Morphometric study of sacrum and its clinical implications in population in Bihar

The sacrum is a large triangular bone formed by fusion of five sacral vertebrae and wedged between two hip bones. Dimension of sacrum varies from region to region therefore morphometric study of sacrum in population of Bihar is important for proper fixation during orthopedic procedure in trauma patients. : The objectives of this study was to evaluate the morphometric parameters of sacrum so that a data can be generated from local population. M: The present study was done on 110 human sacra of known sex (62 male and 48 female) collected from department of Anatomy, IGIMS, Patna and also from other medical colleges of Bihar. Maximum length of sacrum, curved length of sacrum, maximum breadth of sacrum, antero-posterior diameter of the body of first sacral vertebra, transverse diameter of the body of first sacral vertebra and maximum length of articular surface of sacrum were measured. Mean value of sacral straight length were 104.55 cm in male and 94.66 cm in female, Curve length 112.03 cm in male and 103.98 cm in female, Width of sacrum 101.53 cm in male and 105.67 cm in female. Transverse diameter of body of 1st sacral vertebra were 46.53 cm and 40.85 cm in male and female respectively, antero-posterior diameter of body of 1st sacral vertebra were 29.89 cm and 27.73 cm in male and female respectively, Length of auricular surface were 56.08 cm and 54.77 cm respectively. Sacral index, curvature index, index of body of first sacral vertebra, corpora-basal index and auricular index were calculated. Morphometric study of sacrum in population of Bihar is important because dimension of sacrum varies from region to region and this is important for proper fixation during orthopedic procedure in trauma patients.

Pilot-study of ridden walk on the circle – effects of progressive collection and lateral exercises

When collecting the horse, the rider influences stride length, forehand/hindquarters balance, and head-neck position. The study aim was to describe the vertical excursion of the withers and croup, and the sagittal cannon angles during collection and lateral exercises. Ten horses were ridden by five riders during 14 trials (1-5 per rider) on 10 m circles. Each trial included free walk, four degrees of increasing collection, and haunches-in and shoulderin. Inertial measurement units (100 Hz) were positioned on the withers, the first sacral vertebra (S1) and laterally on the cannons. Data for each exercise were stride-split. Range of motion (ROM), minima and maxima were studied in mixed models, controlling for stride duration. S1 vertical ROM ranged between 30-32 mm (highest degree of collection) and 51 mm (free walk), significantly smaller with increasing collection. S1 ROM during the inside hind limb step was smaller in haunches-in and shoulder-in compared to at the lowest degree of collection. Withers ROM ranged between 12 mm (lowest degree of collection) and 16-18 mm (highest degree of collection). Fore cannon protraction-retraction ROM ranged between 57° (highest degree of collection) and 63° (free walk). Hind cannon protraction-retraction ROM ranged between 47-50° (highest degree of collection) and 51-56° (free walk). All limbs had significantly smaller ROM at the highest degree of collection. Cannon ROMs were smaller for the outer limbs in haunches-in, and all limbs but the outer fore in shoulder-in, compared to the lowest degree of collection. Progressively decreasing ROM for fore- and hind limb cannons and S1 suggest that the riders achieved a shortening of the gait at higher degrees of collection. In shoulder-in and haunches-in, the diagonal oriented in the direction of motion showed decreased hind limb cannon ROM while forelimb cannon ROM was maintained, which could suggest increased shoulder freedom and collection of the targeted diagonal.

Frequency of Sacralisation of Fifth Lumber Vertebra in South Punjab Pakistani Population

Background: Lumbosacral joint carries whole body weight and transmits it to tibia. As the 5th Lumbar Vertebra transits into first Sacral Vertebra, fifth Lumbar Vertebra may be fused on one or both sides to the first Sacral Vertebra, Condition known as ‘Sacralisation’. Aim: To find the frequency of sacralisation of 5th Lumbar Vertebra in South Punjab Pakistani Population. Methods: It was a descriptive observational study conducted in Anatomy Department Quaid-e-Azam Medical College, Bahawalpur. This was descriptive observational study conducted on cadaveric sacra collected in last 7 years. 86 dry Human adult sacra of known sex were observed and results were noted for Sacralisation of Lumbar Vertebra. Results: Out of 86 cadaveric Sacra, Sacralisation was found in 12(14%). Out of these 12, 8 Sacra showed complete Sacralisation while 4 Sacra showed incomplete Sacralisation. Conclusion: Sacralisation of 5th Lumbar Vertebra is common (14%) in cadaveric sacra of South Punjab, Pakistani Population. Key words: Lumbar Vertebra, Sacralisation, Cadaveric, L5 (5th lumbar vertebrae), S1 (1st Sacral Vertebrae).

