Sacral Foramina Research Articles

Sacralization of Fifth Lumbar Vertebra- A Case Report

During the osteology demonstration session for medical undergraduate students, we have observed a sacrum with sacralisation of fifth lumbar vertebra. The sacrum had six vertebrae with five pelvic sacral foramina. The body of fifth lumbar vertebra was completely fused with first sacral vertebra. The transverse process on the right side was broad and totally fused with ala of sacrum, whereas left side transverse process was not fused with ala. On the posterior aspect, the inferior articular facets of fifth lumbar vertebra were fused with superior articular facets of first sacral vertebra. From this observation, we conclude that, this is a unilateral sacralisation of fifth lumbar vertebra. Since sacralisation is strongly associated with low back pain, the present case is of high clinical value for medical personnel.

Usefulness of Sacral Sublaminar Wire for Low Transverse Sacral Fractures: Two Cases’ Report

Low transverse sacral fractures are rare, with only two published reports regarding their surgery. The complication associated with surgery for sacral fractures is the prominence of implants. In addition, screw fixation below S3 is impractical. We performed posterior sacral fixation using S2 alar iliac (S2AI) screws and sacral sublaminar wires for low transverse sacral fractures. Case 1 was 65-year-old male with an S2-3 transverse sacral fracture. We performed laminectomy (S2-3) and passed ultrahigh molecular weight polyethylene (UHMWPE) cables from laminectomy area to the third posterior sacral foramina. We inserted S2AI screws and connected rods. We also tightened the UHMWPE cables. The implants did not protrude into skin. One year after surgery, the sacral fracture healed without any displacement. Case 2 was a 42-year-old female with an S2 transverse sacral fracture. We performed laminectomy (S1–3) and passed UHMWPE cables from laminectomy area to the third and fourth posterior sacral foramina. We inserted S1 pedicular screws and S2AI screws and connected rods. We also tightened UHMWPE cables. The implants did not protrude into skin. One year after surgery, the sacral fracture healed without any displacement. We consider sacral sublaminar wires to be useful bone anchors in lower sacrum.

A Cadaveric Study Evaluating the Feasibility of an Ultrasound-Guided Diagnostic Block and Radiofrequency Ablation Technique for Sacroiliac Joint Pain.

Ultrasound (US)-guided diagnostic block/radiofrequency ablation (RFA) along the lateral sacral crest (LSC) has been proposed for managing sacroiliac joint (SIJ) pain. We sought to investigate (1) ease of visualization of bony landmarks using US; (2) consistency of US-guided needle placement along the LSC; and (3) percentage of the posterior sacral network (PSN) innervating the SIJ complex that would be captured if an RFA strip lesion were created between the needles. In 10 cadaveric specimens, 3 needles were placed bilaterally along the LSC from the first to third transverse sacral tubercles (TSTs) using US guidance. The PSN, SIJ, and needles were exposed, digitized, and modeled 3-dimensionally. Ease of visualization of bony landmarks, frequency of needle placement along the LSC, and percentage of the PSN that would be captured if an RFA strip lesion were created between the needles were determined. The LSC, TST2, TST3, and first to third posterior sacral foramina were easily visualized using US; TST1 was somewhat obscured by the iliac crest in some specimens. Needles were placed along the LSC in 18 of 20 specimens; in the first 2 of 20 specimens, needle 1 was placed at the L5/S1 facet joint. On average, 93% (95% confidence interval, 87%-98%) of the PSN would be captured if an RFA strip lesion were created between the needles. The findings suggest that US-guided needle placement along the LSC is consistent and could capture most or all of the PSN. A clinical study evaluating the outcomes of this technique is in progress.

