Sacral Vertebral Body Research Articles

Sirenomelia sequence according to the distance between the first sacral vertebra and the ilia.

The development of the iliac bones and lower limbs are parallel processes depending on the normal ontogeny of the caudal blastema [O'Rahilly and Müller, 1989; Opitz, 1993; Opitz et al., 2000]. We hypothesized that the pathogenetic mechanisms leading to fused lower limbs would in parallel displace the ilia caudally and medially and that the degree of this displacement might correlate with the severity of the iliac and lower limb defects. Thus the purpose of the study was to test this hypothesis in a sample of 12 sirenomelic fetuses. The fetuses GA 16-39 weeks, spontaneously or therapeutically aborted, were radiographed in the frontal projection as part of a requested autopsy. From each radiograph, a line was drawn connecting the most cranial part or the two ilia. After that the distance was measured vertically between this line and the most cranial part of the first sacral vertebral body (iliac-sacral distance (ISD)). A second distance was measured horizontally between the most lateral part of the two iliae (bi-iliac distance (BD)). As a result, ISD correlates with the iliac/femur phenotype. Separate ilia and femora occur only in cases with normal ISD. Fused ilia or femora or both are seen only in fetuses with mildly increased ISD, whereas a single iliac bone and femur occur only in cases with greatly increased ISD. The increase of the ISD does not correlate with the severity of more distal limb involvement. There was a correlation between the ISD and the BD values; the higher the ISD, the shorter the BD. Based on these findings, we propose an extended classification of Sirenomelia to be tested by other researchers.

Superior hypogastric nerve block for pelvic pain

Opioids have been used for a long period in the treatment of pelvic pain. Patients often develop tolerance to opioids or experience unpleasant side effects, necessitating discontinuance. Superior hypogastric plexus nerve block with neurolytic agents may be useful in these patients and also may help in reducing mean opioid consumption in many other patients. Published studies have established that superior hypogastric nerve blocks can significantly reduce visual analog pain scores in patients and/or decrease their opioid intake. Superior hypogastric plexus is located bilaterally at the level of the lower third of the fifth lumbar vertebral body and upper third of the first sacral vertebral body at the sacral promontory, in which it is blocked under fluroscopic guidance. Therefore, this procedure, when performed properly, could help treat patients with chronic pelvic pain, resulting in minimal side effects. Copyright © 2001 by W.B. Saunders Company

Bi-iliac distance and iliac bone position compared to the vertebral column in normal fetal development.

Prenatal standards of bi-iliac width were not found in the literature based on autopsy investigations, nor was the caudo-cranial position of the ilia compared to the vertebral column. The first purpose of the present study was to establish normal standard values for the bi-iliac distance in fetal life, the second to evaluate the level of the iliac bones proportional to the ossified vertebral column. Whole body radiographs in antero-posterior projections from 98 human fetuses (36 female and 44 male fetuses, as well as 18 fetuses on which the sex had not been determined) were analyzed in the study. The fetuses derived from spontaneous or induced abortions and they were radiographed as part of the required autopsy procedure. The crown-rump-length (CRL) of the fetuses varied from 32 to 245 mm. The outer and inner bi-iliac distance was measured from the radiographs with a digital Helios slide caliper. The caudo-cranial position of the iliac bones was evaluated. The present study shows that in normal fetal development there is a continuous linear enlargement of the pelvic region in the transverse and vertical planes. The upper iliac contour stays at the level of the first sacral vertebral body, whereas the lower iliac line moves caudally. Significant differences between male and female fetuses were not found. The value of the present study is that the results can be used as reference standards in prenatal pathology.

Differences in Sacral Angulation and Lumbosacral Curvature in Black and White Young Men and Women

The angle between the base of the sacrum and its pelvic surface (SA), and the lumbosacral curve (LSC) defined as the anteroposterior distance between the L₁ vertebra and the sacrum were studied in 105 fresh cadavers aged 15–32 years at death. The sample is comprised of 27 black males, 20 black females, 37 white males and 21 white females. Measurements of the SA were made with an adjustable protractor with an accuracy of ±1°. A new method using a specially designed instrument was developed for taking LSC measurements. A sliding scale that could be moved in the cranialcaudal direction was fitted with a measurement stick which measured the depth of the lumbar and sacral vertebral bodies (ventral to dorsal). The measuring device was placed on the autopsy table above the supine cadaver to measure these depths from the ventral side. The LSC was calculated as the mean difference between lumbar and sacral depths. The SA is smaller in black than in white men (43.6 ± 3.4 vs. 61.7 ± 2.1°, p <0.001). Similarly, black women have a smaller SA than white women (36.0 ± 2.2 vs. 50.2 ± 1.9°, p <0.001). The LSC is also larger in black than white men (9.4 ± 1.1 vs. 5.1 ± 0.3 cm, p <0.001), and black women also have significantly larger LSC compared to white women (13.2 ± 0.5 vs. 9.2 ± 0.6 cm, p <0.001). These data are so far the largest empirical evidence of differences in the SA and the LSC in young black and white cadaver specimens.

