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PubMed1983

Missed tumors of the sacrum.

Tumors of the sacrum are frequently missed. The actual diagnosis is often long delayed. The low index of suspicion and the difficulties in obtaining adequate X rays of this region due to the presence of gas bubbles and fecal matter in the bowel which obscure the bony markings of the sacrum are factors which contribute to the problem. Furthermore, myelography of the lowest portion of the dural sac may lead to wrong or confusing information. Six cases from a neurosurgical practice of more than 40 years are presented. Methods to ensure early diagnosis and treatment of tumors of the sacrum are described. Computed tomography available during the past several years has become the most important aid in the evaluation of lesions of the sacrum.

Adult↗
PubMed1995

[Fatigue fractures of the sacrum in primary biliary liver cirrhosis].

Insufficiency fractures of the sacrum are found in women after radiation therapy of the pelvis and those suffering from postmenopausal and steroid-induced osteoporosis. We report two female patients with insufficiency fractures of the sacrum occurring on the basis of a primary biliary cirrhosis. Both patients had simultaneous Tarlow cysts of the sacrum. The fractures were diagnosed by computed tomography. The findings were sclerotic bone changes, running from the ventral and lateral parts of the lateral mass of the sacrum parallel to the adjacent sacro-iliac joints. These fractures exhibited increased uptake in bone scintigraphy and were responsible for local pain. In one of the patients, the bilateral fractures healed four months after transplantation of the liver was performed.

Female↗
PubMed2002

Metastatic meningioma in the sacrum: a case report.

STUDY DESIGN: This report describes a 51-year-old woman with a sacral metastatic meningioma that originated from an intracranial meningioma. OBJECTIVES: To describe an unusual presentation of a metastatic meningioma in the sacrum. SUMMARY OF BACKGROUND DATA: Extracranial metastases of meningioma are very rare. The phenomenon of metastasis may have more to do with the ability to invade the wall of a blood vessel than with the mitotic activity of a tumor. Therefore, metastases of the meningioma can occur even with a benign histologic picture in the original intracranial meningioma. METHODS: A 51-year-old woman had experienced low back pain and sciatica of the left leg for several months. Plain radiographs of the lumbosacral spine showed an osteolytic lesion with an irregular margin that occupied the left side of the sacrum. Magnetic resonance imaging revealed a soft mass invading the left sacrum, ilium, and presacral space. RESULTS: Surgical removal of the sacral tumor via an anterior-posterior-anterior approach was done. Histopathologic examination revealed a metastatic meningioma with a meningotheliomatous histologic composition. Sixteen months after excision of the metastatic sacral lesion, the patient was ambulating freely and experiencing mild constipation and urine retention. CONCLUSIONS: In this case of metastatic meningioma in the sacrum, which is the first such report to the authors' best knowledge, total excision of the tumor was successful.

Brain Neoplasms↗
PubMed2000

[Transverse fracture of the upper sacrum with major displacement. CT reconstruction: case report].

PURPOSE OF THE STUDY: Transverse fractures of the upper sacrum are rare. We report a case with major displacement and neurological impairment. The use of 3D computed tomography (CT) reconstruction to facilitate preoperative planning and surgical procedure is discussed. MATERIALS AND METHODS: A 49-year-old depressive woman jumped from the second floor in an attemp to commit suicide. She presented an absence of motor reponse in L5 region on both sides, hypoesthesia of S1 dermatome, perineal problems including saddle hypoesthesia and a hypotonic anal sphincter. Radiologic investigation showed a transverse fracture of the upper sacrum with major displacement. CT with 3D reconstruction visualized the course of the different fracture lines on the different levels of the sacrum. Open reduction, extensive laminectomy and internal fixation were performed 6 days following the injury. RESULTS: After a 1-year post-operative follow up, complete neurological recovery with normal walking and full perineal sphincter control was observed. DISCUSSION AND CONCLUSION: Fractures of the upper sacrum with major displacement are exceptional. They require well prepared surgical management. CT series with 3D reconstruction allow an analysis of the course of the different sagittal fracture lines to facilitate surgical planning.

