Sacrum Research Articles

Spina bifida, the normal, the pathological and the in-between: first evidence from a forensic osteological collection

Spina bifida (SB), a rare congenital disorder, is often mentioned as an individualizing factor in Forensic Anthropology. A lack of empirical data regarding SB is noticed in the scientific literature. Moreover, within the scope of anthropological research on SB disparities in terminology, classification systems, and methodological approaches result in incomparable results. The wide range (1,2%-50%) of “spina bifida occulta” reported prevalences is a good example. This research aims to analyze and debate the standard diagnostic criteria of SB on human skeletal remains, and attempts to elaborate on an universal system, premised on the distinction between SB as a pathology, and cleft neural arch (CNA) as an anatomical variant, according to Barnes (1994, p. 360 [1). A study-base of 209 individuals (88 males; 121 females; 44–99 years old) from the 21st Century Identified Skeletal Collection from the University of Coimbra (CEI/XXI) was macroscopically analyzed, focusing on the sacrum and remaining vertebrae. Four individuals presented complete posterior opening of the sacral canal (2,6%[4/156]). The observed bone changes, combined with the analysis of the entire skeleton, indicate that CNA, rather than SB linked to a neural tube defect, is the most reliable explanation for these cases. Overall, CNA was observed on 11 skeletons (7.05% of 156). The viability and applicability of the developed methodology for the identification of SB/CNA in forensic and/or osteological contexts are discussed, as well as the possibility of a lower prevalence of SB occulta, in the general population, than speculated before.Highlights• Spina bifida has been studied so far under different methodologies, classification systems and nomenclature, leading to unstandardized and incomparable data.• Spina bifida as a pathological manifestation of a neural tube defect, as opposed to cleft neural arch as a simple form of skeletal variation.• Both spina bifida and complete sacral cleft fit the criteria of an individualizing trait in Forensic Anthropology.

Dot-ELISA based on recombinant Hypodermin C of Przhevalskiana silenus for field diagnosis of goat warble fly infestation.

Goat warble fly infestation (GWFI) is an economically important myiasis caused by larvae of Przhevalskiana silenus (Diptera, Oestridae), prevalent in countries of the Mediterranean Basin and Indian subcontinent. GWFI is characterized by the presence of subcutaneous warbles at the lumbar and sacral region of dorsum in the infested animal. The early larval instars (L1 and L2) remain inaccessible to physical detection due to their small size and subcutaneous presence thus causing hindrance in the diagnosis. The objective of present study was to develop a field applicable early diagnostic intervention for GWFI monitoring and prophylactic management for effective control of the disease. Recombinant Hypodermin C (rHyC) antigen of P. silenus was expressed in Escherichia coli. The purified protein was used for optimizing dot-ELISA in a checkerboard titration using goat warble fly infested serum as known positive. The optimized assay was further tested for lower temperature (18°C) and incubation time (30 min). The optimized assay was assessed for inter-rater reliability and field samples. The optimized conditions require 188 ng of protein/dot, 1:800 dilution of serum sample, 1:4000 dilution of anti-goat IgG conjugate and 5% skim milk powder in phosphate buffer saline as blocking buffer. The assay was found to have a diagnostic sensitivity and specificity of 97.3% and 95.8%, respectively. The inter-rater reliability of dot ELISA with rHyC indirect ELISA was found to be almost perfect with a Cohen's kappa index of 0.973. Further testing at ambient temperature (18°C) and shorter incubation steps (30 min) supported suitability of the assay for field diagnosis of GWFI. The present study provides the first report of a sensitive and specific dot-ELISA for early diagnosis of GWFI which is rapid and cost effective. The test may provide an effective field applicable tool for sustainable control of GWFI.

