Shape Of Sacral Hiatus Research Articles

Morphological and morphometric features of sacral hiatus and its clinical significance in caudal epidural anaesthesia.

Caudal epidural block (CEB) failure or complications are not unheard even among experienced anaesthesiologists and are usually due to sacral hiatus (SH) anatomy variations. The aim of the present study is to observe, record and analyse important anatomical features of SH and correlate them with potential CEB limitations. The SH of 155 complete and undamaged Greek adult dry sacra of known sex were included in the study. Three non-metric (shape of SH and location of hiatal apex and base in relation to level of sacral/coccygeal vertebra) and five metric parameters (height of the SH, transverse width of the SH at the base, anteroposterior diameter of the SH at the level of its apex and the distance from the sacral apex and base to the upper border of S2 foramina) were evaluated. Inverted U (34.83%) and inverted V (26.45%) were the commonest shapes. Hiatal apex and base were most commonly related to the level of S4 (78.70%) and S5 vertebra (89.03%), respectively. Mean height, depth and intercornual distance were 19.05 ± 8.65 mm, 5.39 ± 1.84 mm and 12.41 ± 3.16 mm, respectively, whereas mean distance between the upper border of S2 foramen and the apex and base of the SH were 46.34 mm and 63.48 mm, respectively. Anatomical variations of SH that might be responsible for CEB failure, such as elongated SH, absence of SH, complete dorsal wall agenesis of sacral canal and narrowing (< 3 mm) at the apex of SH were found in 17.43% of sacra (male 10.94% and female 25.22%). This study suggests a potential risk of failure of CEB in Greek patients, especially in females, which should be kept in mind while giving caudal epidural anaesthesia.

Clinically Relevant Morphometry of Sacral Hiatus and Morphology of Sacrum.

To outline the variations in morphology and a few clinically relevant morphometric parameters of the sacral hiatus. The study included 50 dry human sacra, of unspecified sex, in the Department of Anatomy at a medical college in South India. The sex was determined using the sacral, auricular and curvature index. The variations and morphometry of the sacra were documented and tabulated. It was observed that the inverted U shape of sacral hiatus was common in both males (n=24) and females (n=26). There was one female sacrum with complete dorsal wall agenesis. In males, the length of the apex of sacral hiatus from 1st sacral spine was 5.82 cm ± 1.27 and in females, it was 6.02 cm ± 1.08. Sacral hiatus depth in males was 0.56 cm ± 0.16 and in females 0.54 cm ± 0.14. The width of sacral hiatus at the cornua in males was 1.42 cm ± 0.29 and in females, it was 1.46 cm ± 0.38 CONCLUSION: Knowledge of incidences of variations in the morphology and morphometry of the sacral hiatus across various population groups is paramount for the success and reliability of epidural anesthesia. The success rate of such procedures depends on the clinicians' understanding of the discrepancy in the sacral hiatus.

Morphometric Study of Sacral Hiatus in Dry Adult Human Sacra: Its Clinical Relevance in Caudal Epidural Block.

Correct localization of the sacral hiatus is essential for administering a successful caudal epidural block. The present study was undertaken to find out the anatomical variations of sacral hiatus by a metrical method so that it could help anaesthesiologists in the clinical field. The study was performed on 140 (83 male and 57 female) adult human sacra. Various parameters of the sacrum studied were as follows: the shape of the hiatus, length of the sacral hiatus, transverse width at the base and anteroposterior diameter at the level of the apex. For each parameter, the mean value (calculated in mm), standard deviation, range and percentage of bones identified correctly were calculated. Various shapes of sacral hiatuswere observed, including inverted "U" in 73 (52.14%), inverted "V" in 33 (23.57%), irregular in 10 (7.14%), elongated in 10 (7.14%) and dumbbell-shaped in 12 (8.57%). Absent sacral hiatus was observed in two (1.43%) specimens. The mean value for the length of sacral hiatus from the apex to the midpoint of the base was found to be 23.26 mm in males and 22.38 mm in females. However, the parameter was found to be statistically not significant. The mean value for transverse width at the base of hiatus was found to be 14.19 mm in males and 13.54 mm in females. The mean value for the anteroposterior diameter of the sacral canal at the apex was found to be 4.57 mm in males and 4.32 mm in females. Both the above parameters were found to be statistically not significant. The anatomical knowledge of sacral hiatus and its variations are important in caudal epidural anaesthesia, and it may improve the success rate of caudal epidural anaesthesia.