Female↗
PubMed1995

A combined abdominoperineal approach for the resection of a large giant cell tumor of the sacrum.

We describe the case of a 24-year-old woman with a giant cell tumor originating from the distal part of the sacrum, which was almost completely filling the pelvis and extending to the umbilicus. At laparotomy, the tumor was separated from all of the pelvic structures including the ureters. The sigmoid colon was transected and the tumor was dissected down to the pelvic floor. A separate perineal incision was made, the rectovaginal septum was entered, and the posterior vaginal wall was bisected to give better access. It was possible to mobilize the tumor completely after dividing the rectum 5 cm from the anus. All macroscopic tumor was removed in continuity with the sigmoid colon. The ovaries were transposed to the paracolic gutter to avoid artificial menopause following radiation therapy. A sigmoid colostomy was formed. Because histology could not provide definite evidence of complete removal of the tumor, radiation therapy to the sacrum was given. Forty-two months after her surgery, the woman remains free of disease. The abdominoperineal approach should be considered for patients with a large tumor which is fixed to the sacrum.

Abdomen↗
PubMed1993

Fatigue fractures of the sacrum in children: two case reports and a review of the literature.

We present the clinical and radiological features of two children with fatigue fractures of the sacrum. Both patients were active, had no underlying bone disease and presented with insidious onset of low back pain. Plain radiography was non-contributory to the diagnosis. In both patients a focal area of increased activity was present in the lateral aspect of the sacrum on bone scintigraphy, which corresponded to linear medullary sclerosis in the sacral ala demonstrated by computed tomography. Magnetic resonance imaging in one patient revealed a linear signal void in the sacral ala on T1- and T2-weighted images. This was surrounded by diffuse low marrow signal on T1-weighted images, and increased marrow signal on T2-weighted images. Fatigue fractures of the sacrum should be considered in the differential diagnosis of low back pain in children. An awareness of their appearance on magnetic resonance imaging is important as this modality is increasingly utilised, particularly in children.

Adolescent↗
PubMed1997

Role of MRI in the diagnosis of insufficiency fractures of the sacrum and acetabular roof.

OBJECTIVE: To review the risk factors and the radiological appearance of insufficiency fractures of the sacrum and acetabular roof. DESIGN AND PATIENTS: Twenty patients with sacral and acetabular roof insufficiency fractures were reviewed retrospectively. There were 16 women (80%) and 4 males (age range 48-86 years, excluding an 8-year-old boy). Thirteen patients had a known tumour, and nine had received pelvic irradiation. All patients, except one who was asymptomatic, presented with low back or hip pain. In patients with a known tumor, metastases were suspected. Plain radiography (20), bone scintigrams (16), MR examinations (20), and bone densitometry (14) were performed. Nine patients also each had a CT scan. RESULTS AND CONCLUSIONS: In three cases the CT scan performed 10-25 days after onset of symptoms was interpreted as normal. MR examination performed a few days after the CT scan showed in each of these three patients a fracture line with a band of edema. Scintigraphy was very sensitive, but the H-shaped pattern of sacral uptake, specific for an insufficiency fracture, was detected in only three of 16 cases. The earliest MR sign was medullary edema, seen as early as 18 days after the onset of symptoms. On spin echo (SE) T1-weighted images (T1WI), the hypointense signal of edema could mask a fracture line. On SE T2WI the fracture line could be detected within the hyperintense edema (10 of 17 patients with examinations including SE T2WI). However, in four patients a fracture of the sacrum was not seen on T2WI, these having been obtained in the axial plane. For this reason, intravenous gadolinium was injected, revealing a fracture line in 12 of 14 examinations, or fat suppression sequences were performed, revealing a fracture line in five of five cases. The total number of fractures detected was 17 [15 fractures of the sacrum (bilateral in 10 cases) and two of the acetabular roof]. At a later stage, the edema resolved and the fracture was clearly seen. The two cases of fracture of the acetabular roof were easily recognized at MRI, particularly in the sagittal plane.

Acetabulum↗
PubMed2001

Surgical treatment of primary tumors of the sacrum.

