RESUMEN
CASE: We present a case of robot-assisted placement of 3 trans-sacral transiliac screws through a single corridor for an unstable U-type sacral fracture in a 95-year-old woman. She had persistent pain and inability to mobilize with physical therapy. At 3-month follow-up, the patient had evidence of interval healing and stable hardware and was able to return to her prior functional baseline. CONCLUSION: We demonstrate successful utilization of robotics to place 3 trans-sacral transiliac screws in a single corridor for fixation of an unstable pelvic ring injury. This technique was used to overcome challenges with visualization and implant placement.
Asunto(s)
Tornillos Óseos , Fijación Interna de Fracturas , Procedimientos Quirúrgicos Robotizados , Sacro , Fracturas de la Columna Vertebral , Humanos , Femenino , Sacro/cirugía , Sacro/lesiones , Sacro/diagnóstico por imagen , Procedimientos Quirúrgicos Robotizados/métodos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Anciano de 80 o más Años , Fracturas de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/diagnóstico por imagenRESUMEN
ABSTRACT: A 58-year-old man with dysphagia and trismus symptoms presented a lobulated tumor in the right tonsil and ipsilateral laterocervical stony adenopathies in the physical examination. He had prostate carcinoma as clinical precedent. The tonsilar lesion showed focal FDG uptake (SUV max , 10.89) on PET/CT and increased glycemic metabolism in the left sacral wing (SUV max , 10.90) without clear morphological lesion in CT. There was also uptake of the tracer in sacrum in the bone scan. Metastatic involvement was suspected, requiring radioguided biopsy to determine the etiology. Due to radioguided biopsy, histological analysis of the metastasis was performed, with epidermoid carcinoma metastasis diagnosis.
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Cámaras gamma , Sacro , Humanos , Masculino , Persona de Mediana Edad , Sacro/diagnóstico por imagen , Biopsia Guiada por Imagen , Periodo Intraoperatorio , Tomografía Computarizada por Tomografía de Emisión de PositronesRESUMEN
BACKGROUND: Congenital spondylolisthesis is characterized by dysplasia of the facet joint or congenital defect in the pars. OBJECTIVE: Our study highlights the clinical and radiological profile, various treatment options, and outcomes in patients with pediatric congenital lumbar and lumbosacral spondylolisthesis. METHODS: A retrospective analysis and follow-up of 22 patients were conducted presented with radiological diagnosis of congenital lumbar/lumbosacral spondylolisthesis (2018-2021). RESULTS: Twenty patients (91%) had L5-S1 listhesis and two patients (9%) had L4-L5 listhesis. Six (27.3%) patients had low-grade listhesis (grades 1-2), 16 (72.7%) had high-grade listhesis (grades 3-5). Seventeen (77.3%) had S1, three (13.6%) had L5, and two (9%) had both L4-L5 radiculopathy. All patients had neurogenic claudication. One had an associated spina bifida occulta. Six (27.3%) patients underwent two-level fixation, and 16 (72.7%) underwent three-level fixation. Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS TLIF) was done in two patients. Revision of at least one screw was done in three patients. After one year of follow-up, all the patients had 75-100% relief in radicular pain and neurogenic claudication. The Oswestry Disability Index (ODI) score in preop for all patients was 41-60% and postoperatively they showed an improvement in ODI score (0-20). The postoperative low back pain score on the Numeric Rating Scale was 0-1 for all patients. CONCLUSION: Congenital lumbar spondylolisthesis usually presents with high-grade listhesis. Management of such cases is a surgical challenge but posterior decompression resulted in relief of pain in all patients. However, in situ fixation without reduction is also effective in selective cases where attempts to reduce the listhesis result in a decline in intraoperative neuromonitoring parameters.
