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At least 145 records · Page 8Linked to original sources
PubMed1982

[Curvature of the human sacrum based on morphometric data].

As demonstrate measurements of 57 human sacrums, 40 of them have either complete or partial sacralization, mainly at the expense of the first coccygeal vertebra. Simultaneously, it has been revealed that in the sacrums studied certain increase of the sacral kyphosis is observed. The pick of the sacral flexure in the masculine pelvis is at the level of the II sacral vertebra, that of the feminine pelvis--at the level of the I sacral vertebra.

Adult↗
PubMed1980

[Combined abdominosacral excision of a giant-cell tumor of the os sacrum].

In 1967 Localio described a synchronous abdomino-sacral approach for resection of sacrococcygeal chordoma. The patient is placed in the lateral position with the left side up. The incision is carried from a point to the right of the midline above the pubis transversely across the rectus and then obliquely parallel to the inguinal ligament, to end at the midaxillary line. Mobilisation of the rectum and control of the pelvic vessels presents no difficulty. The sacrum is then exposed from the dorsal side by a transverse incision. The possibility to work simultaneously in the two operative fields affords excellent exposure and control of bleeding. This approach has been used by the authors for resection of an abundantly vascularized giant cell tumor of the sacrum.

Adult↗
PubMed1994

Techniques of instrumentation in long fusions to the sacrum.

Arthrodesis of long segments of the spine to a sacrum may be necessary for a variety of pathologic conditions and indications. The surgery may be necessary for patients who have had prior surgery, had failure of fusion, or had degeneration above the area of prior fusion. Revision of prior surgeries, in which distraction instrumentation was used and resulted in flat-back deformity, remains a problem. A better understanding of the biomechanical stresses placed on the fixation devices and the bone-implant interface have resulted in development of improved techniques of fixation in the lower lumbar spine and the sacrum. This fixation always requires multiple levels of segmental spinal purchase. The type of purchase obtained is dependent on the design of the fixation, whether it is wire, hook, or screw, and the bone into which it is placed. The surgeon needs to understand the limitations of both the instrumentation and bone prior to proceeding with this demanding surgery. When so much emphasis is placed on instrumentation, a tendency exists to not pay enough attention to the most important part of the operation. This surgery is always an arthrodesis and an attempt to place the spine in a stable and balanced position. Meticulous surgical techniques for arthrodesis are required, or failure is likely to occur. If the spine is placed in an unbalanced situation and the fusion area is placed under tension, failure of fusion and, subsequently, of the instrumentation will occur. The understanding of these concepts and principles is more critical to the success of this type of surgery than the specific instrumentation used. Instrumentation will continue to change using different metallurgy and designs, but these principles and the goal of obtaining a solid arthrodesis and a balanced spine will never change.

Adolescent↗
PubMedDate not supplied

Neurologic deficit after resection of the sacrum.

The authors describe neurologic deficit (sensory, motor, and sphincteral) resulting from sacrifice of the sacral nerve roots removed during resection of the sacrum. The anatomical and functional bases of sphincteral continence and the amount of neurologic deficit are discussed based on level of sacral resection. A large review of the literature on the subject is reported and discussed. The authors emphasize how the neurophysiological bases of sphincteral continence (rectum and bladder) and of sexual ability are still not well known, and how the literature reveals disagreement on the subject. A score system is proposed to evaluate neurologic deficit. The clinical model of neurologic deficit caused by resection of the sacrum may be extended to an evaluation of post-traumatic deficit.

Anal Canal↗
PubMed1983

Main chain fold of a [2Fe-2S]ferredoxin I from Aphanothece sacrum at 2.5 A resolution.

Crystal structure analysis of a [2Fe-2S]ferredoxin I from Aphanothece sacrum, a blue green alga, was carried out at 2.5 A resolution. The phase angle of each reflection was determined by the single isomorphous replacement method coupled with the anomalous dispersion effect for the uranium derivative. The four molecules in an asymmetric unit were clearly seen in a 3.9 A electron density map. The main chains of three molecules were traced at 2.5 A resolution. The structure of the remaining one molecule, however, remains unknown because of the poor electron density of the corresponding region. The three main chain folds exhibit the same topology as that in Spirulina platensis. The structural similarity between A. sacrum and S. platensis ferredoxins, whose amino acid sequences are different from each other by about 30%, strongly suggests that all plant-type ferredoxins have the same main chain fold.