Impact of Therapeutic Electrical Stimulation of Sacral Surface Considering Individual Anatomical Sacral Variations on Early Recovery Urinary Continence after Radical Prostatectomy

Objectives: To investigate the effect of electrical stimulation of different anatomical variations of sacral surface on early recovery of urinary continence after radical prostatectomy. Methods: Twenty of 53 consecutive patients who underwent prostatectomy by a single surgeon were enrolled in this study. Ten patients were prospectively randomized to two groups; five patients in Sacral foramena stimulation group received postoperative surface electrical stimulation of sacral foramina area while five patients in control group did not received any electrical stimulation. Selection of remaining ten patients depended on sacral hiatus anatomical variations, assessed by plan X-rays. Of the ten patients, five patients with sacral hiatus subtotals were grouped under SHS1 while 5 patients with sacral hiatus totals were grouped as SHS2. Electrical stimulation for each group began 7 days after catheter removal, thrice a week for 8 weeks. Each of the 24 treatment sessions for each group composed of 20 minutes for sacral electrical stimulation. Continence was evaluated at baseline, 4 and 8 weeks using the 24-hour pad test and according to the incontinence section of the International Continence Society questionnaire. Results: After 2 weeks of treatment, the mean leakage weight was comparable between SFS group and SHS1 group while it was significantly lowered in SHS2 as compared to SFS and SHS1 groups. Comparing mean leakage weight at 8 weeks revealed further significant reduction in SHS2 group than in SFS and SHS1 groups. Moreover, percentage of continent patients was highest in SHS2 group after 8 weeks of treatment followed by SHS1, SFS and control respectively. Conclusions: Electrical stimulation of sacral hiatus surface area may provide better stimulation for sacral nerve than sacral foramena surface area and appears to be effective treatment for early recovery of urinary continence after radical prostatectomy.

The clinical application of lumbar plexus-the first posterior sacral foramina block for hip arthroplasty in elderly patients

Objective: To evaluate the clinical efficacy of lumbar plexus-the first posterior sacral foramina block as an anesthesia technique for hip arthroplasty in elderly patients. Methods: Forty-four patients, aged 60-91 years, weighing 37-100 kg, American Society of Anesthesiologists (ASA) Ⅰ-Ⅲ, underwent elective hip arthroplasty in Tongji Hospital from February 2015 to January 2016.All patients received lumbar plexus and the first posterior sacral foramina block.The first posterior sacral foramina puncture point of 23 cases were located by traditional positioning method, the others were orientated via ultrasonic method.Measurements included effect of sensory blockade after 30 min of completed injection, hemodynamic parameters, quality of surgery blockade, and postoperative adverse reactions related to nerve block. Results: The success rates of the sensory blockade of pinprick for the dermatomes L1-S3 were from 73% to 100%, with 93% success rates of surgical analgesia.Compared with baseline (T0) , the systolic blood pressure (SBP) decreased at 10 min after incision (T5) and 20 min after incision (T6) [T0 vs T5: (137±23) mmHg vs (119±20) mmHg, t=3.825, P<0.05; T0 vs T6: (137±23) mmHg vs (118±18) mmHg, t=4.403, P<0.05]. Heart rate (HR) and diastolic blood pressure (DBP) had no significant changes at different time points (F=0.877, 1.439, P>0.05). One patient suffered urinary incontinence. Conclusion: Lumbar plexus-the first posterior sacral foramina block is one of safe and effective anesthetic techniques for hip arthroplasty in aged patients.

Surface anatomical landmarks for the location of posterior sacral foramina in sacral nerve stimulation.

Sacral nerve stimulation is a common treatment for various pelvic floor disorders. It consists of the percutaneous introduction of electrodes through the posterior sacral foramina for therapeutic stimulation of the target sacral spinal nerve. The aim of our study was to determine the surface anatomical landmarks of the sacrum to facilitate identification of the posterior sacral foramina. This study was conducted on 20 human cadavers. The cadavers were placed in a prone position, and all the soft tissues of the sacral region were removed to allow exposure of the osseous structures. Different measurements were taken in relation to the posterior sacral foramina, the posterior superior iliac spine (PSIS) and the median sacral crest (MSC). A median coefficient of variation (CV) was determined. The diameter of the second sacral foramen showed the greatest variability. The distances between each individual foramen and the MSC had an acceptable variability (CV<20%). In contrast, the distance between foramina had a high variability. The distance between PSIS and the second posterior sacral foramen was also found to have an acceptable variability (CV<20%). However, the angle formed by an horizontal line between PSIS and a line between PSIS and S2 foramina had high variability. We found that the distance between sacral foramina and MSC is relatively constant while the distance between foramina and the relations between foramina and PSIS is highly variable. Detailed knowledge of the anatomy may facilitate electrode placement and is complementary to the regular use of fluoroscopy.