The effect of peri-implant soft tissues on the stability of the sacral bone in the area of dental implants

Achieving the stability of bone tissue in the field of dental implants is still the most urgent and completely unsolved problem in implantological practice. Modern ideas about the biological principles of the structure and functioning of the tissues of the periimplant zone are one of the most significant factors in ensuring the stability of the crestal bone tissue. The soft-tissue component that forms the basis of the biological complex at the implant-suprastructure interface plays a key role in protecting the implant platform from non-physiological resorption processes.

Proposal of a Route Map for Cervical Spinal Ultrasonography: A Simple and Clear Learning Tool for Beginners.

Spinal ultrasonography has increasingly been used to image axial structures from the cervical to sacral region in recent years. In this work, we propose a comprehensive, systematic cervical scanning protocol that we refined as a route map, especially for beginners, to facilitate teaching, learning, diagnosis, and treatment in clinical pain practice. As a simple and clear tool to demonstrate the scanning protocol, the route map is delineated with rectangles, lines, and arrows. The rectangles represent the positions of the transducer, the arrows indicate route directions, and the lines show the routes of transducer movement. In this article, we describe cervical spinal ultrasonography to illustrate the route map interpretation, scanning protocol and target anatomical structures in detail. We believe that this comprehensive, clear, systematic, and portable route map will be beneficial for inexperienced pain clinicians and ultrasound beginners.

Performance of Fully Automated Algorithm Detecting Bone Marrow Edema in Sacroiliac Joints.

This study evaluates the performance of a fully automated algorithm to detect active inflammation in the form of bone marrow edema (BME) in iliac and sacral bones, depending on the quality of the coronal oblique plane in patients with axial spondyloarthritis (axSpA). The results were assessed based on the technical correctness of MRI examination of the sacroiliac joints (SIJs). A total of 173 patients with suspected axSpA were included in the study. In order to verify the correctness of the MRI, a deviation angle was measured on the slice acquired in the sagittal plane in the T2-weighted sequence. This angle was located between the line drawn between the posterior edges of S1 and S2 vertebrae and the line that marks the actual plane in which the slices were acquired in T1 and STIR sequences. All examinations were divided into quartiles according to the deviation angle measured in degrees as follows: 1st group [0; 2.2], 2nd group (2.2; 5.7], 3rd group (5.7; 10] and 4th group (10; 29.2]. Segmentations of the sacral and iliac bones were acquired manually and automatically using the fully automated algorithm on the T1 sequence. The Dice coefficient for automated bone segmentations with respect to reference manual segmentations was 0.9820 (95% CI [0.9804, 0.9835]). Examinations of BME lesions were assessed using the SPARCC scale (in 68 cases SPARCC > 0). Manual and automatic segmentations of the lesions were performed on STIR sequences and compared. The sensitivity of detection of BME ranged from 0.58 (group 1) to 0.83 (group 2) versus 0.76 (total), while the specificity was equal to 0.97 in each group. The study indicates that the performance of the algorithm is satisfactory regardless of the deviation angle.

Giant sacral schwannoma in a neurofibromatosis type 2 patient

BackgroundNeurofibromatosis type 2 is an autosomal dominant disorder, mainly characterized by multiple neurological lesions, such as schwannomas, meningiomas, neurofibromas and intramedullary ependymomas. Schwannomas are usually small circumscribed lesion. Sacral location of a schwannoma with cystic change is a very rare finding. We are presenting one such case with giant cystic schwannoma with fluid–fluid levels in sacral region.Case presentationWe present a case of 13-year-old female patient, presenting with pelvic pain and gradually progressive bilateral lower limb weakness. On MRI, giant cystic schwannoma with internal fluid–fluid levels was noted in sacral region, extending anteriorly into the presacral region, causing mass effects on pelvic organs, which explained the cause of her symptoms. She also showed the presence of bilateral vestibular schwannoma and multiple small cerebral lesions, leading to the diagnosis of neurofibromatosis type 2.ConclusionsOur current case of neurofibromatosis type 2, diagnosed by presence of bilateral vestibular schwannoma, shows atypically large sacral cystic schwannomas and cerebral subcortical lesions, probably representing glial microhamartomas. Sacral schwannomas can be of giant size with cystic changes and fluid–fluid levels, mimicking aneurismal bone cyst, as in current case.

