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At least 127 records · Page 7Linked to original sources
PubMed1997

Transarticular invasion of iliopelvic sarcomas into the sacrum. Radiological analysis of 47 cases.

Joint cartilage functions as a barrier against the extension of bone tumors. However, transarticular invasion by iliopelvic sarcomas across the sacroiliac (SI) joints into the sacrum sometimes occurs. We made a radiological analysis (CT and/or MRI) of 47 bone sarcomas which originated in the ilium and extended nearly to the SI joint 8 of 17 chondrosarcomas and 3 of 30 other sarcomas (2 of 23 Ewing's sarcomas and 1 of 7 osteosarcomas) invaded the sacrum through the SI joint.

Adolescent↗
PubMed2003

Anatomy of the sacrum.

One of the basic tenets of performing surgery is knowledge of the relevant anatomy. Surgeons incorporate this knowledge along with factors, such as biomechanics and physiology, to develop their operative approaches and procedures. In the diagnosis and management of sacral tumors, the need to be familiar with the anatomy of the sacrum is no less important than knowledge of the pathological entity involved. This article will provide an overview of the embryology and anatomy of the sacrum, along with concepts as applied to surgical intervention.

Adult↗
PubMed1999

Pedicle screw placement at the sacrum: anatomical characterization and limitations at S1.

Anatomical and biomechanical data have suggested that pedicle screw fixation at the sacrum is optimum in the anteromedial direction into the S1 vertebral body, yet the possibility of posterior iliac crest interference with this screw pathway has been considered but not defined. This study aimed to determine if the anteromedial direction of screw placement into the vertebral body is possible in all cases at S1 and to assess the limiting effect of the posterior iliac crest. Computed tomography scans of the upper sacrum at the S1 pedicle parallel to the sacral endplate were examined in 100 patients. Analysis using a digitizer allowed characterization of an ideal screw pathway with variable screw and screw head diameters in an anteromedial direction into the S vertebral body. The effects of the posterior iliac crest upon these pathways were studied. The study demonstrated that anteromedial placement with bicortical fixation at the vertebral body was theoretically possible in almost all (98.5%) cases. Because the sacral body is often wider than the sacral spinal canal, a straight-ahead screw direction will often achieve placement into the S1 vertebral body, if the starting point for the screw allows screw placement adjacent to the medial border of the S1 pedicle with only 1.5 mm of cortical bone separating the canal and the screw. The space between the posterior iliac crest and the lateral aspect of the screw corridor ranges from a maximum of 52.4 mm to a minimum of 12.8, 6.2, and 0 mm for the 7-, 10-, and 12.5-mm screw corridors. On only three occasions (1.5%) was the ideal screw corridor not possible because of posterior iliac crest overlap. In each case, this occurred only unilaterally and when the widest of the screw corridors (12.5 mm) was used. Both the distance between the posterior iliac crests and the space available for optimum screw placement are greater in females than males.

Bone Screws↗
PubMed1999

Imaging diagnosis of insufficiency fracture of the sacrum.

BACKGROUND: Insufficiency fracture of the sacrum has been recognized as a major cause of lower back pain, especially in elderly osteoporotic patients with or without underlying malignancy and/or prior pelvic radiotherapy. Its diagnosis cannot be readily made from its nonspecific clinical features. Consequently some cases may be mistaken for bone metastases, causing patients to receive inappropriate diagnostic measures and management. Recognition of the spectrum of imaging features is the basis of correct diagnosis and treatment. METHODS: The imaging studies of 14 cases (12 women and 2 men; age range, 60-84 years; mean age, 70 years) of sacral insufficiency fracture were reviewed retrospectively. These included 14 radiographs, six bone scintigraphs, eight computerized tomography (CT) scans and 12 magnetic resonance (MR) imaging studies. Six patients had a history of malignancy. Diagnosis was made by characteristic imaging findings, and clinical and radiographic follow-up for one to 3.5 years. RESULTS: Five cases of sacral insufficiency fracture were suspected based on radiographic findings of fracture lines (2 cases) and focal sclerosis (3 cases). Seven cases were diagnosed by CT findings of linear fractures (7 cases) and focal sclerosis (2 cases). Nine MR examinations demonstrated characteristic vertical bands of marrow edema. A hypointense fracture line was identified in eight cases. The remaining two MR imaging studies disclosed nonspecific focal marrow edema. An early case, which appeared normal on CT scan, showed marrow edema on MR imaging. The positive and diagnostic rates were both 36% for plain radiographs, 88% for CT scans, and 100% and 83%, respectively, for MR images. CONCLUSIONS: Plain radiographs are often unrewarding. Although MR imaging is the most sensitive tool, fracture lines are best demonstrated and diagnosed using CT. Due to the better diagnostic rate, popularity and cost effectiveness, CT is recommended as the definitive modality for confirming diagnosis of insufficiency fracture of the sacrum.