Myelokyphectomy in Spina Bifida: The Modified Fackler or Sagittal Shilla Technique

Severe focal kyphosis occurs in approximately 5–10% of infants with myelomeningocele with the apex of the curve centered around the second lumbar vertebra. The kyphosis is fixed in nature and is usually associated with a compensatory thoracic lordosis proximally. Indications for surgery include an impaired sitting balance, recurrent skin ulcerations, respiratory depression, and pain. The modified Fackler or sagittal Shilla technique is used to solve these problems in a child of 9 years of age or younger. It combines aspects of both the Shilla technique described by McCarthy and the originally described Fackler technique for myelokyphosis. The specific steps to performing this procedure include (1) exposure of the midthoracic spine to pelvis with dissection around the gibbus, (2) pedicle screw instrumentation at the 2 vertebrae to be joined, (3) Luque wire instrumentation, (4) removal of vertebral bodies, (5) presacral rod insertion through the sacral foramina, (6) cantilevering and fixation of the rods to the pedicle screws, (7) tensioning the rods to the Luque wires, (8) grafting to create a limited apical fusion, and (9) tension-free wound closure. This procedure is associated with good long-term outcomes including an increased and sustained curve correction, decreased overall surgeries, and height gain.

Myeloid Sarcoma Presenting as Low Back Pain in the Pediatric Emergency Department

BackgroundLow back pain is a common symptom in the pediatric population; approximately half of all children present with at least one episode of low back pain. The majority of cases are due to nonspecific causes such as musculoskeletal trauma with spontaneous regression. On some occasions, however, life-threatening diseases have to be considered. Case ReportA 15-year-old girl presented to the Pediatric Emergency Department for a history of continuous 2-day duration of low back pain and transient paresthesia of the right gluteal area. Low back pain was diagnosed and nonsteroidal anti-inflammatory treatment combined with rest were prescribed. After 7 days, worsening of the clinical conditions was observed with bilateral gluteus paresthesia. A corset was recommended, and magnetic resonance imaging (MRI) and rheumatological evaluation were prescribed on an outpatient basis. After 5 days she was hospitalized due to urinary incontinence and persistence of pain. Blood tests revealed neutrophil leukocytosis associated with mild anemia, thrombocytopenia, hyperuricemia, and increased lactate dehydrogenase. MRI examination of the spine demonstrated a mass involving the sacral canal and the presacral region, extending through the sacral foramina, along the nerve roots. Similar tissue was found at multiple levels in the spine and in the right orbit. Bone marrow aspiration and biopsy highlighted the presence of myeloid blasts and myeloid dysplasia, consequently, myeloid sarcoma was diagnosed. Why Should an Emergency Physician Be Aware of This?Our case demonstrates the importance of prompt identification of diagnostic “red flags” in childhood low back pain, indicating the need for diagnostic investigations such as MRI and blood tests.

Malignant Pelvic Tumors Involving the Sacrum: Surgical Approaches and Procedures Based on a New Classification.

