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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↗
PubMed2003

Nerve sheath tumors involving the sacrum. Case report and classification scheme.

Nerve sheath tumors that involve the sacrum are rare. Delayed presentation is common because of their slow-growing nature, the permissive surrounding anatomical environment, and nonspecific symptoms. Consequently, these tumors are usually of considerable size at the time of diagnosis. The authors discuss a case of a sacral nerve sheath tumor. They also propose a classification scheme for these tumors based on their location with respect to the sacrum into three types (Types I-III). Type I tumors are confined to the sacrum; Type II originate within the sacrum but then locally metastasize through the anterior and posterior sacral walls into the presacral and subcutaneous spaces, respectively; and Type III are located primarily in the presacral/retroperitoneal area. The overwhelming majority of sacral nerve sheath tumors are schwannomas. Neurofibromas and malignant nerve sheath tumors are exceedingly rare. Regardless of their histological features, the goal of treatment is complete excision. Adjuvant radiotherapy may be used in patients in whom resection was subtotal. Approaches to the sacrum can generally be classified as anterior or posterior. Type I tumors may be resected via a posterior approach alone, Type III may require an anterior approach, and Type II tumors usually require combined anterior-posterior surgery.

Accidents, Traffic↗
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↗
PubMed2005

A large giant cell tumor of the sacrum. Advantage of an abdomino-sacral approach.

We report a case of giant cell tumor of the sacrum, presenting with sacral pain, swelling, and change of bowel habits. Rectal examination revealed a huge retrorectal mass fixed to the sacrum but not to the wall of the rectum. Abdominal ultrasonography, computed tomography CT scan, and magnetic resonance imaging MRI showed a huge pelvic mass invading the sacrum. Exploration via posterior sacral approach was not successful due to both, extensive bleeding and difficult accessibility. Re-exploration was carried out 2 days later with the patient in lithotomy position. Using abdomino-sacral approach the mass together with part of the sacrum and the whole coccyx were excised. Histopathology reported giant cell tumor of the sacrum with no evidence of mitosis. The patient was symptomless 12 months after surgery and on follow up.

Adult↗
PubMed2004

Establishment of a pure culture of the hitherto uncultured unicellular cyanobacterium Aphanothece sacrum, and phylogenetic position of the organism.

Aphanothece sacrum, an edible freshwater unicellular cyanobacterium, was isolated by using novel synthetic media (designated AST and AST-5xNP). The media were designed on the basis of the ratio of inorganic elements contained in A. sacrum cells cultured in a natural pond. The isolated strain exhibits unicellular rod-shaped cells approximately 6 microm in length that are scattered in an exopolysaccharide matrix, a feature similar to that of natural A. sacrum. DNA analysis of the isolated strain revealed that it carried two ferredoxin genes whose deduced amino acid sequences were almost identical to previously published sequences of ferredoxins from natural A. sacrum. Analysis of the 16S rRNA gene and ferredoxin genes revealed that A. sacrum occupies a phylogenetically unique position among the cyanobacteria.

Bacteriological Techniques↗
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↗
PubMed2003

Fatigue stress fractures of the sacrum: diagnosis with MR imaging.

The aim of this study was to describe the MRI findings and clinical observations in a fatigue stress fracture of the sacrum. In this retrospective study, 380 conscripts (53 women, 327 men; age range 18-29 years, mean age 20.7 years) who suffered from stress-related hip pain were studied with MRI of the pelvis. The findings of MRI were evaluated with regard to stress fracture of the sacrum. Thirty-one (8%) patients had MRI changes in signal intensity of the cranial part of the sacrum, extending to the first and second sacral foramina. The MRI changes in signal intensity were intermediate on T1-weighted images, and high on short tau inversion recovery or T2-weighted fat-suppressed images. A linear signal void fracture line was also seen. Multiple stress injuries to the pelvic bones were also seen in 7 of 31 (23%) patients. Five patients (16%) had bilateral sacral stress fracture. Fatigue sacral stress fractures appeared more commonly in women than in men ( p<0.001). During recovery time 20 of the 31 patients underwent control MRI, and fatty marrow conversion was seen in 8 (40%) cases as high signal intensity on T1-weighted images, which disappeared 5-6 months after the onset of symptoms. Fatigue sacral stress fractures are associated with stress-related hip pain. These fractures were more common in women than in men. Other stress injuries of the pelvis may be seen simultaneously with sacral stress fractures. Signal intensity of the sacrum was normal after 5-6 months.

Adolescent↗
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↗
PubMed1982

Computed tomography of the sacrum: 1. normal anatomy.

The sacrum of a disarticulated pelvis was scanned with a Pfizer 0450 computed tomographic scanner using contiguous 5 mm sections to display the normal computed tomographic anatomy of the sacrum. These anatomic sections were then compared with normal sacrums. In analyzing the computed tomographic anatomy, emphasis was placed on the central canal and sacral foramina, in that these landmarks are important in determining not only the presence but also the type of pathology involving the sacrum.

Cadaver↗
PubMed1998

Location of the sacral pedicle, foramina, and ala on the lateral aspect of the sacrum: a radiographic study.