A new herrerasaurid dinosaur record from southern BrazilL (Upper Triassic) and its faunal association

The Predebon Site, located in São João do Polêsine, Quarta Colônia region (Rio Grande do Sul, Brazil) has a Triassic fauna, including footprints and traces of small vertebrates and abundant remains of rhynchosaurs. This fauna is typical of the Hyperodapedon Assemblage Zone, which is correlated to the late Carnian Ischigualasto Formation (Ischigualasto-Villa Unión Basin) in Argentina. The present study records new fossil remains for the Predebon Site collected in 2001 that consists of two dorsal and two sacral vertebrae referred to the same individual (MCN-PV 10344), and two isolated, serrated blade-shaped teeth (MCN-PV 10425 and 10426). The trunk vertebrae were identified as between 11th and 15th. The sacral vertebrae are fully fused, with no indication of another fused vertebral element, not even signs suggestive of dorsosacral and caudosacral vertebrae, also because the ilia are not preserved. The general characteristics observed are: (i) lateral fossa in the vertebral body; (ii) concave ventral face of the vertebral body; (iii) neural spine high and wide at the top, subquadrangular in shape, in both dorsal and sacral vertebrae; (iv) infrapre- and infrapostzygapophyseal ridges on the dorsals; (v) presence of hyposphene and hypantrum; and (vi) first sacral vertebra larger than the second, with transverse processes and broad sacral ribs, triangular in shape in dorsal view. This set of features in the vertebral elements is similar to that present in Herrerasaurus ischigualastensis from the Ischigualasto Formation and allows us to consider MCN-PV 10344 as a member of the Herrerasauridae clade. It differs from Staurikosaurus pricei, which has three smaller and more slender sacral vertebrae and a low neural spine without subquadrangular platform at the top, and from Gnathovorax cabreirai, which has subrectangular platforms, slightly more elongated anteroposteriorly, suggesting the presence of a new herrerasaurid morphotype. The two isolated, serrated blade-shaped teeth were attributed to Archosauriformes indet., because this morphotype is observed in several groups within this clade. Keywords: Dinosauria, Hyperodapedon Assemblage Zone, late Carnian, Predebon Site, Rio Grande do Sul, Brazil.

Clinical observation on electroacupuncture at "four points of sacral region" on moderate to severe stress urinary incontinence after radical prostatectomy

To compare the clinical therapeutic effect between electroacupuncture at "four points of sacral region" and transurethral Erbium laser in treatment of moderate to severe stress urinary incontinence after radical prostatectomy. A total of 68 patients of moderate to severe stress urinary incontinence after radical prostatectomy were divided into an electroacupuncture group (34 cases) and an Erbium laser group (34 cases, 3 cases dropped off) according to the settings. In the electroacupuncture group, electroacupuncture was applied at "four points of sacral region", i.e. points of 0.5 cun beside bilateral sacrococcygeal joints and bilateral Huiyang (BL 35), with continuous wave, 2 Hz in frequency, 60 min each time, once every other day, 3 times a week, 12 times as one course of treatment. In the Erbium laser group, transurethral Erbium laser technology was given, once every 4 weeks as one course of treatment. Both groups were treated for 5 courses. The scores of the International Consultation on Incontinence questionnaire-short form (ICI-Q-SF) and the incontinence quality of life questionnaire (I-QOL) were observed before treatment, after each course of treatment and in follow-up after 1 and 2 months of treatment completion, respectively, and the clinical efficacy was evaluated after treatment in the two groups. Compared with those before treatment, the ICI-Q-SF scores were decreased while the I-QOL scores were increased after 5 courses of treatment and in follow-up after 1, 2 months of treatment completion in the two groups (P<0.01). The ICI-Q-SF score in follow-up after 2 months of treatment completion were higher than that after 5 courses of treatment in the Erbium laser group (P<0.05). After 3, 4, 5 courses of treatment and in follow-up after 1 and 2 months of treatment completion, the ICI-Q-SF scores in the electroacupuncture group were lower than those in the Erbium laser group (P<0.05, P<0.01); after 2, 3, 4, 5 courses of treatment and in follow-up after 1 and 2 months of treatment completion, the I-QOL scores in the electroacupuncture group were higher than those in the Erbium laser group (P<0.01). The change ranges of ICI-Q-SF score and I-QOL score between before treatment and after each course of treatment in the electroacupuncture group were lager than those in the Erbium laser group (P<0.01, P<0.05). The total effective rate was 61.8% (21/34) in the electroacupuncture group, which was superior to 19.4 (6/31) in the Erbium laser group (P<0.01). Both electroacupuncture at "four points of sacral region" and transurethral Erbium laser can improve the clinical symptoms and the quality of life in patients of moderate to severe stress urinary incontinence after radical prostatectomy. The short-term efficacy and long-term efficacy of electroacupuncture are superior to the Erbium laser technology.