To introduce a new classification of Enneking type IV pelvic tumors involving the sacrum and a corresponding system of standardized surgical approaches and procedures for resection of such tumors, and to investigate the feasibility and therapeutic effect of the new system. Data on 59 patients treated between February 2003 and February 2013 by standardized surgical approaches and procedures were retrospectively reviewed. The study subjects comprised 28 male and 31 female patients with a mean age at diagnosis of 36 years (range, 2-72 years). There are four subtypes in the new classification: (i) subtype IVa, neoplasms invading the ipsilateral sacral wing; (ii) subtype IVb, neoplasms invading the ipsilateral sacral foramina; (iii) subtype IVc, neoplasms invading the contralateral sacral foramina; and (iv) subtype IVd, neoplasms invading the whole of the sacrum. Standardized surgical approaches and procedures were devised for en-bloc resection for each subtype with adequate margins. Adequate margins were achieved in 43/59 patients (72.9%). The mean operation time was 5.0 h and the mean intraoperative blood loss 2157 mL. At the final follow-up, 27/53 patients (50.9%) who had been followed up were alive and in complete remission. The mean Musculoskeletal Tumor Society 93 score was 17.4 (58%) of a possible 30 points. The mean functional score for patients who had undergone a pelvic zone II resection was 15.2, compared with 19.0 for those with an intact pelvic zone II. The proposed standardized protocols should help orthopaedic surgeons to achieve adequate margins, manage risk, achieve better oncologic and functional outcomes, and minimize perioperative complications when treating massive pelvic tumors involving the sacrum.

Developmental identity versus typology: Lucy has only four sacral segments.

Both interspecific and intraspecific variation in vertebral counts reflect the action of patterning control mechanisms such as Hox. The preserved A.L. 288-1 ("Lucy") sacrum contains five fused elements. However, the transverse processes of the most caudal element do not contact those of the segment immediately craniad to it, leaving incomplete sacral foramina on both sides. This conforms to the traditional definition of four-segmented sacra, which are very rare in humans and African apes. It was recently suggested that fossilization damage precludes interpretation of this specimen and that additional sacral-like features of its last segment (e.g., the extent of the sacral hiatus) suggest a general Australopithecus pattern of five sacral vertebrae. We provide updated descriptions of the original Lucy sacrum. We evaluate sacral/coccygeal variation in a large sample of extant hominoids and place it within the context of developmental variation in the mammalian vertebral column. We report that fossilization damage did not shorten the transverse processes of the fifth segment of Lucy's sacrum. In addition, we find that the extent of the sacral hiatus is too variable in apes and hominids to provide meaningful information on segment identity. Most importantly, a combination of sacral and coccygeal features is to be expected in vertebrae at regional boundaries. The sacral/caudal boundary appears to be displaced cranially in early hominids relative to extant African apes and humans, a condition consistent with the likely ancestral condition for Miocene hominoids. While not definitive in itself, a four-segmented sacrum accords well with the "long-back" model for the Pan/Homo last common ancestor. Am J Phys Anthropol 160:729-739, 2016. © 2016 Wiley Periodicals, Inc.

Sacral Bone Mass Distribution Assessed by Averaged Three-Dimensional CT Models: Implications for Pathogenesis and Treatment of Fragility Fractures of the Sacrum.

Fragility fractures of the sacrum are increasing in prevalence due to osteoporosis and epidemiological changes and are challenging in their treatment. They exhibit specific fracture patterns with unilateral or bilateral fractures lateral to the sacral foramina, and sometimes an additional transverse fracture leads to spinopelvic dissociation. The goal of this study was to assess sacral bone mass distribution and corresponding changes with decreased general bone mass. Clinical computed tomography (CT) scans of intact pelves in ninety-one individuals (mean age and standard deviation, 61.5 ± 11.3 years) were used to generate three-dimensional (3D) models of the sacrum averaging bone mass in Hounsfield units (HU). Individuals with decreased general bone mass were identified by measuring bone mass in L5 (group 1 with <100 HU; in contrast to group 2 with ≥100 HU). In group 1, a large zone of negative Hounsfield units was located in the paraforaminal lateral region from S1 to S3. Along the trans-sacral corridors, a Hounsfield unit peak was observed laterally, corresponding to cortical bone of the auricular surface. The lowest Hounsfield unit values were found in the paraforaminal lateral region in the sacral ala. An intermediate level of bone mass was observed in the area of the vertebral bodies, which also demonstrated the largest difference between groups 1 and 2. Overall, the Hounsfield units were lower at S2 than S1. The models of averaged bone mass in the sacrum revealed a distinct 3D distribution pattern. The negative values in the paraforaminal lateral region may explain the specific fracture patterns in fragility fractures of the sacrum involving the lateral areas of the sacrum. Transverse fractures located between S1 and S2 leading to spinopelvic dissociation may occur because of decreased bone mass in S2. The largest difference between the studied groups was found in the vertebral bodies and might support the use of transsacral or cement-augmented implants.