Twenty-two patients with primary tumors of the sacrum were surgically treated between 1983 and 1997. Seventeen male and 5 female patients were followed up for a mean of 53.6 months (range 12-203 months). The histopathologic diagnoses were giant cell tumor (GCT) in 7 patients, chordoma in 4 patients, aneurysmal bone tumor in 3 patients, chondrosarcoma in 2 patients, osteoblastoma in 2 patients, synovial sarcoma in 2 patients, Ewing's sarcoma in 1 patient, and simple bone cyst in 1 patient. Currettage and thermo- or chemocauterization was applied to 8 patients, a subtotal sacrectomy was done in 11 patients, and total sacrectomy and lumbopelvic stabilization was done in 3 patients. The surgical margins were wide in all patients with GCT. The surgical margins were wide in 3 patients and wide contaminated in 1 patient with chordoma. The 2 patients with chondrosarcoma had high sacral lesions and were managed with total sacrectomy and lumbopelvic fixation. The surgical margin was wide in 1 patient and wide contaminated in the other, who relapsed locally and systemically in the 30th postoperative month. Three patients with aggressive aneurysmal bone cyst and 1 patient with simple bone cyst were managed by curettage and thorough debridement. One patient with low sacral Ewing sarcoma was managed by subtotal sacrectomy with wide margins. The two osteoblastomas were localized to the posterior elements of the sacrum. None of the patients relapsed. Most of the tumors of the sacrum are benign aggressive lesions or low grade malignancies. Intralesional resections in the form of curettage, with the addition of chemo- or thermocauterization, provide a complete cure for benign lesions. In contrast, wide resections are necessary for complete disease control in radio- and chemoresistant malignancies. Nerve root dissection should be performed in order to achieve wide margins.

Adolescent↗
PubMed1998

The stability of bone screws in the os sacrum.

A variety of points of insertion and implantation techniques are recommended for inserting screws into the os sacrum. On the basis of 16 complete human sacrum specimens the following axial pull-out tests were performed: 1. Insertion of convergent measuring screws, 6.0 mm and 7.0 mm in outside diameter respectively, into the body of vertebra S1 using a monocortical and bicortical technique respectively with perforation of the ventral cortex. 2. Insertion of divergent screws into the ala sacralis at the level of S1 with 6-mm and 7 mm screws respectively, using a monocortical technique without perforation of the ventral cortex. 3. Insertion of convergent 6-mm screws into the body of vertebra S2 using a monocortical and bicortical technique respectively with perforation of the ventral cortex. The highest axial pull-out force was reached using convergent 6-mm screws inserted into the body of vertebra S1 using the bicortical technique with perforation of the ventral cortex (2392.4 N). The use of a 7.0-mm screw in the same implantation technique did not result in higher pull-out forces (2274.7 N). The monocortical technique reached a pull-out force of 1657.53 N with a 6-mm screw and 1505.64 N with a 7-mm screw. Convergent insertion of 6-mm screws into the body of S2 resulted in pull-out forces of 537.02 N using a bicortical and only 297.71 N using a monocortical technique. Divergent insertion of screws into the ala sacralis reached a maximal pull-out force of 495.47 N using 6-mm screws and 449.79 N using 7-mm screws. These data resulted from a monocortical implantation technique without perforation of the ventral cortex of the ala sacralis. The results of the present biomechanical study show that convergent bicortical implantation in the body of S1 is the most stable technique for screw fixation in the sacrum. The use of 7-mm rather than 6-mm screws did not lead to increased primary stability. Anatomic studies have shown that a safe area exists in the region of the ventral promontory, so this implantation technique appears to be unobjectionable.

Adult↗
PubMed2000

Changes of the sacrum in severe spondylolisthesis: a possible key pathology of the disorder.