Amino Acid Sequence↗
PubMed1999

S rod fixation to the sacrum in patients with neuromuscular spinal deformities.

A new form of pelvic fixation has been designed for use in patients with neuromuscular spinal deformities to overcome the problems imposed by the Galveston technique. One end of a Luque rod is prebent into an S shaped configuration and placed over the sacral ala supplying firm fixation across the lumbosacral junction without crossing the sacroiliac joint. It fixes firmly against the sacral ala by distracting against a hook or screw in the lumbar spine. A 12 year retrospective review of 67 patients with severe neuromuscular spinal deformities was accomplished. All surgeries were performed by one surgeon. All patients had good deformity correction with an average followup of 6 years and 2 months. Complications included: recurrence of pelvic obliquity (one patient), skin break-down over hardware (one patient), migration of hardware at sacrum (two patients), and rod breakage (five patients). The S rod is recommended for all patients with neuromuscular spinal deformities who require instrument fixation to the pelvis. Its ease of insertion and decreased operative time allow for a safe and dependable alternative fixation to the sacrum without crossing the sacroiliac joint.

Adolescent↗
PubMed2004

Primary hydatid disease of sacrum affecting the sacroiliac joint: a case report.

STUDY DESIGN: A case report of hydatid disease of the spine. OBJECTIVE: To describe an unusual case of hydatid disease of the sacrum affecting the sacroiliac joint and to discuss imaging, differential diagnosis, and treatment. SUMMARY OF BACKGROUND DATA: Hydatidosis or echinococcosis affecting the spine is rare and has a characteristic geographic distribution. Signs of sacroiliac joint involvement and accompanying neurologic deficits cause difficulties in differential diagnosis of this rare condition. METHODS: A case of 38-year-old female patient with low back pain and sciatica was presented. RESULTS: Plain radiographs, computed tomography, and magnetic resonance imaging scans revealed destructive expansive lesion located on the right sacrum and extended through the right sacroiliac joint. Surgical enucleation of the cysts was performed together with mebendazole treatment and histopathologic examination confirmed hydatidosis. CONCLUSION: This unusual disease should be kept in mind in the differential diagnosis of sacroiliac pain and sciatica, especially in endemic areas.

Adult↗
PubMedDate not supplied

Long-term invasive measurement of subcutaneous oxygen partial pressure above the sacrum on lying healthy volunteers.

Pressure ulcers are frequently seen dermal lesions, but little is known about their pathophysiology. It is generally assumed that prolonged tissue pressure impairs blood circulation thus causing ischemic damage to tissue. Therefore, subcutaneous oxygen partial pressure was measured to confirm this hypothesis. In the past, various authors have conducted tests on healthy subjects to determine oxygen partial pressure transcutaneously during periods not exceeding 20 minutes. All found a decrease at susceptible sites, e.g., the sacrum. The present study was the first one to measure oxygen partial pressure subcutaneously above the sacrums of four test subjects during a period of 5 hours. In all cases, the values first decreased to a minimum of 37% of baseline before they returned to the initial values. This observation is in contradiction to former studies, which start from the assumption of critical ischemia due to interface pressure, measured on healthy volunteers too.

Adult↗
PubMed2002

Horizontal sacrum as an indicator of a tethered spinal cord.

The horizontal sacrum has never been described as an indicator of a tethered spinal cord following myelomeningocele closure. We retrospectively analyzed 30 children with a myelomeningocele for this progressive change and its correlation with symptoms. At least two lateral radiographs over time were examined and the lumbosacral angle (LSA) was measured. We found that the majority of these children had an LSA that was greater than would be expected in patients with late and decreased ambulatory abilities. Also, we observed that the LSA was often inappropriately increased at the time many of these patients presented with symptoms indicative of a tethered spinal cord. We hypothesize that the LSA in this group of children is altered by a tethered spinal cord and that the horizontal nature of the sacrum may predate the clinically appreciable symptoms of a tethered spinal cord.