Internal Fixation for the Transforaminal Sacral Fracture

The mechanical stability of alternate forms of internal fixation of the transforaminal sacral fracture were compared. A transforaminal sacral fracture was made in each of 6 fresh-frozen cadaveric pelvic specimens. Implants compared for fixation included: a single and 2 fully threaded iliosacral screws inserted through the posterior ilium and anchored into the first sacral vertebral body both with and without the addition of a posterior tension band plate; and 2 transiliac bars inserted through the posterior tubercles. The femora of each specimen were potted and fixed to the table of a materials tester. The pelvis was restrained only from flexing and extending, and a compressive load was applied through the lumbar spine, representing a standing loading condition. Flexion of the sacrum and displacement at the fracture site were measured during loading. Although creation of the injury increased motion considerably, there was no measurable increase in stability provided by any of the implants or combination of implants in this model when an anatomic reduction was obtained.

腰仙椎部後方すべりのＸ線学的検討

We performed a radiological study to assess morphological features of the lumbo-sacral spine contribute to posterior slip of the lumbar spine. Padiological measurements were carreid out in 147 cases of retrolisthesis, 30 cases of retro-position of L5 spine and a control group of 408 cases of low cack pain. The incidence of posterior slip in the controls was 26%.The average age was younger in the posterior slip group compared to the control group, and the retro-position group were younger than the retrolisthesis group.A higher incidence of lumbo-sacral transitional vertebrae was noted in the posterior slip group than in a control group. Also the angle between the superior surface and the posterior border of the sacral vertebral body was lower in the posterior slip group.The laminar angle was similar in the posterior slip group and controls.In conclusion, special morphological features such as low posterior superior sacral angles and the existence of lumbo-sacral transitional vertebrae were considered to be risk factor for the development of posterior slip.

Newly designed occluder pin for presacral hemorrhage

Conventional hemostatic measures are often unsatisfactory in presacral venous bleeding occurring during surgical mobilization of the rectum. We designed a new type of hemorrhage occluder pin, with a ridged shaft, which may be rapidly placed into the sacrum to control hemorrhage. The aims of this study were 1) to assess the best pin shaft length by measuring the thickness of human sacral vertebral bodies, 2) to measure the forces needed to pull the newly designed pin out of the human sacrum compared with conventionally shaped titanium thumbtacks, and 3) to assess clinically the efficacy of the new device. Four fresh cadaveric pelves were isolated and cut on a sagittal plane, and the thickness of each vertebral body was measured. Titanium pins, both with ridged and with smooth shafts, were used. Twelve-millimeter-shaft pins were used for S1 and S2, and 7-mm pins were used for S3, S4, and S5. Pins were inserted into each sacral vertebra, and the forces needed to extract them from the bone were measured by computerized dynamometry. Significantly more force was required to extract ridged vs. smooth pins, both with 12-mm and with 7-mm shafts. There was no significant difference between the forces needed to pull out 12-mm vs. 7-mm pins. The new pin was successfully used to stop presacral hemorrhage in three patients with no complications one, three, and six months after surgery. This newly designed hemorrhage occluder pin may represent an improved method of controlling presacral venous hemorrhage.

Proconsul did not have a tail

This study describes two new sacral specimens of Nacholapithecus kerioi, KNM-BG 42753I and KNM-BG 47687A, from the Aka Aiteputh Formation in Nachola, northern Kenya, excavated in 2002. They are of roughly equal size and are considered to belong to males. When scaled by body mass, the lumbosacral articular surface area of the better preserved specimen, KNM-BG 42753I, is smaller than that in Old World monkeys but similar to that in extant great apes and New World monkeys, as well as Proconsul nyanzae. The relatively narrow dimensions of the first sacral vertebral body in the transverse and sagittal planes are characteristics of N. kerioi and P. nyanzae and similar to those of extant great apes. In N. kerioi, lumbosacral surface area relative to body mass is small. This may simply be an extension of a trend from the previously reported small thoracolumbar vertebrae to the sacrum. ​The first sacral vertebrae of N. kerioi and Epipliopithecus vindobonensis have a higher craniocaudal vertebral body reduction (CVR; a higher CVR indicates a wider cranial width relative to a narrower caudal width), similar to that in Old World monkeys. Old World monkeys have a higher CVR, and usually have three sacral vertebrae, fewer than seen in extant great apes, which have a lower CVR and four to six (sometimes as many as eight) sacral vertebrae. New World monkeys have a lower CVR than Old World monkeys, but generally possess only three sacral vertebrae, and have a large caudal articular surface, which may be related, at least in the Atelidae, to the grasping ability of their tails. The possibility that N. kerioi had only three sacral vertebrae cannot be ruled out, because E. vindobonensis and Old World monkeys, with higher CVRs, have sacra consisting of three sacral vertebrae.

Percutaneous punch biopsy of vertebral bodies with Jamshidi's needle (author's transl)

In 24 patients with vertebral body changes which could not be clarified either by x-ray examination or scintigraphy, percutaneous vertebral body punch biopsies were performed between the twelfth thoracic vertebral body and the first sacral vertebral body, using Jamshidi's needle. Findings were malignant in six cases and benign in twelve cases, NAD in six cases. Jamshidi's biopsy needle, which is easy to manipulate, has proved very successful, with a good yield of material. Biopsies were conducted on an outpatient basis. No complications were seen.