Cuff meshoma post-laparoscopic sacrocolpopexy: vaginal-endoscopic mesh excision.

The objective was to present endoscopic images of a meshoma and describe the complete excision of a complicated mesh after sacrocolpopexy (SCP) using a combined vaginal-endoscopic technique. We present a video documentation of an innovative technique. A 58-year-old woman was referred with painless, foul-smelling vaginal discharge and recurrent vaginal mesh erosions. She had undergone a laparoscopic SCP 12years ago and her symptoms had begun 5 years ago. A pre-operative MRI scan revealed a cuff meshoma and an inflammatory sinus around the mesh extending from the cuff to the sacral promontory. Under general anesthesia, a 30° hysteroscope was inserted transvaginally into the sinus, where the retained mesh was seen in the form of a shrunken meshoma, and then the mesh arms were recognized extending cephalad into a sinus tract. Under direct endoscopic visualization, the mesh was carefully mobilized at its highest point with the use of laparoscopic grasping forceps. Then, the mesh was dissected with hysteroscopic scissors in close proximity to the bone. No peri-operative complications were recognized. A combined vaginal-endoscopic approach was successfully used to remove an eroded mesh and cuff meshoma after SCP. This procedure offers a minimally invasive, low-morbidity, and rapid-recovery approach.

Morphology and morphometry of the spinal cord and meninges in Egyptian Baladi goat (Capra hircus): Stereomicroscopy of blue-stained gray matter.

The study objective is to obtain normal morphology and morphometric data from Baladi goat spinal cord segments. Using Tompsett's technique for staining gray matter with a blue stain allowed us to calculate the quantity or area of gray and white matter and thus the total area of each segment. The spinal cord of the goat started at the extent of the middle-third of the occipital condyles, and the tapered end of the spinal cord terminated at the center of the first sacral vertebra. The total length of the spinal cord was 73.3 ± 2.5 cm on average. C3 was the longest spinal segment, measuring 3.95 cm. The gray matter area had a high value at the cervical and lumbar enlargements, with C8 having the highest value of gray matter cross sectional area at 12 mm2 and C7 having the highest value of white matter cross sectional area at 42 mm2 . The area of white matter of the cervical region was higher than that of the other spinal regions. At C7, the total cross section area reached its maximum of 53 mm2 . The cervical enlargement included segments from C6 to T1, while the lumbar enlargement included L5 to S1. The dura mater is connected cranially to the dens of the axis and caudally to the fourth and fifth lumbar vertebrae. The epidural space height between lumbar vertebrae was 2 mm in all lumbar spaces and 3 mm in the lumbosacral space. The normal morphology and morphometric data of the goat spinal cord segments may be useful in pathological conditions of the spinal cord and during epidural anaesthesia technique.