Asunto(s)
Vértebras Lumbares , Fusión Vertebral , Espondilolistesis , Humanos , Espondilolistesis/cirugía , Espondilolistesis/diagnóstico por imagen , Niño , Estudios Retrospectivos , Masculino , Femenino , Vértebras Lumbares/cirugía , Fusión Vertebral/métodos , Adolescente , Región Lumbosacra/cirugía , Resultado del Tratamiento , Sacro/cirugía , Sacro/diagnóstico por imagen , Preescolar , Descompresión Quirúrgica/métodosRESUMEN
PURPOSE: We developed a 3D-printed phantom model for ultrasound-guided caudal block for educational or training purposes because there have been no reports of the 3D-printed phantom model for ultrasound-guided caudal block. This study aimed to identify the needs for the phantom model in a lecture and demonstration at hands-on training (HoT) to promote the use of caudal block for sufficient pain control during high-dose-rate intracavitary/interstitial brachytherapy for gynecological cancers. MATERIALS AND METHODS: The sacrum and formwork were designed by computed tomography imaging. A 3D-modeling software program was used to create the sacrum and formwork. The phantom was solidified by injecting a gelatin-based gel. Ultrasonography was performed to visualize the sacral hiatus and puncture needle in the phantom. In October 2023, 10 radiation oncologists who did not perform caudal block in daily clinical practice from ten Japanese facilities participated in HoT on ultrasound-guided caudal block. After the HoT, questionnaires were distributed to each participant, and feedback was obtained through online channels. RESULTS: After receiving a lecture and demonstration on ultrasound-guided caudal block, 90% of the respondents would like to practice the procedure in their daily clinical practice. Moreover, 100% of the respondents would like to use the 3D-printed phantom model for ultrasound-guided caudal block for educational or training purposes. CONCLUSION: The 3D-printed phantom model for ultrasound-guided caudal block can be used in training and is in demand for facilities introducing caudal block.
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Braquiterapia , Neoplasias de los Genitales Femeninos , Fantasmas de Imagen , Impresión Tridimensional , Ultrasonografía Intervencional , Humanos , Femenino , Braquiterapia/instrumentación , Braquiterapia/métodos , Neoplasias de los Genitales Femeninos/radioterapia , Neoplasias de los Genitales Femeninos/diagnóstico por imagen , Bloqueo Nervioso/métodos , Sacro/diagnóstico por imagenRESUMEN
BACKGROUND: Sacral screw loosening is a typical complication after internal fixation surgery through the vertebral arch system. Bicortical fixation can successfully prevent screw loosening, and how improving the rate of bicortical fixation is a challenging clinical investigation. OBJECTIVE: To investigate the feasibility of improving the double corticality of sacral screws and the optimal fixation depth to achieve double cortical fixation by combining the torque measurement method with bare hands. METHODS: Ninety-seven cases of posterior lumbar internal fixation with pedicle root system were included in this study. Based on the tactile feedback of the surgeon indicating the expected penetration of the screw into the contralateral cortex of the sacrum, the screws were further rotated by 180°, 360°, or 720°, categorized into the bicortical 180° group, bicortical 360° group, and bicortical 720° group, respectively. Intraoperatively, the torque during screw insertion was recorded. Postoperatively, the rate of double-cortex engagement was evaluated at 7 days, and screw loosening was assessed at 1 year follow-up. RESULTS: The bicortical rates of the 180° group, 360° group, and 720° group were 66.13%, 91.18% and 93.75%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05).The rates of loosening of sacral screws in the 180° group, 360° group, and 720° group were 20.97%, 7.35% and 7.81%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05). The bicortical 360° group achieved a relatively satisfactory rate of dual cortical purchase while maintaining a lower rate of screw loosening. CONCLUSION: Manual insertion of sacral screws with the assistance of a torque measurement device can achieve a relatively satisfactory dual cortical purchase rate while reducing patient hospitalization costs.