Landmarks for Sacral Debridement in Sacral Pressure Sores.

Most cases of sacral osteomyelitis arising in the setting of sacral pressure ulcers require minimal cortical debridement. When faced with advanced bony involvement, the surgeon is often unclear about how much can safely be resected. Unfamiliarity with sacral anatomy can lead to concerns of inadvertent entry into the dural space and compromise of future flap options. A cadaveric study (n = 6), in which a wide posterior dissection of the sacrum, was performed. Relationships of the dural sac to bony landmarks of the posterior pelvis were noted. The termination of the dural sac was found in our study to occur at the junction of S2/S3 vertebral bodies, which was located at a mean distance of 0.38 ± 0.16 cm distal to the inferior-most extent of the posterior superior iliac spine (PSIS). The mean thickness of the posterior table of sacrum at this level was 1.7 cm at the midline and 0.5 cm at the sacral foramina. The PSIS is a reliable landmark for localizing the S2/S3 junction and the termination of the dural sac. Sacral debridement medial to the sacral foramina above the level of PSIS must be conservative whenever possible. If aggressive debridement is necessary above this level, the surgeon must be alert to the possibility of dural involvement.

CT evaluation of acupuncture needles inserted into sacral foramina.

To use CT scanning to evaluate the precision with which acupuncture needles can be inserted into sacral foramina to establish sacral nerve modulation by electroacupuncture. The subjects were five adult women (mean age 71.6 years). These five cases were divided into two groups. In the first three subjects (group A) the intention was to insert acupuncture needles in the S3 and S4 foramina; in the remaining two subjects (group B) the intention was to insert acupuncture needles in the S2 and S3 foramina. CT scanning showed that in subject 1 of group A, the acupuncture needle intended for insertion in S3 was actually in the S4 foramen, and the acupuncture needle intended for insertion in S4 was actually distal to the sacral body. In subjects 2 and 3, the acupuncture needles were inserted accurately in the S3 and S4 foramina. In the three subjects who had acupuncture needles inserted in the S4 foramen, the tip of the acupuncture needle was an average distance of 6.0 mm from the rectum. The acupuncture needles inserted in subjects 4 and 5 of group B were inserted accurately into the S2 and S3 foramina. Inserting acupuncture needles into the sacral foramina of S2 and S3 at an angle of about 60° has the potential to be used for sacral nerve modulation by repeated electroacupuncture stimulation. Needling may be less accurate in subjects with higher body mass index. Because of the potential risk of perforating the rectum with the needle, this technique must be used by specialists only. 2013-026.

Sacral epidural chordoma

A 56-year-old man presented with an 8-month history of lower back pain radiating down the posterior aspect of the thighs bilaterally and a 5-month history of perianal paresthesia. These symptoms markedly increased in severity 1 day before admission and were associated with difficulty passing urine. Examination revealed reduced sensation in an S2–S4 distribution. Magnetic resonance imaging of the spine showed a T1 hypointense (Fig. 1), T2 hyperintense (Fig. 2) central mass within the sacral anterior epidural space which was eroding into the posterior aspect of the S1, S2, and S3 vertebral bodies and causing severe stenosis of the S1 and S2 sacral foramina bilaterally. Further to these investigations, a biopsy was conducted under computed tomography guidance. The histologic diagnosis was chordoma. This patient

Percutaneous Neurolysis with Continuous Radiofrequency Energy for the Treatment of Symptomatic Sacroiliac Joints: Study of Clinical Safety and Efficacy