Validity and application of Doiguchi's pelvic tilt measurement method

BackgroundThe validity of Doiguchi's pelvic tilt measurement method has not been proven. The objective in our study was to validate the method. MethodsOur investigation included 73 total hip arthroplasties (THAs) performed using our cup placement procedure from July 2020 to November 2021. Pelvic tilt formed by the pubic symphysis and sacral promontory (PTPS) in supine and lateral positions was calculated by two methods (the Doiguchi method and the digital reconstructed radiograph (DRR) method using a 3D computer templating system) based on the transverse and longitudinal diameters of the pelvic ring measured immediately before THA. ResultsThere was a strong/moderate correlation in the values of PTPS between the Doiguchi and DRR methods. However, the value of PTPS calculated by the Doiguchi method was significantly lower than that calculated by DRR, and there was a partially direct match. On the other hand, there was no significant difference in the value of PT change from supine to lateral position between the Doiguchi and DRR methods. The PT changes based on both methods were strongly correlated, and the PT change calculated by the Doiguchi method was almost identical to that calculated by the DRR method. ConclusionsDoiguchi's pelvic tilt measurement method was validated for the first time. These results demonstrated that the ratio of the transverse and longitudinal diameters of the pelvic ring was an important factor defining the change in pelvic tilt. The slope in the linear function of the Doiguchi method was found to be almost the correct value, although the intercept of the linear function exhibited individual differences.

A Case Report on Complex Sacral Fracture Treated by Spinopelvic Fixation

Abstract Unstable sacral fractures are mostly associated with spinopelvic instability. This type of fracture occurs following a fall from height or a high-energy mechanism. Roy–Camille’s classification system helps in identifying and treating those fractures. Lumbopelvic fixation or spinopelvic fixation is an option to be considered for treating these unstable fractures. The principle of treating these fractures is to maintain the sacropelvic stability. A 54-year-old male patient presented with a history of falling from a tree from a height of 9–11 feet on his back. On further examination, he was having severe tenderness over the sacral region and dorsal spine region. His power was normal on both lower limbs, with numbness over the base of the scrotum with intact sensation distally. Deep tendon reflexes and plantar reflexes were normal. Radiographs show fracture over D12 (AO A5 – stable incomplete burst fracture) and the sacrum. Computerized tomography and magnetic resonance imaging were taken to decode the sacral fracture and to assess the neurology and posterior ligament integrity. His sacral fracture was classified by Roy–Camille type 3, U-shaped fracture, and Denis type 2 fracture.

Surgical Management of Symptomatic Tarlov Cyst: A Case Report

We aim to present a case depicting the gradual onset of symptomatic sacral Tarlov cyst with complaints that include: low back pain, numbness, altered sensation, and inability to control bladder and bowel movements (incontinence). The patient under our care was treated by performing an operation that involved laminectomy and excision of the cyst. Tarlov cysts are perineural dilations that are fluid-filled nerve root cysts most commonly found in the sacral region of the spine adjacent to the dorsal root ganglion. Tarlov cyst was first described in medical literature in 1938 and the etiology of the disease is unknown. Tarlov cysts are extremely rare with an incidence of around 5% and were found incidentally in our patient on magnetic resonance imaging as a hyper-intense lesion at the level of S1-S2. Other imaging tools can be used to diagnose Tarlov cysts like CT, MRI, CT myelogram however the gold standard is MRI.