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Tornillos Óseos , Vértebras Lumbares , Sacro , Fusión Vertebral , Torque , Humanos , Masculino , Femenino , Sacro/cirugía , Sacro/diagnóstico por imagen , Persona de Mediana Edad , Anciano , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Vértebras Lumbares/cirugía , Adulto , Estudios de Factibilidad , Resultado del Tratamiento , Estudios de SeguimientoRESUMEN
BACKGROUND: Hip abductor deficiency is a common cause of lateral hip pain in middle-aged patients. Identifying upstream muscle denervation originating in the lumbo-sacral spine could potentially impact the management of patients who have abductor deficiency. The purpose of this study was to estimate the prevalence of lumbo-sacral pathology (L4 to S1) in patients undergoing hip abductor tendon repair. METHODS: All cases of primary hip abductor repair performed at a tertiary care center between January 2010 and December 2021 were reviewed. Patients were classified into the following groups: A) confirmed L4 to S1 disease based on preoperative or perioperative L4 to S1 interventions (ie, surgery, epidural injections, and/or positive electromyography findings); B) radiographic evidence on lumbar spine magnetic resonance imaging demonstrating nerve compression at L4 to S1; and C) no evidence of L4 to S1 disease. RESULTS: There were 131 cases of primary hip abductor repair that were included. Over 80% of patients were women, who had a mean age of 64 years (range, 20 to 85). There were thirteen patients (9.9%) who underwent concomitant total hip arthroplasty (THA). Of the included patients, 29% (n = 38) were categorized into group A, 12% (n = 16) into group B, and 59% (n = 77) into group C. Patients who had L4 to S1 pathology were older than patients who did not have L4 to S1 pathology (67 versus 61 years, P = .004). Of the patients undergoing concomitant THA and hip abductor repair, 54% demonstrated evidence of lumbo-sacral spine pathology. CONCLUSIONS: Over 40% of patients undergoing isolated hip abductor tendon repair and >50% of patients undergoing concomitant hip abductor tendon repair and THA demonstrated evidence of L4 to S1 disease perioperatively. Patients demonstrating symptomatic hip abductor deficiency should be screened for concomitant lower lumbo-sacral spine pathology.
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Vértebras Lumbares , Imagen por Resonancia Magnética , Humanos , Femenino , Persona de Mediana Edad , Masculino , Anciano , Adulto , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Anciano de 80 o más Años , Estudios Retrospectivos , Articulación de la Cadera/cirugía , Articulación de la Cadera/diagnóstico por imagen , Tendones/cirugía , Sacro/cirugía , Sacro/diagnóstico por imagen , Artroplastia de Reemplazo de Cadera , Adulto Joven , Músculo Esquelético , Región Lumbosacra/cirugía , ElectromiografíaRESUMEN
BACKGROUND: Caudal regression syndrome (CRS), also known as caudal agenesis, results from abnormal development of the caudal aspect of the spinal cord and vertebral column due to an earlier abnormality of gastrulation. RESULTS: This report showcases a unique scenario where three siblings, devoid of any prior family history or identifiable risk factors, exhibit symptoms of CRS and receive care at a government-run tertiary facility dedicated to children's health. In establishing a concrete diagnosis, we relied on skeletal surveys, comprehensive symptom evaluation, and medical history assessment. Additionally, we recommended further investigation through magnetic resonance imaging and genetic testing to attain a more in-depth understanding and confirmation of the condition. Unfortunately, the financial constraints faced by the parents led to the unfeasibility of pursuing these advanced diagnostic options. Given the rarity of this syndrome and the limited existing literature, our report is a significant contribution. It marks the first comprehensive exploration of CRS from the genetic and familial predisposition perspective, shedding new light on this rare condition. CONCLUSION: This case series pioneers our understanding of the familial and genetic connections between CRS and sacral agenesis. Strikingly, each subsequent generation has experienced more severe manifestations earlier, furnishing compelling evidence that underpins the genetic predisposition to CRS.
Asunto(s)
Hermanos , Humanos , Masculino , Femenino , Sacro/anomalías , Sacro/diagnóstico por imagen , Niño , Preescolar , Imagen por Resonancia Magnética , Lactante , Meningocele/diagnóstico por imagen , Anomalías Múltiples , Región Sacrococcígea/anomalíasRESUMEN
OBJECTIVE: This study aimed to identify which lumbar vertebral level above a lumbosacral transitional vertebra (LSTV) demonstrated the longest transverse process (TVP) lengths. METHODS: In this exploratory quantitative osteological cohort study using a digital Vernier caliper, dried human cadaveric lumbar TVPs were measured for linear horizontal length at each lumbar vertebra, left and right sides. Data collection was conducted in South Africa at the Raymond A. Dart Collection of Modern Human Skeletons and the Pretoria Bone Collection. The LSTV cohort consisted of 110 spinal columns and an LSTV-free control cohort of a sex-balanced randomized selection of 30 male and 30 female spinal columns. RESULTS: Compared with the control cohort, the LSTV cohort demonstrated longer TVPs for every vertebral level, particularly L3, while the left side demonstrated longer TVPs overall. There were no statistical differences in TVP length within the LSTV cohort when comparing all levels (P > 0.05). The L3 TVPs demonstrated the longest mean lengths in both control (65%) and LSTV (58%) cohorts. The general trend was that the TVPs of L3 had the longest mean length for both the left and the right sides in both cohorts and both sexes. CONCLUSIONS: In the absence of whole-spine imaging, these findings indicate that L3 TVPs may offer an alternative bony landmark, which may aid in spinal enumeration estimation in the setting of LSTV. This is of value for radiograph appraisal and may aid with correct-level intervention.