Purpose: To prove safety and efficacy of percutaneous neurolysis with continuous radiofrequency energy for the treatment of symptomatic sacroiliac joints in a series of consecutive patients. Materials and methods: During the last 2 years, 15 patients suffering from low back pain due to degenerative disorder of the sacroiliac joint underwent percutaneous neurolysis with continuous radiofrequency energy. Under extended local sterility and fluoroscopy 4 cannulas were placed along the sacral foramina and at the L5- S1 level and neurolysis session was performed post motor and sensory evaluation test. NVS pain scores prior and post therapy were compared using Paired Samples t-Test and Wilcoxon Signed Rank Test. Results: Mean pain score prior to any therapy was 8.05±1.449 NVS units. Mean pain score post therapy was 2.37 ± 2.715, 2.42 ± 2.754, 2.70 ± 2.928 and 3.55 ± 2.837 NVS units at 1, 6, 12, 24 months. The comparison of the patients’ selfreported outcomes concerning pain reduction and mobility improvement prior and post therapy is statistically significant (p<0.001). No complication was noted. Conclusion: Percutaneous neurolysis with continuous radiofrequency energy seems to be a safe and efficient technique for the treatment of symptomatic, sacro-illiac joints resulting in significant pain reduction and mobility improvement. Proper patient selection is a prerequisite for high success rate.

Space Available for Sacroiliac Screws in the S1 Vertebral Body

Objectives: To define the maximal sagittal cross sectional dimensions of the S1 vertebral body and quantify the area available for safe placement of transverse sacroiliac (SI) screws. Methods: A laboratory investigation was performed using twelve fresh, frozen, non-preserved cadaveric pelvic specimens (six males, six females). The sacrum was dissected and removed from each pelvis. After the gross height and widths were measured, the sacra were split in the midsagittal plane and the dimensions of the first sacral segment were recorded. Then, starting from the center, the vertebral bodies were sequentially reamed in a medial to lateral direction in increasing one millimeter increments until a cortical breech occurred in the narrowest portion of the ala at the first sacral neural foramina. Using the diameter of the largest reamer, the cross-sectional area of space available for a transverse sacroiliac screw in the S1 body was calculated. Results: The cross-sectional area of space in the sagittal plane, corresponding to a transverse sacroiliac screw trajectory, of the first sacral vertebral body averaged 204 mm2 (range, 153 mm2 to 226 mm2 ), corresponding to a mean maximum reamer diameter of 16.1 mm (SD 1.08). The male and female sacra did not differ significantly with respect to overall size (mean height, 15.6 cm, SD 1.02; mean width 10.7 cm; SD 0.75) and the dimensions of the S1 body (mean height 28.41 mm, SD 2.23, mean depth 27.17 mm, SD 3.69). Conclusions: Our results improve upon our understanding of the surgical anatomic parameters of the upper sacral segment with respect to placement of transverse sacroiliac screw(s) by quantifying the cross-sectional area in the sagittal plane.

Morphometric study of variations of sacral hiatus among West Bengal population and clinical implications

The study was conducted on one hundred and seventeen human sacra to categorize the sacral hiatus of West Bengal population to improve the accuracy of caudal epidural block for anesthesia and analgesia. Various contours of hiatus were observed in this study which included inverted U (70.09%), inverted V (14.53%), irregular (12.82%), bifid (1.71%) and dumbbell (0.85%).The most frequently observed positions of apex and base of the hiatus were fourth and fifth sacral vertebrae respectively (74.36% and 95.73%). The average length, width and depth of hiatus were 20.21 mm, 12.10 mm and 6.02 mm with standard deviation of 7.7 3mm, 3.13 mm and 2.43 mm respectively. All the measurements were taken by Vernier calipers. Only in 27.35% cases the points on the lateral sacral crests at the level of first sacral foramina formed an equilateral triangle with the apex of the hiatus and thus could be used as an important landmark to locate sacral hiatus.

Sacro-Iliac Joint Sensory Block and Radiofrequency Ablation: Assessment of Bony Landmarks Relevant for Image-Guided Procedures.

