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PubMed2004

Tamponade of presacral hemorrhage with hemostatic sponges fixed to the sacrum with endoscopic helical tackers: report of two cases.

Presacral venous hemorrhage is a severe complication in low rectal surgery. This complication was encountered in 5 of 165 patients (3 percent) who underwent a presacral dissection for rectal mobilization. Conventional hemostatic measures often are ineffective to arrest this hemorrhage, and a number of alternative hemostatic techniques have been proposed. We report the successful tamponade of presacral hemorrhage with absorbable hemostatic sponges fixed to the sacrum with endoscopic helical tackers.

Adult↗
PubMed1984

Abdominosacral resection for malignant tumors of the sacrum.

Malignant sacral tumors present unique problems because of their location deep in the pelvis, their juxtaposition to the ureters, rectum, and iliac vessels, and the need to preserve spinal stability and sacral nerve function after resection. The simultaneous abdominosacral resection circumvents many of these problems since it provides good exposure of the intraabdominal structures, allows precise selection of the level of sacral resection, and avoids damage to the sacral nerve roots. Tolerable control of bladder and bowel functions is possible by preservation of the S1 nerve roots, and spinal stability can be maintained with preservation of the body of the S1 vertebra. Because malignant tumors of the sacrum have a high propensity for local recurrence, we believe that the exposure afforded by the sacroabdominal approach provides an opportunity to obtain a wide margin of resection during initial resection of these tumors.

Abdomen↗
PubMed2005

Epithelioid cellular chordoma of the sacrum: a potential diagnostic problem.

We describe a sacral chordoma composed of solid nests of epithelioid cells. The tumor originated in the presacral area. Extensive clinical workup did not reveal any other lesion in the patient. In contrast to typical chordomas, this tumor contained only rare physaliferous cells, had no myxoid stroma, and was immunohistochemically unreactive with the antibody to S-100. The diagnosis of chordoma was supported by electron microscopy, which showed that the tumor cells contained numerous mitochondria surrounded by profiles of rough endoplasmic reticulum. The abundance of mitochondria, the narrow intercellular spaces, combined with a lack of glycogen, and a lack of extracellular myxoid material accounted for the epithelioid appearance of the tumor. We report this case to point out that the cellular chordomas can appear epithelioid in the sacrum and they may resemble metastatic squamous or transitional cell carcinomas.

Adult↗
PubMedDate not supplied

Solitary plasmacytoma of the sacrum. Radiologic findings of three cases.

We report the radiologic findings from three cases of solitary plasmacytoma (SP) of the sacrum. Common findings included lytic changes on computed tomography (CT) and relatively low signal intensity on T2-weighted magnetic resonance (MR) images, with intense enhancement after contrast administration. All cases showed infiltrating and slightly expansive growth, but the sacral structure was generally maintained. These radiologic findings may be of utility when generating a differential diagnosis of a solitary sacral tumor.

Aged↗
PubMed1976

Sexual function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves.

The sexual function of nine patients with severance of sacral nerves bilaterally (five patients) or unilaterally (four patients), performed during operations for radical extirpation of tumors of the sacrum or its vicinity, was studied. Sexual histories were obtained and sensibility tests were performed. In four of the five male patients an attempt was made to collect electromyographic recordings from the external urethral and anal sphincters during ejaculation. Bilateral loss of S3 to S5 nerves in two women seemed not to affect their sexual function. Bilateral loss of S2 to S5 nerves in one man was compatible with gratifying sexual intercourse, the stimulation for erection being purely psychogenic, and "ejaculation" of a dripping nature. Unilateral loss of all sacral nerves did not impair previously normal sexual function, although the penises and vulvae of these patients were anesthetic on one side. The sensibility of the penis seemed to be subserved by the second sacral nerve. The myoelectric activity of the striated urethral and anal sphincters during ejaculation recorded in one patient with unilateral total loss of sacral nerves was normal bilaterally considering the duration of, and intervals between, the clonic contractions.

Adult↗
PubMedDate not supplied

[A diagnosis to consider: insufficiency fracture of the sacrum].

The authors report a case of insufficiency fracture of the sacrum in an 81-year old woman. The fracture was related to disjunction of the pubic symphysis consecutive to curettage of the pubic bones for septic osteitis developed after vulvectomy for cancer. The diagnosis was suspected on the results of bone scintigraphy and was confirmed by computerized tomography with frontal sections and contrast inversion, showing the characteristic H-shaped fracture.

Aged↗
PubMedDate not supplied

Delayed diagnosis of primary non-Hodgkin's lymphoma of the sacrum.