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Vértebras Lumbares , Humanos , Masculino , Femenino , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/anatomía & histología , Cadáver , Anciano , Persona de Mediana Edad , Estudios de Cohortes , Adulto , Sacro/diagnóstico por imagen , Sacro/anatomía & histología , Puntos Anatómicos de Referencia , Región Lumbosacra/diagnóstico por imagen , Región Lumbosacra/anatomía & histología , Anciano de 80 o más Años , Sudáfrica , Relevancia ClínicaRESUMEN
BACKGROUND: Severe sagittal plane deformity with loss of L4-S1 lordosis is disabling and can be improved through various surgical techniques. However, data are limited on the differing ability of anterior lumbar interbody fusion (ALIF), pedicle subtraction osteotomy (PSO), and transforaminal lumbar interbody fusion (TLIF) to achieve alignment goals in severely malaligned patients. METHODS: Severe adult spinal deformity patients with preoperative PI-LL >20°, L4-S1 lordosis <30°, and full body radiographs and PROMs at baseline and 6-week postoperative visit were included. Patients were grouped into ALIF (1-2 level ALIF at L4-S1), PSO (L4/L5 PSO), and TLIF (1-2 level TLIF at L4-S1). Comparative analyses were performed on demographics, radiographic spinopelvic parameters, complications, and PROMs. RESULTS: Among the 96 included patients, 40 underwent ALIF, 27 underwent PSO, and 29 underwent TLIF. At baseline, cohorts had comparable age, sex, race, Edmonton frailty scores, and radiographic spinopelvic parameters (P > 0.05). However, PSO was performed more often in revision cases (P < 0.001). Following surgery, L4-S1 lordosis correction (P = 0.001) was comparable among ALIF and PSO patients and caudal lordotic apex migration (P = 0.044) was highest among ALIF patients. PSO patients had higher intraoperative estimated blood loss (P < 0.001) and motor deficits (P = 0.049), and in-hospital ICU admission (P = 0.022) and blood products given (P = 0.004), but were otherwise comparable in terms of length of stay, blood transfusion given, and postoperative admission to rehab. Likewise, 90-day postoperative complication profiles and 6-week PROMs were comparable as well. CONCLUSIONS: ALIF can restore L4-S1 sagittal alignment as powerfully as PSO, with fewer intraoperative and in-hospital complications. When feasible, ALIF is a suitable alternative to PSO and likely superior to TLIF for correcting L4-S1 lordosis among patients with severe sagittal malalignment.
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Lordosis , Vértebras Lumbares , Complicaciones Posoperatorias , Fusión Vertebral , Humanos , Lordosis/cirugía , Lordosis/diagnóstico por imagen , Femenino , Masculino , Persona de Mediana Edad , Fusión Vertebral/métodos , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Anciano , Osteotomía/métodos , Sacro/cirugía , Sacro/diagnóstico por imagen , Estudios Retrospectivos , Resultado del Tratamiento , AdultoRESUMEN
Nicolaides-Baraitser syndrome (NCBRS) is a rare autosomal dominant genetic condition that is characterized by severe intellectual disability, dysmorphic facial features, short stature, sparse hair, and early onset seizures. This diagnosis is established by suggestive clinical findings and the identification of a heterozygous SMARCA2 pathogenic variant by molecular genetic testing. There are not, however, consensus clinical diagnostic criteria for this condition as there are so few documented cases. Here, we present a case of prenatally diagnosed caudal regression with sacral agenesis and congenital vertical talus (rocker bottom feet) that was ultimately found to have a de novo SMARCA2 pathogenic variant. The patient had an amniocentesis with normal karyotype and microarray followed by failed direct rapid whole exome sequencing (WES) due to maternal cell contamination. She elected for termination of the pregnancy based on the clinical prognosis of the ultrasound findings; WES revealed a pathogenic variant after her termination. We believe this is the first case of these findings associated with NCBRS. If any future cases of either finding are found in association with a SMARCA2 genetic variant, caudal regression and rocker bottom feet should be included in the spectrum of physical traits associated with this pathogenic variant.
