questions we evaluated the CT-examinations of 30 pat. with 14 primary tumors, 9 metastatic tumors and 7 tumors involving secondary the sacrum. The CT findings were correlated with clinical symptoms and surgical reports in 11 pat., with clinical symptoms alone in 19 pat. There was good correlation in the criterias: location and number of involved segments (8/11, 17/19), infiltr. of SI-joints (11/11), infiltr. of lumbar spine (9/11, 18/19), and infiltr. of pelvic organs (10/11), worse correlation in the criterias: nerve root-involvement (2/11, 3/19), and sciatic nerve-infiltr. (7/11, 15/19). Our conclusions are that CT gives helpful preoperative informations deciding about extent of surgical procedure, and surgical approach. The major problem, however, consist in diagnosis of nerve root and sciatic nerve involvement, therefore in poor prediction of postoperative conservation of neural functions. The knowledge of CT-anatomy of sacrum- and important condition for correct segment-location of the tumor is refreshed by outlines of characteristic segmental CT-sections of the sacrum.

Adult↗

PubMed1996

Zone III fractures of the sacrum. A case report.

STUDY DESIGN: Case reports. OBJECTIVES: To define the radiologic characteristics, management, and results of Zone III fractures of the sacrum. SUMMARY OF BACKGROUND DATA: Zone III fractures of the sacrum are rare. There are few case reports of longitudinal fractures of the sacrum involving Zone III. METHOD: The authors report eight (four transverse, four longitudinal) Zone III fractures of the sacrum. Seven patients were treated surgically by posterior sacral decompression with or without transiliac bar fixation, and one neurologically intact patient with undisplaced longitudinal fracture was treated conservatively. RESULTS: Two neurologically compromised patients had return of normal bladder and rectal function, and another had bladder recovery only. The rest continued to show neurogenic bladder and required intermittent self-catheterization. The patient with bilateral foot drop had partial motor recovery and did not require an ankle-foot orthosis. CONCLUSIONS: These fractures may be difficult to diagnose in polytraumatized patients and require a high index of suspicion. The longitudinal fractures may not be apparent on anteroposterior radiographs, and computed tomography scan may be necessary for establishing the diagnosis. The transverse fractures may show a characteristic step ladder sign on anteroposterior radiographs when the fracture is displaced severely. Proper lateral radiographs often are difficult to obtain, particularly in obese polytraumatized patients. Routine computed tomography scan may overlook the diagnosis. Therefore 2- to 3-mm computed tomography cuts are recommended, which may show double neural foramina in presence of significant anteroposterior displacement and overriding of the fracture fragments. Sagittal computed tomography reconstructions are useful in evaluating the transverse fractures. Posterior sacral decompression is safe and probably promotes nerve root recovery. Longitudinal fractures may be stabilized satisfactorily by transiliac rod fixation.

Adolescent↗