Primary non-Hodgkin's lymphoma of bone is a rare, malignant hematologic tumor affecting most commonly persons in the fourth decade of life. The tumor produces predominantly osteolytic lesions usually in the femur and pelvic bones and, very rarely, may present with spinal epidural involvement. The authors discuss an interesting case of primary non-Hodgkin's lymphoma of bone involving the sacrum with epidural invasion, in which the atypical imaging findings along with negative biopsy results delayed diagnosis.

Bone Neoplasms↗
PubMed2006

A Cretaceous terrestrial snake with robust hindlimbs and a sacrum.

It has commonly been thought that snakes underwent progressive loss of their limbs by gradual diminution of their use. However, recent developmental and palaeontological discoveries suggest a more complex scenario of limb reduction, still poorly documented in the fossil record. Here we report a fossil snake with a sacrum supporting a pelvic girdle and robust, functional legs outside the ribcage. The new fossil, from the Upper Cretaceous period of Patagonia, fills an important gap in the evolutionary progression towards limblessness because other known fossil snakes with developed hindlimbs, the marine Haasiophis, Pachyrhachis and Eupodophis, lack a sacral region. Phylogenetic analysis shows that the new fossil is the most primitive (basal) snake known and that all other limbed fossil snakes are closer to the more advanced macrostomatan snakes, a group including boas, pythons and colubroids. The new fossil retains several features associated with a subterranean or surface dwelling life that are also present in primitive extant snake lineages, supporting the hypothesis of a terrestrial rather than marine origin of snakes.

Animals↗
PubMedDate not supplied

[Surgical therapy of metastases of the pelvis and sacrum].

We are reporting on 42 surgical and 5 conservative treatment approaches in metastases of the pelvis and sacrum. With an average disease-free survival of 14.4 months the majority of the lesions were resected intralesionally. In the area of the ischium and the pubis resection alone was done without further stabilizing measures. If the resection was in the area of the iliac wings, stabilization was achieved by means of osteosynthesis in 50% of the cases. Periacetabular resections required reconstruction with endoprotheses in all cases. In patients with good prognosis and solitary metastases also extralesional resections were performed. Reoperated embolization was used in advanced stages of the disease or if the metastases were not easily accessible surgically. Because of the complexity of pelvic resections and the often considerable loss of function, patients with metastases are often treated with intralesional resection and osteosynthesis. In exceptional cases, if radiotherapy had failed or multiple intralesional resections were followed by recurrences, we feel however that extralesional resection should be attempted with good prognosis for the patient.

Adenocarcinoma↗
PubMed2002

Transverse fracture-dislocation of the sacrum: a diagnostic pitfall and a surgical challenge.

Transverse fracture-dislocations of the sacrum are rare. Associated lesions of the lumbosacral spine as well as neurological injuries are common. Conventional radiographs of the pelvis often fail to clearly visualize the fracture. Delayed diagnosis increases the risk of progressive neurological disfunction. True lateral sacral views and CT-scans with 3-dimensional reconstructions are very helpful in establishing the full extent of the injury. These examinations should be considered in all patients with a history of high energy trauma and clinical signs indicating lumbosacral injury, such as severe low back pain and neurological disturbances of the lower extremities. The management of transverse sacral fracture-dislocations with or without associated neurological damage is controversial. Conservative treatment is associated with a high rate of persistent deformity and residual neurological dysfunction. Surgical management allows for anatomical fracture reduction, stable fixation and revision of the spinal canal and lumbosacral nerve roots. The dorsal approach is preferred. Two patients with transverse sacral fracture-dislocations and neurological disturbances are presented. One patient had an additional fracture-dislocation of the lumbar spine at the L4L5 level with intrusion of the lumbosacral spine into the pelvis. Both lesions in this patient were successfully stabilized using an internal fixator system. The other patient presented with a bilateral transforaminal sacral fracture. The transverse component was not recognized on the initial radiographs, which resulted in loss of reduction and progressive neurological disfunction after sacroiliac screw fixation.

Adult↗
PubMed1997

Deletion of a HoxD enhancer induces transcriptional heterochrony leading to transposition of the sacrum.

A phylogenetically conserved transcriptional enhancer necessary for the activation of Hoxd-11 was deleted from the HoxD complex of mice by targeted mutagenesis. While genetic and expression analyses demonstrated the role of this regulatory element in the activation of Hoxd-11 during early somitogenesis, the function of this gene in developing limbs and the urogenital system was not affected, suggesting that Hox transcriptional controls are different in different axial structures. In the trunk of mutant embryos, transcriptional activation of Hoxd-11 and Hoxd-10 was severely delayed, but subsequently resumed with appropriate spatial distributions. The resulting caudal transposition of the sacrum indicates that proper vertebral specification requires a precise temporal control of Hox gene expression, in addition to spatial regulation. A slight time delay in expression (transcriptional heterochrony) cannot be compensated for at a later developmental stage, eventually leading to morphological alterations.