Clinically Relevant Morphometry of Sacral Hiatus and Morphology of Sacrum.

To outline the variations in morphology and a few clinically relevant morphometric parameters of the sacral hiatus. The study included 50 dry human sacra, of unspecified sex, in the Department of Anatomy at a medical college in South India. The sex was determined using the sacral, auricular and curvature index. The variations and morphometry of the sacra were documented and tabulated. It was observed that the inverted U shape of sacral hiatus was common in both males (n=24) and females (n=26). There was one female sacrum with complete dorsal wall agenesis. In males, the length of the apex of sacral hiatus from 1st sacral spine was 5.82 cm ± 1.27 and in females, it was 6.02 cm ± 1.08. Sacral hiatus depth in males was 0.56 cm ± 0.16 and in females 0.54 cm ± 0.14. The width of sacral hiatus at the cornua in males was 1.42 cm ± 0.29 and in females, it was 1.46 cm ± 0.38 CONCLUSION: Knowledge of incidences of variations in the morphology and morphometry of the sacral hiatus across various population groups is paramount for the success and reliability of epidural anesthesia. The success rate of such procedures depends on the clinicians' understanding of the discrepancy in the sacral hiatus.

Morphometric Measurement of Sacral Hiatus in Dry Human Sacrum

Introduction: Sacral hiatus is the chief location for caudal epidural anesthesia during surgery of perineal region and also for a pain free parturition. Thus, this study was conducted to examine, measure and record the morphometry of sacral hiatus and to analyze it for any anatomical variations with clinical implications.&#x0D; Methods: The cross-sectional study was carried in the Department of Anatomy, Sikkim Manipal Institute of Medical Science, Gangtok, Sikkim. For the study seventy dry human sacral bone with entire sacral hiatus were measured. The shape of the sacral hiatus was observed. Level of the apex, base, length, width and anterior posterior diameter of sacral hiatus was measured with Digital Vernier Caliper. The study was approved by Institutional Ethical Committee (IEC No:SMIMS/IEC/2017-01). Data were analysed by one-way analysis of variance (ANOVA) and the difference was considered significant when P&lt;0.05. SPSS 20 was used for data analysis.&#x0D; Results: The study revealed inverted “U” shaped sacral hiatus as the common shape in 35(50%) followed by inverted “V” shaped sacra in 18 (25.71 %) followed by irregular shaped sacral hiatus in 8 (11.42 %) cases. A Dumbbell shaped sacral hiatus was observed in 4 (5.71%) cases with a bony protuberance protruding medially from both edges. Absence or complete agenesis of sacral hiatus, a rare phenomenon, was observed in 3 (4.28%) and bifid in 2(2.85%) specimens only.&#x0D; Conclusion: The prevalence of inverted “U” shaped sacral hiatus and constriction of the sacral canal at apex of sacral hiatus was found high. This knowledge of variation in shape of sacral hiatus could be clinically important while providing caudal anesthesia and doing epidural block.