Variability in size and shape of male and female sacrum in the middle and lower Volga regions

Objective: identification of variability in the size and shape of the sacrum of men and women of the Middle and Lower Volga regions. Material and methods. Macerated sacrums 21 men aged 18-75 and 21 women aged 22-85. Osteometry was performed according to the method of V. P. Alekseev. Results. In the sacrum of men, the sagittal diameter (by 3 mm, p&lt;0.001) and width of the body of the first vertebra (by 4 mm, p=0.003), height (by 8 mm, p=0.006) and width (by 5 mm, p&lt;0.001) predominate) ear-shaped surfaces, the lower width of the sacrum (by 7 mm, p=0.007). In the sacrums of women, the upper width of the pelvic surface (by 7 mm, p=0.008) and the sagittal diameter of the sacral canal (by 1 mm, p=0.007) predominate. The index of narrowing of the sacrum as a whole (63.8% in men, 58.5% in women) and the index of narrowing in the lower part (75.5% in men, 69% in women) demonstrate a high level of statistical significance of differences (by 5.3%, p=0.001, and 6.5%, p=0.008, respectively). Conclusion. The revealed variability in the size and shape of the sacrum of men and women of the Middle and Lower Volga regions lies in the large size of the body of the first vertebra and ear-shaped surface of the male sacrum, which is less narrowed in the lower part than the female one, while in women the sacrum has a greater degree of narrowing from top to bottom.

Evaluating the Necessity of Screw Replacement in Sacral Bone Loosening: A Percutaneous Approach to Bridging the Bone-Screw Gap

Evaluating the Necessity of Screw Replacement in Sacral Bone Loosening: A Percutaneous Approach to Bridging the Bone-Screw Gap

Clinical and cost effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for the prevention of hospital-acquired pressure injuries. A randomised controlled trial.

Pressure injuries affect 13.1% to 45.5% of patients in the intensive care unit and lead to pain and discomfort for patients, burden on healthcare providers, and unnecessary cost to the health system. Turning and positioning systems offer improvements on usual care devices, however the evidence of the effectiveness of such systems is still emerging. We conducted an investigator initiated, prospective, single centre, two group, non-blinded, randomised controlled trial to determine the effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for preventing PIs. The trial was prematurely discontinued after enrolment of 78 participants due to COVID-19 pandemic related challenges and lower than expected enrolment rate. The study groups were comparable on baseline characteristics and adherence to the interventions was high. Four participants developed a PI (in the sacral, ischial tuberosity or buttock region), n = 2 each in the intervention and control group. Each participant developed one PI. As the trial is underpowered, these findings do not provide an indication of the clinical effectiveness of the interventions. There was no participant drop-out or withdrawal and there were no adverse events, device deficiencies, or adverse device effects identified or reported. The results of our study (in particular those pertaining to enrolment, intervention adherence and safety) provide considerations for future trials that seek to investigate how to prevent PIs among ICU patients.

Stroke-like presentation of acute toxic leukoencephalopathy due to capecitabine treatment with extensive intramyelinic edema.

Stroke-like presentation of acute toxic leukoencephalopathy due to capecitabine treatment with extensive intramyelinic edema.

RISK OF INJURY DEVELOPMENT DUE TO SURGICAL POSITIONING: AN OBSERVATIONAL STUDY

Objective: To classify the risk of developing injury due to surgical positioning. Method: Observational, longitudinal, prospective study with a quantitative approach carried out in a public hospital, with 135 patients undergoing elective surgery. Instruments containing sociodemographic, clinical, and surgical characteristics and a risk assessment scale for the development of injuries due to surgical positioning were used. Descriptive analysis, Fisher’s exact test or χ2 test and odds ratio association measure were used as appropriate. Results: Most participants were male (51.11%), adults (52.59%) and were classified as having a higher risk for developing injuries due to surgical positioning (51.85%). Elderly, hypertension, diabetes mellitus and urological surgeries were statistically significant (p &lt; 0.05) for a higher risk of developing lesions. The incidence of pressure injuries was 0.74%, with observation only in the sacral region. Conclusion: There was a greater risk of developing lesions due to surgical positioning and low incidence of pressure injury. Perioperative nursing should incorporate validated risk measurement tools into care practice for safe, individualized and quality care for surgical patients.

Multiple Orocutaneous Extraintestinal Manifestations in Ulcerative Colitis Patient: Complete Response to Ustekinumab.