Child↗
PubMed1992

Transcutaneous gas tensions in the sacrum during the acute phase of spinal cord injury.

The first few months following injury to the spinal cord requires constant care of the subject if tissue breakdown is to be avoided. The management of acute traumatic cases involves complete bedrest in a supine position with appropriately positioned pillows to minimize trauma to the bone prominences. This study assesses the effectiveness of the management procedure in terms of the tissue response at the sacrum of 15 acute spinal cord injured subjects. The measurement of mean interface pressures during a representative period of recumbency was performed and these were related to changes in transcutaneous gas tensions (TcPO2 and TcPCO2), which are reliable indices of tissue viability. A series of six variables was established which were compared to each other using non-parametric statistical analyses. It was shown that this group of subjects demonstrated a normal mechanism whereby the level of carbon dioxide was able to control the local vascular tone. The results also suggested that the practice of gapping at the sacrum should be revised to reduce mean sacral pressures and minimize the possibility of tissue breakdown, the risk of which is constant throughout the first three months following injury.

Adolescent↗
PubMed2000

Intraspinal extradural myxopapillary ependymoma of the sacrum arising from the filum terminale externa. Case report.

Extradural ependymomas of the sacrococcygeal region are very rare, with most arising from the soft tissues of the presacral area or from the regions dorsal to the sacrum. In even rarer circumstances, the tumor may arise within the sacral canal, likely as a result of ependymal cells of the extradural filum terminale. Because of bone erosion caused by extension of the tumor into the pelvis or dorsal to the sacrum, a truly intraspinal extradural ependymoma in this region has until now never been clearly demonstrated. The authors present a patient with a myxopapillary ependymoma arising from the filum terminale externa in which there was no involvement of the intradural filum or extension outside the sacral canal. A review of the literature is presented, with emphasis on the pathogenesis and clinical management of these rare tumors.

Cauda Equina↗
PubMed2000

Prognostic factors in chordoma of the sacrum and mobile spine: a study of 39 patients.

BACKGROUND: The prognosis of patients with chordoma of the sacrum and mobile spine has been reported to be dismal and attributable in the majority of cases to intralesional surgery. The purpose of this study was to evaluate the clinical outcome of these patients using modern surgical principles aimed at complete resection and to identify prognostic factors. METHODS: The clinical and morphologic features, type of surgery, and follow-up of 39 consecutive patients with chordoma were reviewed and analyzed statistically. RESULTS: Thirty sacral and 9 mobile spine chordomas (size range, 3-20 cm; mean, 8 cm) occurring in 22 women and 17 men (median age, 55 years) were analyzed. The preoperative morphologic diagnosis was based on fine-needle aspiration (FNA) biopsy, core needle biopsy, or incisional biopsy. The final surgical margins were wide in 23 patients and marginal or intralesional in 16. The mean follow-up was 8.1 years (range, 0.1-23 years). Seventeen patients (44%) developed local recurrences and 11 patients (28%) developed metastases. The estimated 5-, 10-, 15-, and 20-year survival rates were 84%, 64%, 52%, and 52%, respectively. Local recurrence was associated significantly with an increased risk of metastasis and tumor-related death (P < 0.001). CONCLUSIONS: New surgical techniques have improved local control and survival of patients with sacral or spinal chordoma significantly and have decreased progressive neurologic deterioration. Larger tumor size, performance of an invasive morphologic diagnostic procedure outside of the tumor center, inadequate surgical margins, microscopic tumor necrosis, Ki-67 > 5%, and local recurrence were found to be adverse prognostic factors. FNA is the preferred method for establishing the preoperative morphologic diagnosis of chordoma.

Adult↗
PubMed1990

Metastatic ependymoma of the sacrum.