STUDY OF DORSAL SACRAL TRIANGLE IN HUMAN SACRA

Introduction:&#x0D; Sacrum is a triangular bone shaped by combination of five sacral vertebrae. It is embedded as a wedge between the two innominate bones at the upper and back portion of pelvic bone. The opening show at the caudal conclusion of sacral canal is known as sacral rest. It is shaped due to the disappointment of combination of laminae of the fifth (every so often 4th) sacral vertebra. It is situated inferior to the 4th (or 3rd) fused sacral spines or lower end of median sacral crest. Sacrum is a vital bone for recognizable proof of sex in human skeletal framework. Since it may be a component of hub skeleton and and pelvic support, it has an applied significance in deciding sexual orientation with the assistance of estimation carried upon it. The well- known strategy for assurance of male and female sacra has been the Sacral file (SI). The varieties within the structure of dorsal divider of sacral canal are various. It may be open all through its whole length or there may be moo lying lamina of to begin with sacral vertebra. Other varieties incorporate lacks between its predominant and second rate limits, pulverization of lumen of sacral canal and hard abundance annihilating the break. The nearness of any gaps may allow the needle to elude the canal coming about in subcutaneous statement of anesthetic operator. The sacral hiatus has been used for administration of caudal epidural anesthesia in obstetrics as well as orthopedic practice for treatment and diagnosis. The foremost visit issue experienced in caudal epidural square is needle situation as in some cases it is troublesome to decide the anatomical area of sacral rest particularly in grown-ups. Clinical assessment of needle arrangement can be done with ultrasonography or fluoroscopy. In any case, it isn't continuously doable to do so since of time and cost limitations. Varieties have been found within the shape and level of sacral break. Anatomical points of interest and the information of real shape and size of sacral rest and its varieties play a major part within the victory of needle situation. &#x0D; Aim: The main of this study is to find out the anatomical variations of sacral hiatus of the cadaver in human.&#x0D; Material and Methods: This is a Cross-sectional study carried out on dry human sacra to study the anatomical variations of sacral hiatus. Total 80 human sacra were collected from Department of Anatomy. Only dry sacra with complete sacral hiatus were included in this study. Damaged sacra were excluded in this study. For the study various parameters and measurement were used for the study. With the help of naked eye the shape of the sacral hiatus was noted. The length of sacral hiatus was measured from apex to the midpoint of base; the antero-posterior depth of sacral hiatus at the apex was measured with the help of vernier calipers and recorded as data. With the help of vernier caliper the transverse width of sacral hiatus at the base was also measured between the inner aspects of inferior limit of the sacral cornu with the help of divider and then adjusted and calculated.&#x0D; Result: In this all the sacrum studied was composed of five segments in 80 cases. There were many variations in the shape of sacral hiatus. In 38 (47.5%) sacra the shape was Inverted-U whereas sacra Inverted V was seen in 21(26.3%). Both the over sorts were considered as ordinary and the sacral break was show against 4th and 5th sacral sections. The irregular shaped of sacral hiatus was observed in 12(15%) cases. A “Dumbbell” shaped sacral hiatus was observed in 5(6.3%) cases with a nodular bony growth projecting medially from both margins. The dorsal wall of sacral canal was entirely absence in 3(3.8%) cases. a rare phenomenon, absence of sacral hiatus was observed in 1(1.3%) only.&#x0D; Conclusion: There was variability in the anatomical structure of the sacral hiatus. The inverted U shape of sacral hiatus was most commonly seen. Apex and base of the hiatus were most commonly seen at the level of S4 and S5 respectively. These estimations will be of colossal esteem in administration of caudal epidural anesthesia and variations in shape and estimate of sacral rest will help in preoperative assessment of patients. There are anatomical varieties within the sacral break, which may relate to the complication to caudal epidural anesthesia. Understanding of these varieties may progress the victory rate of caudal epidural anesthesia.&#x0D; Keywords: Sacrum, Sacral hiatus, apex, base, caudal epidural anaesthesia

Morphology of Sacrum and its Variations

Sacrum is formed by the fusion of five Sacral vertebrae and forms the lower part of Vertebral column. The opening present at the lower end of Sacral canal is known as Sacral hiatus. Anatomical variations, Morphology and Morphometry of Sacral hiatus are important clinically as well as surgically 1 . This study was carried out on 75 dry human sacra of unknown sex to know different features of Sacrum, anatomical variations of sacrum and to study the variations of sacral hiatus. Anatomical variations – failure of formation of superior articular process and lamina of left first sacral vertebra, incomplete development and fusion of second sacral vertebra, multiple foramens on either side of spinous process above the sacral hiatus, multiple foramens in the dorsal surface of base of the sacrum behind the auricular surface, incomplete median crest, bilateral five pelvic and dorsal foramens were identified. Various shapes of sacral hiatus were observed which included inverted u, inverted v, irregular, dumbbell and bifid 2 . The apex of sacral hiatus was commonly found at the level of fourth sacral vertebra. The mean length of sacral hiatus was measured. The mean anteroposterior diameter of sacral canal and narrowing of sacral canal at the apex of sacral hiatus was measured 1&2 . The knowledge of anatomical variations of Sacrum and variations of Sacral hiatus are clinically important for Caudal epidural block in Pediatric, Obsteric, Orthopedic, Urologic and Surgical practice. The reliability and success of Caudal epidural block depends upon Knowledge of Variations of Sacrum and Variations of Sacral hiatus.