Deficient development of the posterior lumbosacral portion has been thought to be a possible etiology of severe spondylolisthesis. However, the precise causes of the deformity have yet to be revealed. To our knowledge, progression of the disorder has not been discussed in the light of sacral changes on magnetic resonance imaging (MRI). The objectives of the present study were to document changes of the sacrum on MRI scans in patients with severe spondylolisthesis and to discuss the relation of these changes to the progression of deformities. Roentgenograms and MRI scans of 13 patients (10 women and 3 men) with severe spondylolisthesis were retrospectively reviewed. Average age at first MRI examination was 20 years (range, 12 to 50 years). The MRI scans commonly showed a defect at the antero-superior portion of the sacrum. This lesion seems to appear during the period of progression of slipping associated with lumbosacral kyphosis. The defect of the sacrum was considered a unique feature to discriminate this type of olisthesis from others. Taking into consideration the present results, the deformity can be called kyphospondylolisthesis.

Adolescent↗
PubMed1989

Measurement of soft tissue thickness over the sacrum of elderly hospital patients using B-mode ultrasound.

The thickness of soft tissues over the sacrum of elderly hospital in-patients has been measured using B-mode ultrasound. Forty patients were scanned, of which nine had recognizable superficial pressure sores at the sacrum. No correlation was found between the depth of soft tissue and either age or Norton score. Patients with sores had less soft tissue over the sacrum (p less than 0.025). Excluding one patient whose sacral sore appeared to be the final stage of the healing process, the remaining eight all had less than 8.5 mm of sacral soft tissue cover. Five patients without sacral sores also had less than 8.5 mm of sacral soft tissue cover. However, a combination of the presence of incontinence and the depth of sacral soft tissue cover identified seven of the eight patients with sacral sores with no inclusion of patients without sores.

Aged↗
PubMed2006

Stress fractures in the spine and sacrum.

Stress fractures of the pars, pedicle, and sacrum are important considerations in the differential diagnosis of lower back pain in the child or adolescent athlete. A thorough history and physical examination as well as a high index of suspicion are essential when assessing a patient with lower back pain. Diagnostic imaging, including radiographs, bone scans, CT scans, and other imaging modalities are important for further narrowing the diagnosis. The early identification and proper management of stress fractures of the pars, pedicle, and sacrum are integral in the prevention of stress fractures in the adolescent athlete population. This article reviews current concepts in the assessment and management of stress fractures of the lumbosacral spine, particularly of the pars (spondylolysis), pedicles, and sacrum.

Adolescent↗
PubMedDate not supplied

[Calcifying solitary bone cyst of the sacrum--A rare type of bone cyst and its unknown localisation, differential diagnosis and management].

AIM: The diagnostic procedures and management of calcifying bone lesions occurring in the sacrum. METHOD: A case report of a rare type of bone cyst at an unknown localisation including the differential diagnosis and management. RESULTS: Low back pain of a 41-year-old women was correlated with a calcifying bone formation of the sacrum on X-ray, demonstrating cystic, solid and exophytic components. On radionuclide bone scan, additional skeletal lesions were ruled out, the focus showed an increased uptake. An inflammatory process was excluded by lab studies. On computed tomography and magnetic resonance imaging, the calcifying bone formation was identified as surrounding the sacral canal, respecting the anatomical borders. Considering this anatomic region, a neurogenic tumor could be eliminated by the absence of neurological disorders, but the radiologic feature of this osseogenic process was not clear enough for classification. Hence, an incisional biopsy was essentially required. Describing the lesion as a bony cavity, the operating surgeon could macroscopically exclude an chordom a (known to be soft consistency). The histological work-up classified this tumor-like lesion as a calcifying solitary bone cyst (CSBC). A dorsal exostosis causing the complaint of the patient was resected. The patient became asymptomatic. CONCLUSION: For the first time, a calcifying solitary bone cyst located in the sacrum is described, By sole resection of a dorsal exostosis causing the complaint, an overtreatment of grave consequences was avoided.

Adult↗
PubMed1997

[Osteoporotic stress fractures of the sacrum: MR-tomography findings].