Pyostomatitis vegetans (PV) is characterized by exophytic-erythematous pustules with superficial erosions of the oral mucosa, while pyoderma gangrenosum (PG) is a rare skin disorder characterized by the development of painful and deeply ulcerated necrotic areas.1 The diagnosis of PV and PG is based on clinical features while histology is unspecific and not always required.2 We report a case of a 73-year-old woman with steroid-dependent, long-standing pancolonic ulcerative colitis (UC) previously treated with azathioprine and naïve to biologics. She was admitted to hospital for sepsis (fever 39 °C, white blood cell count 18 000, C-reactive protein >200 mg/dL, procalcitonin 0.75 ng/mL) and moderate UC relapse (partial Mayo score 10, Mayo endoscopic subscore 1) with multiple painful, ulcerated, vegetative and purulent lesions in the oral cavity and skin (leg and sacral regions) (Figure 1). ... Intravenous (IV) piperacillin-tazobactam was started and sepsis resolved after 3 days. After dermatological assessment a diagnosis of multiple PG and oral PV was made, IV methylprednisolone 60 mg/d was started. Remission of intestinal symptoms and improvement of orocutaneous lesions were observed until steroid tapering, when orocutaneous lesions worsened. Due to the age of the patient and the recent septic event, anti-tumor necrosis factor (TNF) treatment was considered not indicated and IV ustekinumab 390 mg was started followed by a maintenance regimen with 90 mg every 8 weeks. Complete healing of the orocutaneous lesions and clinical and biochemical remission (partial Mayo score 0, C-reactive protein normalization, fecal calprotectin <150 µg/g) was obtained by the end of induction and maintained off of steroids during the following 10 months.

Surgical outcomes and risk factors for recurrence of myxopapillary ependymoma: a single-center experience.

Myxopapillary ependymomas (MPEs) are low-grade, well-circumscribed tumors that often involve the conus medullaris, cauda equina, or filum terminale. They account for up to 5% of all tumors of the spine and 13% of spinal ependymomas, with a peak incidence between 30 and 50 years of age. Because of the rarity of MPEs, their clinical course and optimal management strategy are not well defined, and long-term outcomes remain difficult to predict. The objective of this study was to review long-term clinical outcomes of spinal MPEs and identify factors that may predict tumor resectability and recurrence. Pathologically confirmed cases of MPE at the authors' institution were identified and medical records were reviewed. Demographics, clinical presentation, imaging characteristics, surgical technique, follow-up, and outcome data were noted. Two groups of patients-those who underwent gross-total resection (GTR) and those who underwent subtotal resection (STR)-were compared using the Mann-Whitney U-test for continuous and ordinal variables and the Fisher exact test for categorical variables. Differences were considered statistically significant at p ≤ 0.05. Twenty-eight patients were identified, with a median age of 43 years at the index surgery. The median postoperative follow-up duration was 107 months (range 5-372 months). All patients presented with pain. Other common presenting symptoms were weakness (25.0%), sphincter disturbance (21.4%), and numbness (14.3%). GTR was achieved in 19 patients (68%) and STR in 9 (32%). Preoperative weakness and involvement of the sacral spinal canal were more common in the STR group. Tumors were larger and spanned more spinal levels in the STR group compared with the GTR cohort. Postoperative modified McCormick Scale grades were significantly higher in the STR cohort compared with the GTR group (p = 0.00175). Seven of the 9 STR patients (77.8%) underwent reoperation for recurrence at a median of 32 months from the index operation, while no patients required reoperation after GTR, for an overall reoperation rate of 25%. Findings of this study emphasize the importance of tumor size and location-particularly involvement of the sacral canal-in determining resectability. Reoperation for recurrence was necessary in 78% of patients with subtotally resected tumors; none of the patients who underwent GTR required reoperation. Most patients had stable neurological status postoperatively.