Morphometry of sacral hiatus and its clinical relevance in caudal epidural block

Context: The variation in anatomical features of sacral hiatus and the dorsal wall of sacral canal is related to its clinical application in caudal epidural anesthesia. Through the sacral hiatus, it is employed in operation in the anal region and on the external genital organs, as well as cystoscopic examination of male. Continuous caudal anesthesia is also used in obstetrics during parturition for better cervical dilatation and shortening the first stage of labor. Methods: The present study was performed on 172 (one hundred seventy two) adult human dry sacra of unknown sex. The study samples were distributed in male and female sex groups by discriminant function analysis. The study was cross sectional analytical type and was conducted in the department of Anatomy, Dhaka Medical College, Dhaka, from January 2011 to December 2011. The various landmarks of sacral hiatus were measured with the help of digital slide calipers. Results: The mean length of sacral hiatus in male and female was found 26.38±12.02 mm and 25.63±10.46 mm respectively. The mean anterior-posterior diameter of sacral hiatus at the apex was found 4.76±1.73 mm in male and 4.92±2.13 mm in female. Transverse width of the sacral hiatus at the base found 17.29±3.89 mm in male and 18.01±3.70 mm in female. Different in shape of sacral hiatus between male and female found statistically not significant. Location of apex of sacral hiatus was found highest in number at the level of 4th sacral vertebra (60.20%) and maximum location of base of the sacral hiatus was at the level of 5th sacral vertebra (91.20%). The sacral hiatus has anatomical variations and understanding of these variations may improve the success of caudal epidural anesthesia. DOI: http://dx.doi.org/10.3329/jdmc.v23i1.22690 J Dhaka Medical College, Vol. 23, No.1, April, 2014, Page 31-36

A study of variations of sacral hiatus of dry human sacra in north interior Karnataka region

Abstract Background and aims: The shape of sacral hiatus is known to show a number of anatomical variations. The shape and extent of sacral hiatus is important because in caudal epidural anaesthesia, the approach is made through sacral hiatus. The detailed anatomical knowledge of variations of sacral hiatus is very helpful to the anaesthetists to increase the success rate of caudal anaesthesia. The present study is an attempt to find out variations of sacral hiatus in north interior Karnataka region. Materials and methods: For the present study, one hundred dry human sacra obtained from north interior Karnataka region were used. Results: The inverted U shaped sacral hiatus was most common (56%). Inverted V shaped sacral hiatus was found in 24% of sacra. The other variations like irregular shaped hiatus (10%), bifid hiatus (2%), dumbbell shaped hiatus (5%), complete spina bifida (1%) and absent hiatus (2%) were also found. Conclusion: Abnormal shapes of sacral hiatus like irregular, bifid, dumbbell, completespina bifida and absent hiatus were seen in 20%of total 100 sacra belonging to north interior Karnataka.

Anatomical study of sacral hiatus in South Indian population and its clinical significance in caudal epidural anaesthesia