Aged↗
PubMed2000

Tumor-like tuberculosis of the sacrum.

Isolated tuberculosis of the sacrum in a 43-year-old woman manifested as functional impairment of the right lower limb. Sacral tuberculosis is rare in patients with no history of tuberculosis. Another unusual feature was the tumor-like aspect of the lesion, with diffuse, ill-defined osteolysis of a large part of the sacrum and extension to the presacral soft tissues responsible for rectal displacement.

Adult↗
PubMed2001

Fibrous dysplasia of both alae of the sacrum.

A case of monostotic fibrous dysplasia involving both alae of the sacrum is reported. Only 2 cases of monostotic sacral involvement were published previously. The lesion was detected in a 42-year-old man suffering from lumbosacral pain after minimal trauma. Radiographic studies revealed cystic images on both alae of the sacrum, with internal condensations and some liquid contents. A trephine biopsy did not produce enough diagnostic data, and a posterior surgical approach was elected. Curettage and refilling with allograft were performed. The pathologic anatomy study diagnosed a fibrous dysplasia. Two years after surgery, the patient was asymptomatic.

Adult↗
PubMed2001

[The insufficiency fracture of the sacrum. An often unrecognized cause of low back pain: results of bone scanning in a major hospital].

AIM: The insufficiency fracture of the sacrum is often radiographically occult. Bone scintigraphy is a method of reference for the diagnosis; the results have been analysed retrospectively. METHODS: Bone scintigraphy was done on patients who, predominantly after minor trauma, suffered from lower back pain and whose radiographic findings were negative. RESULTS: During a 24 month period, a sacral insufficiency fracture was diagnosed in 102 patients. H-shaped hyperfixation of the tracer--described as typical--was present in only 19.6% of the cases. Tracer accumulation was found as follows: located uni/bilateral in the sacral wings (32.4%/6.9%), horizontal (27.4%) and half H-shaped (13.7%). In 85% of the cases there were further fractures with main localisations in the public bone, in the spine and the ribs. CONCLUSION: The insufficiency fracture of the sacrum as cause of lower back pain is not uncommon, especially in postmenopausal women with risk factors. Bone scintigraphy is not only an adequate procedure for the detection of often radiographically occult sacral fractures, but also an easy method to reveal the often concomitant fractures.

Fractures, Stress↗
PubMed1992

[Sacrum abnormalities and neural tube closure defect: different manifestations of a same genetic disease?].

The authors report the case of a full-term female infant exhibiting an anterior meningocele, combined with a hemi-sacrum and an anal dysfunction. Both her father and brother had the same although less pronounced abnormalities. The father's sister was anencephalic. This case, together with previously published data, suggests that sacrum malformations and neural tube defects may derive from a unique dominant autosomal gene with variable expressivity.

Female↗
PubMed1991

Treatment of adult spinal deformity with fusion to the sacrum using CD instrumentation.

The effectiveness of Cotrel-Dubousset (CD) instrumentation in long fusions to the sacrum for adult spinal deformity was evaluated in 27 consecutive patients. The CD system provided acceptable correction of kyphosis and scoliosis while restoring or maintaining lumbar lordosis. However, the standard CD pelvic fixation using sacral pedicle and alar screws was problematic. Instrumentation-related complications were frequent (70%). Sagittal and frontal plane balance was difficult to achieve and not consistently maintained. The CD system using sacral pedicle and alar screws in the adult patient does not appear to offer advantages over alternative techniques for achieving arthrodesis to the sacrum for adult deformity.

Adult↗
PubMed1990

[Insufficiency fracture of the sacrum].

Three cases of insufficiency fracture of the sacrum are reported. Cortical disruption and linear sclerosis with or without linear fracture line at the upper sacral segment parallel to the sacroiliac joint are characteristic. Bone scintigram is suitable for screening, but plain radiographic and CT findings are diagnostic. Insufficiency fracture of the sacrum should not be confused with other conditions, such as metastatic disease.

Aged↗
PubMedDate not supplied

Hemophiliac pseudotumor of the sacrum.

Although the pelvis is a common site for hemophiliac pseudotumors, involvement of the axial skeleton, such as the spine and sacrum, is rare. A rare case of hemophiliac pseudotumor arising from a healed fracture of the sacrum is reported. Findings of plain radiographs, CT, and radionuclide bone scan may simulate tumors of neural origin, but the heterogeneity of MRI is suggestive of hemophiliac pseudotumor.