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Anomalías Múltiples , Facies , Discapacidad Intelectual , Factores de Transcripción , Adulto , Femenino , Humanos , Embarazo , Anomalías Múltiples/genética , Anomalías Múltiples/diagnóstico por imagen , Anomalías Múltiples/diagnóstico , Secuenciación del Exoma , Deformidades Congénitas del Pie , Hipotricosis , Discapacidad Intelectual/genética , Discapacidad Intelectual/diagnóstico , Discapacidad Intelectual/diagnóstico por imagen , Sacro/anomalías , Sacro/diagnóstico por imagen , Factores de Transcripción/genética , Ultrasonografía PrenatalRESUMEN
BACKGROUND: posterior pedicle screw fixation is common method, one of the most severe complications is iatrogenic vascular damage, no report investigated association of different introversion angles (INTAs) and length of pedicle screw. The aims were to investigate the optimal introversion angle and length of pedicle screw for improving the safety of the operation, and to analyze the differences of vascular damage types at L1-S1. METHODS: Lumbar CT imaging data from110 patients were analyzed by DICOM software, and all parameters were measured by new Cartesian coordinate system, INTAs (L1-L5:5°,10°,15°,S1: 0°, 5°,10°,15°), DO-AVC (the distance between the origin (O) with anterior vertebral cortex (AVC)), DAVC-PGVs (the distance between AVC and the prevertebral great vessels (PGVs)), DO-PGVs (the distance between the O and PGVs). At different INTAs, DAVC-PGVs were divided into four grades: Grade III: DAVC-PGVs ≤ 3 mm, Grade II: 3 mm < DAVC-PGVs ≤ 5 mm, Grade I: DAVC-PGVs > 5 mm, and N: the not touching PGVs. RESULTS: The optimal INTA was 5° at L1-L3, the left was 5° and the right was 15° at L4, and screw length was less than 50 mm at L1-L4. At L5, the left optimal INTA was 5° and the right was 10°, and screw length was less than 45 mm. The optimal INTA was 15° at S1, and screw length was less than 50 mm. However, screw length was less than 40 mm when the INTA was 0° or 5° at S1. CONCLUSIONS: At L5-S1, the risk of vascular injury is the highest. INTA and length of the pedicle screw in lumbar operation are closely related. 3 mm interval of screw length may be more preferable to reduce vascular damage.
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Vértebras Lumbares , Tornillos Pediculares , Fusión Vertebral , Lesiones del Sistema Vascular , Humanos , Femenino , Masculino , Persona de Mediana Edad , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Anciano , Lesiones del Sistema Vascular/prevención & control , Lesiones del Sistema Vascular/etiología , Adulto , Fusión Vertebral/métodos , Fusión Vertebral/instrumentación , Tomografía Computarizada por Rayos X , Sacro/cirugía , Sacro/diagnóstico por imagen , Sacro/lesiones , Estudios RetrospectivosRESUMEN
OBJECTIVES: Lateral compression type II pelvic ring injuries can be treated with fixation through open or percutaneous approaches depending on the injury pattern and available osseous fixation pathways. The start site of iliosacral screws to stabilize these injuries should be on the unstable posterior iliac fragment; however, our understanding of start sites for iliosacral screws has not been developed. The purpose of this study is to provide an analysis of iliosacral screw start sites on the posterior ilium to help guide treatment of pelvic ring injuries. METHODS: One-hundred and seventeen consecutive patients at an academic level I trauma center with pelvic ring injuries who underwent surgical treatment with iliosacral screws were included in the final analysis. The start sites of iliosacral screws with confirmed intraosseous placement on a postoperative computed tomography were mapped on the posterior ilium and analyzed according to the sacral segment and type of iliosacral screw. RESULTS: One-hundred and seventeen patients were included in the final analysis. Of the total of 272 iliosacral screw insertion sites analyzed, 145 (53%) were sacroiliac-style screws and 127 (47%) were transsacral screws. The insertion sites for sacroiliac-style screws and transsacral screws at different sacral segment levels can vary but have predictable regions on the posterior ilium relative to reliable osseous landmarks. CONCLUSIONS: Iliosacral screws start sites on the posterior ilium have reliable regions that can be used to plan posterior fixation of pelvic ring injuries.