Abstract Background: Caudal anaesthesia is administered into the epidural space through Sacral Hiatus(SH). Hence reliability and success of caudal epidural anaesthesia depends upon the anatomical knowledge of sacral hiatus. Aim: The aim is to study the morphological measurements and variations of structures around the sacral hiatus and to identify possible anatomical reasons for failure of caudal epidural anaesthesia (CEA). Materials and methods: Fifty three dry adult sacral bones of both sexes were measured using Vernier Caliper, scale and divider. The shape of sacral hiatus (SH) was observed and its length and breadth were measured. The measurements were focused on sacral hiatus and its relation with surrounding bony projections. Results: The shape of the sacral hiatus showed a maximum occurrence of inverted 'V' and 'U' shapes with 35.85% and 26.42% respectively. The level of apex of SH was maximum at S4 foramen level in 68.63% cases followed by S5 and S3 level. In 62.26%, the level of base was observed at S5 level . The average length of the sacral hiatus was 23.02(± 8.95 mm), APdiameter was 5.49 (±l.44 mm) and base of SH was 14.6 (± 3.99 mm). The distance from apex and base of SH to S2 foramen level was 31.07 mm and 52.86 mm respectively. Conclusion: The anatomical knowledge of SH is very much necessary to increase the reliability and success of CEA. Surrounding bony irregularity, different shapes of hiatus and defect in dorsal wall of sacral canal should be taken into consideration before undertaking CEA so as to avoid its failure.

A study of variations of sacral hiatus of dry human sacra in north interior Karnataka region

Background and aims: The shape of sacral hiatus is known to show a number of anatomical variations. The shape and extent of sacral hiatus is important because in caudal epidural anaesthesia, the approach is made through sacral hiatus. The detailed anatomical knowledge of variations of sacral hiatus is very helpful to the anaesthetists to increase the success rate of caudal anaesthesia. The present study is an attempt to find out variations of sacral hiatus in north interior Karnataka region. Materials and methods: For the present study, one hundred dry human sacra obtained from north interior Karnataka region were used. Results: The inverted U shaped sacral hiatus was most common (56%). Inverted V shaped sacral hiatus was found in 24% of sacra. The other variations like irregular shaped hiatus (10%), bifid hiatus (2%), dumbbell shaped hiatus (5%), complete spina bifida (1%) and absent hiatus (2%) were also found. Conclusion: Abnormal shapes of sacral hiatus like irregular, bifid, dumbbell, completespina bifida and absent hiatus were seen in 20% of total 100 sacra belonging to north interior Karnataka.

Importance of knowing the level of sacral hiatus for caudal epidural anesthesia

Abstract Introduction and Materials and Methods: The Study was carried out on 100 dry human sacra to know the Anatomical variations of sacral hiatus. Results: Different shapes of sacral hiatus were observed which included- Inverted U (56%), Inverted V (14%), Irregular (16%), Dumb-bell (10%), Bifid (2%) and Elongated (2%). The apex of the sacral hiatus was most commonly found at the level of 3rd sacral vertebrae in 62%. The mean length of sacral hiatus was 25.2mm, the mean anteroposterior diameter of sacral canal at the apex of sacral hiatus was 5.53mm. The mean distance between sacral cornu at the base of sacral hiatus was observed to be 19.5mm. Conclusion: This study was done to clarify the anatomical variations of sacral hiatus using bony landmarks of sacrum for improving the reliability of caudal epidural anesthesia and to improve its success rate and reduce the complications and failure rate.

Anatomical study of sacral hiatus for successful caudal epidural block

Background: Present study determined the landmarks for caudal epidural block (CEB) after morphometric measurements of the sacral hiatus on dry sacral bones. The CEB has been widely used procedure for the diagnosis and treatment of lumbar spinal disorders. Anatomical features of the sacral hiatus and the detailed knowledge about sacral hiatus. Materials & Methods: 116 sacral bones are used for the study. Anatomical measurements were measured by using vernier caliper accuracy to 0.1 mm. Results: Agenesis of sacral hiatus was detected in two sacral bones. Various shapes of sacral hiatus were observed which included inverted U (31%), inverted V (25.8%), irregular (20.6%), Elongated (17.2%) and dumbbell (5%). Apex of sacral hiatus was commonly found at the level of 4th sacral vertebra in 50.8%. The distance between the two supero lateral sacral crests and the distance between the apex of sacral hiatus and the right and left supero lateral crests were 69.5 (5.8) mm, 61.4 (11.2) mm, 57.4 (9.7) mm respectively, on average. The mean, mode, SD is calculated for all the measurements. Conclusion: The sacral hiatus has anatomic variations. Understanding of these variations may improve the reliability of CEB.