Adult↗
PubMed1989

Stress fractures of the sacrum following strenuous activity.

Three military recruits developed stress fractures in the sacral wing during rigorous elite basic training. Stress fractures in the sacrum have previously not been reported in a healthy population. Sacrum, like every bone of the pelvis and the lower limb that participates in weight bearing, may be susceptible to stress fracture following sustained excessive physical activity.

Adolescent↗
PubMed1989

[Osteomyelitis of the sacrum].

The authors had 11 patients of different age with osteomyelitis of the sacrum; 9 were males and 2 females. The process was unilateral in most (9) of them. The duration of the disease was approximately 4 months. Before admission to the clinic 8 patients were treated for a long time and unsuccessfully by other specialists. From their experience the authors describe the characteristic complaints, signs, and clinical picture of the disease. They suggest that modern methods of examination (scintigraphy of the skeletal bones, computerized tomography) should be used more frequently. These methods ensure earlier and more reliable detection of destruction of the sacrum and leakage of pus. The 11 patients were operated on. One patient died on the 11th postoperative day from thromboembolism of the pulmonary artery. The disease did not recur in any of the patients who recovered.

Aged↗
PubMed1988

[Insufficiency fractures of the sacrum. 5 cases].

Five cases of insufficiency fracture of the sacrum in women aged over 60 are reported. The elements of diagnosis and causative factors are reviewed. In all cases the diagnosis was confirmed by technetium bone scintigraphy and computerized tomography of the sacrum. Bone tissue evaluation in search of a bone-wasting disease, the principal cause of this type of fracture, was conducted in all 5 patients, using photon absorptiometry and/or double energy computerized tomography and histomorphometry. These examinations provided detailed information on disorders of mineralization in the genesis of these insufficiency fractures.

Aged↗
PubMed1988

Treatment of scoliosis in the adult thoracolumbar spine with special reference to fusion to the sacrum.

The major indication for operative intervention in adults with lumbar and thoracolumbar curves is pain. A careful analysis of the pain, including a careful history and the use of discography and facet blocks, has greatly enhanced the success rate both in terms of correction and relief of symptoms postoperatively. Zielke instrumentation is the preferred surgical technique for thoracolumbar curves that do not require extension of the fusion to the sacrum. Cotrel-Dubousset fixation is particularly advocated in those cases that show evidence of spinal stenosis and require posterior decompression or in cases of rigid kyphoscoliosis following an anterior release. Fusions of the sacrum require a combined anterior and posterior approach. Iatrogenic loss of lumbar lordosis can be prevented by careful attention to detail and posterior instrumentation with preservation of lumbar lordosis, contouring of rods, and hyperextension of spine and hips at the time of surgery. Loss of lumbar lordosis, which may result in marked fatigue and pain as well as a deformity often worse than the initial one, can be corrected, preferably by a combined anterior and posterior approach (Fig. 5).

Adult↗
PubMed1988

[Osteomyelitis of the sacrum].

In the axial skeleton, osteomyelitis of the os sacrum is rare, although it occurs more frequently than tuberculosis of the sacrum. Secondary osteomyelitis as a complication of tumours, metastases or inflammatory processes of the adjacent areas is seen more often than primary sacral osteomyelitis.

Abscess↗
PubMed1986

Anthropometric studies of the human sacrum relating to dorsal transsacral implant designs.

The sacrum offers several possibilities for fixation that, when combined, appear to provide a secure foundation for a dorsally-placed, transsacrally-fixed implant. The dorsal sacral landmarks, particularly the first and second dorsal foramina, are readily identifiable and relate in a consistent manner both qualitatively and quantitatively to the major mass of sacral bone, which is located ventrally to the vital structures of the sacrum. The authors have utilized these findings in the design of a new implant for direct sacral fixation.

Anthropometry↗
PubMed1982

Spontaneous osteoporotic fracture of the sacrum. An unrecognized syndrome of the elderly.

Three elderly patients with incapacitating back and leg pain were found to have spontaneous osteoporotic fractures of the sacrum. The clinical picture in these three patients suggests a distinct clinical entity of spontaneous osteoporotic fracture of the sacrum (SOFS). This is characterized by severe low back, hip, and leg pain that suggests initially lumbosacral radicular compression, either from disk disease, spinal stenosis, tumor. However, objective mechanical signs more typical of those entities may be absent or minimal in SOFS. Symptoms suggestive of a cauda equina syndrome may be present, but there is minimal or no neurological deficit on examination. Marked sacral tenderness is a hallmark of SOFS.

Age Factors↗