Pelvic antropometric measurement in 3D CT for placement of two unilateral iliosacral S1 - 7.3 mm screws

Purpose Stability of the dorsal pelvic ring is important for patient mobilisation and can be restored using several surgical procedures after fracture. Placement of percutaneous iliosacral screws is a reliable and minimal-invasive technique to achieve stabilisation of the dorsal pelvic ring by placement of two screws in the first sacral vertebra. Aim of this study was to evaluate 3D CT scans regarding the anatomical possibility to place two 7.3 mm iliosacral screws for fixation of the dorsal pelvic ring. Methods 3D CT datasets of 500 consecutive trauma patients with 1000 hemipelves of a mid-european level I trauma centre with or without pelvic injury were evaluated and measured bilaterally in this retrospective study. Results One thousand hemipelvic datasets of 500 patients (157 females, 343 males) with a mean age of 49.7 years (18 to 95) were included in this study. Only 16 hemipelves (1.6%, 11 in females, 5 in males) in 14 patients (2.8%, 9 females = 5.73%, 5 males = 1.5%) showed too narrow corridors so that 7.3 mm screw placement would not be possible (p = 0.001). In women, too narrow corridors occurred 3.9 times as often as in men. Only two females showed this bilaterally. Conclusion The evaluation of 3D CT scans of the pelvis showed the importance of planning iliosacral screw placement, especially if two 7.3 mm screws are intended to be placed in the first sacral vertebra.

Visualization of the epimysium and fascia thoracolumbalis at the lumbar spine using MRI

Background The fascia thoracolumbalis (FTL) is an important component for stabilization and motion control of the lumbar spine. It coordinates the traction forces of the autochthonous muscles of the back (AM) and connects them to the muscles of the abdominal wall, shoulder, and buttocks. Objectives The aim of our study was to describe the assessment of the normal FTL and epimysium of the AM in MRI and to identify patterns associated with pathological changes in the lumbar spine. Material and methods A total of 33 patients were retrospectively evaluated: 15 patients had no pathology at the lumbar spine; six patients had previous hemilaminectomy, three had spondylodesis, two had ventrolisthesis, and seven had scoliosis. The thickness of the FTL and EM was measured, and the adhesion of both structures was assessed. Results The fascial thickness at the levels of the lumbar vertebral bodies LVB 3 was 1.8, of LVB 4 it was 2.0, of LVB 5 it was 2.1, and at the sacral vertebra SVB 1 it was 1.8 mm. Fascial adhesions together with thickening of the EM occurred at the level of LVB 4 in 36% of the cases independently of the underlying disorder. Only thickening of the EM was seen in 48% of cases at the level of SVB 1. By contrast, adhesion of the FTL without epimysial changes occurred in 36% of cases at the level of LVB 3. Conclusion Thickening and adhesions at the EM and FTL occurred both postoperatively and in the case of scoliosis. Furthermore, lipomatous and muscular herniation could be detected in the FTL postoperatively. Epimysial and fascial alterations may be imaging manifestations of chronic myofascial back pain and should be included in radiological assessments.

Congenital anomalies of the lumbosacral spine

The aim of the study is to compare the structure of the lumbosacral transitional vertebra, which were detected by computed tomography (CT) and identified on dried human sacral, and to discuss possible pathogenetic mechanisms of this congenital malformation. The article presents 9 cases of lumbosacral transitional vertebra, including 6 cases of L5 sacralization and 3 cases of S1 lumbarization. The formation of the transitional lumbosacral vertebra is genetically determined. All types of such developmental anomaly can be detected only on CT. L5 sacralization repeats the process of fusion of the sacral vertebra into a single bone. A lack of the costotransverse bars of the first sacral vertebrae fusion results in the S1 lumbarization.

Sacral osteoid osteoma: a rare cause of back pain in childhood

Involvement of the sacrum is extremely rare, and it has also been reported that the diagnosis of osteoid osteoma in the sacrum can be delayed compared to other skeletal locations. We report the case of a six-year-old girl student who complained of chronic back pain for several months and with some relief with non-steroid anti-inflammatory drugs (NSAID). Further investigations, which included bone and CT scan, revealed the presence of an osteoid osteoma at the second sacral vertebra (S2 vertebra). The patient made an excellent recovery after surgical excision.

STUDY OF DORSAL SACRAL TRIANGLE IN HUMAN SACRA

Introduction: 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. Aim: The main of this study is to find out the anatomical variations of sacral hiatus of the cadaver in human. 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. 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. 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. Keywords: Sacrum, Sacral hiatus, apex, base, caudal epidural anaesthesia