Twenty-one adult dry-bone sacral specimens were used to quantitatively determine the location of the sacral pedicle, foramina, and ala on the lateral radiographic view of the sacrum. The anterior and posterior sacral foramina from S1 to S3, the midlines of the anterior sacrum and cephalad border of the S1 vertebral body, and the lateral limit of the lateral sacral mass were outlined with wires. A lateral radiograph was taken, and measurements were made directly from the radiograph. The average sacral pedicle height for both male and female specimens was approximately 20 mm for S1, 12 mm for S2, and 7 mm for S3. The sacral foramina height averaged approximately 13 mm for S1 and S2, and 10 mm for S3. The average ala and S1 body-ala angles were 88 degrees and 35 degrees. The distance from the ala tip to the anterior aspect of the sacrum averaged 12 mm, and the average anterior height of the S1 vertebral body above the ala was 11 mm. These measurements, in conjunction with inlet and outlet radiographs, may aid in the recognition of the vital structures of the sacrum on the lateral radiographic view and enhance the safety of dorsal sacral screw placement.

Adult↗
PubMed2003

[Surgical treatment of dislocated transverse fractures of the sacrum].

PURPOSE OF THE STUDY: Transverse fractures of sacrum are quite rare. Only about 70 cases have been reported in the relevant literature. Low frequency and rather difficult fracture imaging lead to therapeutical uncertainty and are a cause of a delay of urgent surgery. MATERIAL AND METHODS: A group of three male patients aged 17.43 and 31 years was studied. Two patients sustained the injury at a paragliding accident, one by fall from height. One patient underwent only a simple spinal canal decompression 24 days after the injury. The second patient underwent surgery on the fourth day and in the third patient the procedure was carried out sixteen hours after the injury. Procedure on the second and third patient included decompression of neural structures, fracture stabilization as well as spinal-pelvic fixation using an internal fixation. RESULTS: The delayed simple spinal canal decompression didn't improve patient's condition. On the other hand, surgeries performed urgently in the other two patients provided a considerable improvement of the neural deficit. DISCUSSION: Transverse fractures of the upper part of sacrum without any concomitant pelvic fracture are rare and rather difficult to diagnose. Clinical symptoms are inconclusive. However, low back pain, numbness in lower extremities and in the genital, anal region anesthesia should induce the suspicion of this type of trauma even in cases of normal AP and lateral lumbar spine X-rays. In addition to neurological investigation, a lateral x-ray of sacrum and CT and NMR imaging are essential. Conservative treatment, even if complemented with halo-femoral traction does not provide satisfactory results. Also the simple spinal canal decompression gives no contribution to the patient's recovery. Authors suggest a staged surgical procedure providing decompression of neural structures, reduction and stable fixation of the fracture (using screws and plates) and spinal-pelvic stabilization (using the internal spine fixator). Urgent and comprehensive treatment of this type of injury facilitates patient's early mobilization, enables his early discharge and improves neurological recovery. CONCLUSION: Severely displaced fractures of sacrum associated with a neural deficit require the same urgent and comprehensive treatment as vertebral fractures succeeded by a spinal cord injury. Due to low incidence of such injuries patients should be treated at highly specialized centers experienced with this type of surgery.

Adolescent↗
PubMed2005

[Insufficiency fracture of the sacrum after hormonal therapy and radiotherapy for prostate cancer: A case in which 99mTc-MDP bone scintigraphy was useful for differential diagnosis].

A case in which radiotherapy was requested for bone metastases from prostate carcinoma after hormonal and radiation therapy and diagnosed as insufficiency fracture of the sacrum on bone scan was reported. A 78-year-old man underwent endocrine therapy with luteinizing hormone releasing hormone agonists and radical radiotherapy toward pelvis for prostate cancer. The onset of buttock pain started from the nine-month after the beginning of radiotherapy, and was diagnosed as sacrum metastasis by MRI, and radiotherapy was requested again for pain control. However, on bone scan, butterfly-like changed accumulation was noted, therefore sacrum insufficiency fracture was suspected. Addition of CT inspection and reconfirmation of MRI were performed, and bone metastases became negative, and serial observation was performed of the painkilling effect after that. No tumor marker rise was seen after five months without sigh of new bone metastases and the final diagnosis became insufficient fracture. In order to avoid unnecessary treatment, we think that the view of bone scintigram for diagnosis of sacrum insufficient fracture should be known.

Aged↗
PubMed1990

[Giant-cell tumor of the sacrum: an analysis of 10 cases].

Giant-cell tumor of the sacrum is rare. There were only a few reports of large series in the literature. From 1960-1988 a total of ten cases giant-cell tumor of the sacrum were treated in our Department. The average age of the patients was 34 years (with range of 19-49 years). The lesions located in the proximal parts of the sacrums in 8 cases, and in S3-5 in another 2 cases. of 10, 7 were treated with en bloc resection or subtotal resection. of the sacrum, and followed by irradiation in 5 of 7 cases (with range of 2000r-4500r). All the 7 cases were followed up without any evidence of local recurrence or distant metastases. The average follow-up period was 10.3 years (with range of 1.5-27.5 years). The rectal, bladder and sexual function were normal or restored. The other 3 cases, biopsied in 2, partially resected in 1, died less than one year after diagnosis. Comparing the died group with the survival group, we concluded that early diagnosis and thorough excision of the tumor are the two decisive factors for a favorable prognosis.

Adult↗
PubMed1989

[The biostatics of the human sacrum: is there a relationship between the sacral inclination and the spatial orientation of the upper articular process of the sacral plate?].

The orientation of the superior articular processes with regard to the upper end-plate of the sacrum does not depend on the inclination of the sacrum. This assertion can be made by interpreting certain angles already described in literature and may be confirmed by a research following strict biomechanic principles: The orientation of the articular processes is put in relation to the direction of the forward shear brought upon by the Vth lumbar vertebra and caused by the inclination of the sacrum. This is achieved by measuring the angle between the articular facet and a plane normal to the mentioned forward shear. The result is that the size of this angle does not at all depend on the degree of the inclination of the sacrum.

Adult↗