Ependymomas originating in the sacrum or extraspinal parasacral soft tissues are rare tumors. The majority are of the myxopapillary type and may be locally destructive. Even though metastases are not uncommon in retrosacral ependymomas, they have been rarely described in intrasacral locations. A case is reported of a large intrasacral ependymoma with metastases to several vertebrae. Radiologic and pathologic studies are presented. Treatment options are discussed.

Aged↗
PubMed2001

Fine-needle aspiration cytologic diagnosis of giant-cell tumor of the sacrum presenting as a rectal mass: A case report.

A giant-cell tumor of the sacrum is rare, and poses significant therapeutic and surgical difficulties largely because of its location. Patients usually present with pain in the lower back radiating to one or both lower limbs, with or without neurological deficit. The index case presented with difficulty in defecation, in addition to pain in both lower limbs for 6 mo. The patient was seen to have a rectal mass, and a per-rectal fine-needle-aspiration was performed. The smears showed a cellular aspirate composed of a large number of osteoclastic giant cells, admixed intimately with clusters and a scattered population of mononuclear cells. Mitotic figures were not observed. Although the differential diagnosis of osteoclastic giant cell-containing lesions is broad, the presence of strong cohesiveness between the mononucleated cells and giant cells in cohesive clusters is a very helpful diagnostic feature, and was a prominent finding in the present case.

Biopsy, Needle↗
PubMed1978

Univariate and multivariate methods for sexing the sacrum.

Metric data on 200 sacra of known sex, age and race are analyzed to determine the usefulness of conventional observations for determining sex in this bone. Results of the univariate analysis show that significant sex differences in the sacrum involve primarily the top portion of the bone for both whites and blacks. However, measurements of curvature are important sex differences in the sample of blacks. A new index relating the S1 body to sacral breadth is proposed as more useful in classifying the bones by sex than indices involving other measurements. Discriminant analysis shows that the sample of whites can be analyzed significantly better by this method than by using an index. The choice of univariate or multivariate method must depend on the condition of the bone, and will be influenced to some extent by the race from which the sample is drawn.

Black People↗
PubMed1997

Interspecies exchange of a Hoxd enhancer in vivo induces premature transcription and anterior shift of the sacrum.

The precise activation, in space and time, of vertebrate Hox genes is an essential requirement for normal morphogenesis. In order to assess for the functional potential of evolutionary conserved Hox regulatory sequences, a phylogenetically conserved bipartite regulatory element necessary for proper spatial and temporal activation of the Hoxd-11 gene was replaced by its fish counterpart in the HoxD complex of mice, using an ES cell-based targeted exchange. Fetuses carrying this replacement activated Hoxd-11 transcription prematurely, which led to a rostral shift of its expression boundary and a consequent anterior transposition of the sacrum. These results demonstrate the high phylogenetic conservation of regulatory mechanisms acting over vertebrate Hox complexes and suggest that minor time difference (heterochronies) in Hox gene activation may have contributed to important morphological variations in the course of evolution.

Animals↗
PubMed1996

Time-dependent changes of insufficiency fractures of the sacrum: intraosseous vacuum phenomenon as an early sign.

Sacral insufficiency fractures develop over a period of time and show time-dependent changes. We report on 15 CT examinations of 5 patients with early-stage insufficiency fractures of the sacrum. In 4 patients only irregular sclerosis without distinct fracture lines was present in 7 of 8 fractures. Of these 4 patients; 3 exhibited intraosseous gas inclusions in a ventral part of a lateral mass; 5 of 8 fractures disclosed a ventral cortical break. When distinct fracture lines had developed in 1 patient, intraosseous vacuum phenomenon had disappeared. Fracture lines evolve over weeks to months and show central bone absorption. The fractures can heal as demonstrated in 4 of 6 fractures in 3 patients, can persist over 1 year without significant changes or can progress to pseudoarthrosis with bone destruction similar to neuropathic joint disease. Intraosseous vacuum phenomena can persist to this stage. Intraosseous vacuum phenomenon is recognized as a potential finding in the early stage of sacral insufficiency fracture, which also is true for irregular sclerosis and ventral cortical disruption.

Follow-Up Studies↗