Animals↗
PubMed1996

Stress fractures of the sacrum and lower extremity.

Stress fractures of the lower extremity and sacrum occur in a variety of patients, ranging from young, healthy athletes to elderly persons with underlying illnesses. Knowledge of the activities and risk factors associated with these fractures may heighten clinical suspicion and help direct an appropriate evaluation. Diagnosis is usually based on characteristic features of the history and physical examination accompanied by radiologic findings. Bone scintigraphy remains the standard, but the specificity of computed tomography scanning or magnetic resonance imaging may be required to differentiate stress fractures from other processes such as malignant bone lesions. Management of stress fractures is usually conservative, with variation depending on fracture location and patient characteristics.

Adult↗
PubMed1975

Giant-cell tumors of the spine and sacrum causing neurological symptoms.

Pain and neurological disturbances were the most frequent symptoms in patients with giant-cell tumors of the spine (4 cases) and sacrum (1 case). A good prognosis is possible in patients with vertebral tumor localization. There were no recurrences at follow-up 6 to 16 years after the first admission. The patient with a sacral tumor is alive more than 15 years after the first admission with some remaining neurological symptoms. Early surgical and/or radiation therapy is important. If institution of treatment is delayed more than three months after the onset of nerve root symptoms, there is a great risk of development of irreversible neurological lesions.

Adolescent↗
PubMed1996

Internal fixation of displaced fractures of the sacrum.

The results of internal fixation in 30 patients with displaced fractures of the sacrum were retrospectively reviewed. All fractures were displaced at least 1 cm. Neurologic injuries occurred in 40% (12 of 30) patients. In 17 patients who underwent open reduction, the preoperative displacement averaged 24 mm and the postoperative displacement averaged 4 mm. In the 13 patients in whom percutaneous fixation was done, the preoperative displacement averaged 15 mm and the postoperative displacement averaged 5 mm. All 30 fractures united. This review of 30 patients with displaced sacral fractures suggests that open reduction and iliosacral screw fixation leads to better reduction of the fracture site than does closed reduction and percutaneous fixation. Functional assessment indicated that the presence of a neurologic injury is the most important predictor of compromised outcome in patients with displaced sacral fractures.

Activities of Daily Living↗
PubMed1999

Extension to the sacrum of previous adolescent scoliosis fusions in adult life.

Numerous reports have indicated an increased risk for the development of precocious degenerative changes leading to pain in patients who had fusions done in adolescence for scoliosis, which extended into the lower lumbar spine. The anatomic situation may lead to instability, or spinal stenosis or both. This paper represents the evolving experience in reconstructive surgery for patients in whom a fusion was to be extended to the sacrum. Reconstructive surgery will require, if necessary, decompression posteriorly for spinal stenosis if present. Stabilization is acquired through an anterior and posterior approach with anterior and posterior instrumentation. The evolution of treatment modalities since 1976 shows a decreased pseudarthrosis rate from an initial 83% to 3% at present.

Adult↗
PubMedDate not supplied

Triangular osteosynthesis of vertically unstable sacrum fractures: a new concept allowing early weight-bearing.

OBJECTIVE: Presentation of a new triangular osteosynthesis technique that permits early weight-bearing in vertically unstable sacral fractures. DESIGN: Retrospective evaluation of a consecutive series. SETTING: Level I trauma center. PATIENTS: Thirty-four patients, twenty-eight of whom were polytraumatized, all with vertically unstable sacral fractures. This group included eight women and twenty-six men, with a mean age of thirty-five years. Average time between trauma and definite operation was thirteen days (range 0 to 28 days). INTERVENTIONS: All patients underwent triangular osteosynthesis using a combination of a vertical vertebropelvic distraction osteosynthesis (pedicle screw system) and a transverse fixation of the sacrum fracture with either iliosacral screws or transsacral plating. Immediate postoperative weight-bearing was permitted postoperatively. RESULTS: Nineteen patients were treated with early progressive weight-bearing and advanced to full weight-bearing, on average, after twenty-three days (range 8 to 70 days). Three of the thirty-four patients (9 percent) experienced loosening of hardware, including two patients (6 percent) who required secondary intervention because of loss of the original reduction. Further complications included one pulmonary embolism (3 percent), one iatrogenic nerve lesion (3 percent), one wound necrosis (3 percent), and two local infections (6 percent). CONCLUSIONS: Triangular osteosynthesis is a demanding procedure that can be performed on vertically unstable sacral fractures to allow early progressive weight-bearing with an acceptable complication rate.

Adult↗