PURPOSE: Evaluation of the morphologic appearance of sacral osteoporotic insufficiency fractures in MRI. PATIENTS AND METHOD: 6 patients (5 female and one male, 54-80 years) with osteoporotic insufficiency fractures of the sacrum were examined with CT and MRI. Plain and contrast-enhanced T1- and T2-weighted spin-echo images were acquired, three patients were studied with T1-weighted gradient-echo-sequences with fat suppression. RESULTS: Fracture-lines and sclerotic areas of the massae laterales were visible in 5 of 6 CT examinations, one patient showed no abnormalities of the sacrum on the initially performed CT scans. All patients had a diffuse bone marrow oedema of the fractured massae laterales with a decreased signal on the T1-weighted spin-echo images and an increased signal on the T1-weighted gradient-echo images with fat suppression and in the T2-weighted SE-sequences. Gadopentate dimeglumine enhanced MRI images showed a remarkable diffuse configurated high signal of the whole sacrum in bilateral fractures (H-pattern). An additional soft tissue mass could be excluded in each case. CONCLUSION: Gadopentate dimeglumine enhanced MRI of sacral insufficiency fractures allows early diagnosis and helps to exclude intraosseous tumour formation.

Aged↗
PubMed1992

Fractures of the sacrum and disk herniation: rare lesions in the pediatric surgical patient?

Fractures of the sacrum and lesions of the intervertebral disks are seldom reported in childhood and adolescence. In our report, illustrated by three representative cases that we treated during the past six months, we show that sacrum fractures, not an easy diagnosis, may be more frequent than currently assumed, and that in quite a number of children and adolescents an anterior pelvic fracture may in fact be an unrecognized Malgaigne type pelvic fracture with a posterior fracture plane cutting through the sacrum. They may be accompanied by herniations and/or lacerations of intervertebral disks.

Adolescent↗
PubMed2001

Contribution of soft tissue deformation below the sacrum to the measurement of total height loss in sitting.

This study investigated the contribution of soft tissue deformation below the sacrum (S) and vertical spinal creep to total height loss (THL) measured in sitting. Eight asymptomatic subjects (four males, four females) aged between 21 and 51 years were measured. Simultaneous measurement of THL and S were commenced after the subjects had been sitting for 5 min. THL was recorded while subjects were positioned in a seated stadiometer, which controlled their spinal posture. S was measured by placing an ultrasound transducer at the level of the top of the subject's sacrum. Over 25 min of sitting with loaded and unloaded interventions applied to their spine, different response characteristics between S and THL were noted. This study demonstrated that soft tissues below the sacrum could contribute up to 30% on average of total height loss. This suggests that researchers should take into account the soft tissue deformation outside the spine when studying vertical creep in sitting.

Adult↗
PubMedDate not supplied

Measured versus predicted vertical displacement of the sacrum during gait as a tool to measure biomechanical gait performance.

The vertical displacement of the sacrum during walking is proposed as an estimation of the overall biomechanical performance of walking, independent of cardiopulmonary factors. Vertical sacral displacement during walking was measured using an optoelectronic motion analysis system in 10 normal volunteers at variable speeds. Oxygen consumption was simultaneously measured. The actual vertical displacement of the sacrum, when correlated with body weight, reliably predicted oxygen consumption (r2 = 0.91). The relationship between vertical sacral displacement and oxygen consumption persisted when controlling for the variables, velocity, square of velocity, cadence or stride length, each known to co-vary with cardiopulmonary performance. A mathematic model designed to predict the vertical displacement of the sacrum, based on sacral height and average stride length, was tested. The actual vertical sacral displacement correlated with predicted displacement (r = 0.94). Unilateral immobilization of each subject's knee resulted in a greater average vertical sacral displacement during gait than predicted. Comparing measured with predicted vertical sacral displacement may provide a clinically useful and specific overall assessment of biomechanical gait performance.

Adult↗
PubMed1993

Isolated fracture-dislocation of the sacrum: case report.

An unusual case of isolated fracture-dislocation of the sacrum is reported. A 19-year-old woman had a fracture-dislocation of S-1-2 combined with two longitudinal fractures of the sacrum, but no other pelvic fractures were identified. The possible mechanisms of fracture-dislocation of the sacrum are discussed. The fracture site was identified accurately on a CT scan. Pain relief was obtained by application of an external fixator. A mild neurologic deficit in the S-1 root distribution disappeared uneventfully.

Adult↗