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Tornillos Óseos , Fijación Interna de Fracturas , Fracturas Óseas , Ilion , Huesos Pélvicos , Sacro , Tomografía Computarizada por Rayos X , Humanos , Ilion/cirugía , Ilion/lesiones , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/instrumentación , Fracturas Óseas/cirugía , Fracturas Óseas/diagnóstico por imagen , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Huesos Pélvicos/diagnóstico por imagen , Masculino , Femenino , Sacro/cirugía , Sacro/lesiones , Sacro/diagnóstico por imagen , Adulto , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Centros Traumatológicos , AncianoAsunto(s)
Fijación Interna de Fracturas , Vértebras Lumbares , Huesos Pélvicos , Sacro , Fracturas de la Columna Vertebral , Humanos , Sacro/lesiones , Sacro/cirugía , Sacro/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fracturas de la Columna Vertebral/cirugía , Fracturas de la Columna Vertebral/diagnóstico por imagen , Huesos Pélvicos/lesiones , Huesos Pélvicos/cirugía , Huesos Pélvicos/diagnóstico por imagen , Vértebras Lumbares/cirugía , Vértebras Lumbares/lesiones , Tornillos Óseos , Resultado del TratamientoRESUMEN
PURPOSE: Spinopelvic sagittal alignment is crucial for assessing balance and determining treatment efficacy in patients with adult spinal deformity (ASD). Only a limited number of reports have addressed spinopelvic parameters and lumbosacral transitional vertebrae (LSTV). Our primary objective was to study spinopelvic sagittal parameter changes in patients with LSTV. A secondary objective was to investigate clinical symptoms and quality of life (QOL) in patients with LSTV. METHODS: In this study, we investigated 371 participants who had undergone medical check-ups for the spine. LSTV was evaluated using Castellvi's classification, and patients were divided into LSTV+ (type II-IV, L5 vertebra articulated or fused with the sacrum) and LSTV- groups. After propensity score matching for demographic data, we analyzed spinopelvic parameters, sacroiliac joint degeneration, clinical symptoms, and QOL for these two participant groups. Oswestry Disability Index (ODI) scores and EQ-5D (EuroQol 5 dimensions) indices were compared between the two groups. RESULTS: Forty-four patients each were analyzed in the LSTV + and LSTV- groups. The LSTV + group had significantly greater pelvic incidence (52.1 ± 11.2 vs. 47.8 ± 10.0 degrees, P = 0.031) and shorter pelvic thickness (10.2 ± 0.9 vs. 10.7 ± 0.8 cm, P = 0.018) compared to the LSTV- group. The "Sitting" domain of ODI (1.1 ± 0.9 vs. 0.6 ± 0.7, P = 0.011) and "Pain/Discomfort" domain of EQ-5D (2.0 ± 0.8 vs. 1.6 ± 0.7, P = 0.005) were larger in the LSTV + group. CONCLUSION: There was a robust association between LSTV and pelvic sagittal parameters. Clinical symptoms also differed between the two groups in some domains. Surgeons should be aware of the relationship between LSTV assessment, radiographic parameters and clinical symptoms.