Image-guided sensory block and radiofrequency ablation of the nerves innervating the sacro-iliac joint require readily identifiable bony landmarks for accurate needle/electrode placement. Understanding the relative locations of the transverse sacral tubercles along the lateral sacral crest is important for ultrasound guidance, as they demarcate the position of the posterior sacral network (S1–S3 ± L5/S4) innervating the posterior sacro-iliac joint. No studies were found that investigated the spatial relationships of these bony landmarks. The purpose of this study was to visualize and quantify the interrelationships of the transverse sacral tubercles and posterior sacral foramina to inform image-guided block and radiofrequency ablation of the sacro-iliac joint. The posterior and lateral surfaces of 30 dry sacra (15 M/15 F) were digitized and modeled in 3D and the distances between bony landmarks quantified. The relationships of bony landmarks (S1–S4) were not uniform. The mean intertubercular and interforaminal distances decreased from S1 to S4, whereas the distance from the lateral margin of the posterior sacral foramina to the transverse sacral tubercles increased from S1 to S3. The mean intertubercular distance from S1 to S3 was significantly (p < 0.05) larger in males. The interrelationships of the sacral bony landmarks should be taken into consideration when estimating the site and length of an image-guided strip lesion targeting the posterior sacral network.

Evidence of Helminth Infection in Guanche Mummies: Integrating Paleoparasitological and Paleogenetic Investigations.

The Guanches, ancient inhabitants of the Canary Islands, Spain, practiced mummification of their dead. A paleoparasitological and paleogenetic analysis was conducted on mummified bodies (n = 6) (AD 1200, Cal BP 750) belonging to the Guanche culture from Gran Canaria Island. Coprolite and sediment samples (n = 19) were removed from below the abdominal region or sacral foramina. The samples were rehydrated in 0.5% trisodium phosphate solution for 72 hr at 4 C, and the paleoparasitological investigation was conducted by spontaneous sedimentation method and microscopic examination. The results revealed the presence of well-preserved eggs of Ascaris sp., Trichuris trichiura , Enterobius vermicularis , and hookworms. Ancient DNA was extracted from sediment samples to elucidate the ancestry of the mummies and for molecular detection of Ascaris sp. infection. Results of paleogenetic analysis demonstrated Ascaris sp. infection using 2 molecular targets, cytb and nad1. The mtDNA haplotypes U6b, U6b1, and HV were identified, which confirmed records of Guanche ancestry. The excellent preservation of Guanche mummies facilitated the paleoparasitological and paleogenetic study, the results of which contribute to our knowledge of Guanche culture and their health status.

Topography and landmarks for the nerve supply to the levator ani and its relevance to pelvic floor pathologies.

The aim of this study was to explore the anatomical variations of the nerve to the levator ani (LA) and to relate these findings to LA dysfunction. One hundred fixed human female cadavers were dissected using transabdominal, gluteal, and perineal approaches, resulting in two hundred dissections of the sacral plexus. The pudendal nerve and the sacral nerve roots were traced from their origin at the sacral foramina to their termination. All nerves contributing to the innervation of the LA were considered to be the nerve to the LA. Based on the spinal nerve components, the nerve to the LA was classified into the following categories: 50% (n = 100) originated from S4 and S5 (type I); 19% (n = 38) originated from S5 (type II); 16% (n = 32) originated from S4 (type III); 11% (n = 22) originated from S3 and S4 (type IV); 4% (n = 8) originated from S3, S4, and S5 (type V). Two patterns of nerve termination were observed. In 42% of specimens, the nerve to the LA penetrated the coccygeus muscle and assumed an external position along the inferior surface of the LA muscle. In the remaining 58% of specimens, the nerve crossed the superior surface of the coccygeus muscle and continued along the superior surface of the iliococcygeus muscle. Damage to the nerve to LA has been associated with various pathologies. In order to minimize injuries during surgical procedures, a thorough understanding of the course and variations of the nerve to the LA is extremely important.