Quantative assessment of the position of the sacrum in young, elderly and senile patients

Abstract

Introduction. Quantifying the spatial position of the sacrum is an important task for many medical specialties, including osteopathy. Knowing exactly how the patient′s sacrum is located is important for the correct osteopathic treatment. Digital radiography made it possible to process images of the entire spine and sacrum on a personal computer screen, without the patient′s participation.The aim of the research was to determine the boundaries of the values of indicators of the spatial position of the sacrum from radiographs in the sagittal projection and investigate the frequency of three types of sacral position in young, elderly and senile people.Materials and methods. Digital radiography of all parts of the spine was performed in 103 patients with dorsopathies. Group 1 — 32 patients aged 21 to 45 years, 15 men and 17 women; Group 2 — 50 patients aged 60 to 74 years, 16 men and 34 women; Group 3 — 21 patients aged 75–88 years, 6 men and 15 women. Combined digital X-ray images of all parts of the spine in the sagittal projection were obtained. From the point inion of the occipital bone, the occipital vertical descended, it served as the axis of the coordinate system for all measurements. To the contour of the base of the sacrum, and then to the contour of the dorsal surface of the body of the sacrum, tangents were drawn until they intersect with the occipital vertical. At the intersection point, a perpendicular was restored to each tangent. The angle between the perpendicular and the occipital vertical was measured. Two parameters were studied: angle α — the angle of inclination of the base of the sacrum; angle δ — the angle of the slope of the dorsal contour of the sacral body.Results. The boundaries of the δ and α angle are determined, which allow us to attribute the spatial position of the sacrum to one of three types: vertical (δ=46–70°, α=8–31°), normal (δ=35–45°, α=20–37°) or horizontal (δ=15–34°, α=33–52°). It was revealed that in patients aged 21–45 years, the normal position of the sacrum was present in 44 %, horizontal — 28 %, vertical — 28 % of patients. At the age of 60–74 years, the normal position of the sacrum was determined in 46 %, horizontal — in 12 %, vertical — in 42 %. In patients aged 75–88 years, the normal position of the sacrum was diagnosed in 24 % of patients, horizontal — 10 %, vertical — 66 %.Conclusion. The criteria for quantifying the spatial position of the sacrum are determined. The boundaries of these parameters are proposed, and it allows us to objectively register the type of sacral position. In elderly patients, the vertical position of the sacrum was detected ¹⁄³ more often than in young people. The number of patients with an upright position of the sacrum in old age is diagnosed more than 2 times more often than in young patients. This position of the sacrum was most common in this age group.