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Vértebras Lumbares , Calidad de Vida , Sacro , Humanos , Masculino , Femenino , Persona de Mediana Edad , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/anomalías , Anciano , Sacro/diagnóstico por imagen , Adulto , Articulación Sacroiliaca/diagnóstico por imagenRESUMEN
BACKGROUND: It was reported the paraspinal muscle played an important role in spinal stability. The preoperative paraspinal muscle was related to S1 screw loosening. But the relationship between preoperative and postoperative change of psoas major muscle (PS) and S1 pedicle screw loosening in degenerative lumbar spinal stenosis (DLSS) patients has not been reported. This study investigated the effects of preoperative and follow-up variations in the psoas major muscle (PS) on the first sacral vertebra (S1) screw loosening in patients with DLSS. METHODS: 212 patients with DLSS who underwent lumbar surgery were included. The patients were divided into the S1 screw loosening group and the S1 screw non-loosening group. Muscle parameters were measured preoperatively and at last follow-up magnetic resonance imaging. A logistic regression analysis was performed to investigate the risk factors for S1 screw loosening. RESULTS: The S1 screw loosening rate was 36.32% (77/212). The relative total cross-sectional areas and relative functional cross-sectional areas (rfCSAs) of the PS at L2-S1 were significantly higher after surgery. The increased rfCSA values of the PS at L3-S1 in the S1 screw non-loosening group were significantly higher than those in the S1 screw loosening group. The regression analysis showed male, lower CT value of L1 and longer segment fusion were independent risk factors for S1 screw loosening, and postoperative hypertrophy of the PS was a protective factor for S1 screw loosening. CONCLUSIONS: Compared to the preoperative muscle, the PS size increased and fatty infiltration decreased after surgery from L2-3 to L5-S1 in patients with DLSS after short-segment lumbar fusion surgery. Postoperative hypertrophy of the PS might be considered as a protective factor for S1 screw loosening. MRI morphometric parameters and postoperative selected exercise of PS for DLSS patients after posterior lumbar fusion surgery might contribute to improvement of surgical outcome.
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Vértebras Lumbares , Tornillos Pediculares , Músculos Psoas , Fusión Vertebral , Estenosis Espinal , Humanos , Masculino , Estenosis Espinal/cirugía , Estenosis Espinal/diagnóstico por imagen , Femenino , Vértebras Lumbares/cirugía , Vértebras Lumbares/diagnóstico por imagen , Anciano , Músculos Psoas/diagnóstico por imagen , Persona de Mediana Edad , Estudios de Seguimiento , Fusión Vertebral/instrumentación , Fusión Vertebral/efectos adversos , Imagen por Resonancia Magnética , Sacro/diagnóstico por imagen , Sacro/cirugía , Estudios Retrospectivos , Factores de Riesgo , Anciano de 80 o más Años , Periodo PreoperatorioRESUMEN
Inability to remain motionless owing to pain during magnetic resonance imaging (MRI) may increase the need for sedation and analgesia. Here, we present a case where ultrasound-guided sacral erector spinae plane block (ESPB) was used successfully for pain management during an MRI in a patient suffering from severe sacral pain. Sacral ESPB was performed with a total of 30 mL of 0.25% bupivacaine at the level of the intermediate sacral crest. The patient achieved sensory block in the L5-S4 dermatomes without motor block, resulting in complete pain relief. This case report highlights the feasibility of ultrasound-guided sacral ESPB as a potential pain management technique.
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Imagen por Resonancia Magnética , Bloqueo Nervioso , Manejo del Dolor , Ultrasonografía Intervencional , Humanos , Anestésicos Locales/administración & dosificación , Bupivacaína/administración & dosificación , Bloqueo Nervioso/métodos , Manejo del Dolor/métodos , Músculos Paraespinales/diagnóstico por imagen , Músculos Paraespinales/inervación , Sacro/diagnóstico por imagen , Sacro/inervación , Ultrasonografía Intervencional/métodosRESUMEN
BACKGROUND: Sacral fatigue fractures are a rare injury but should be considered as a differential diagnosis for low back and buttock pain in young adults. Collective reports are limited, most of which have focused on long-distance runners. PURPOSE: To investigate the characteristics of sacral fatigue fractures in adolescents. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We analyzed patient background characteristics, physical examination and imaging findings, and treatment courses of those diagnosed with sacral fatigue fractures using magnetic resonance imaging. RESULTS: Among 34 patients with sacral fatigue fractures, 15 and 19 were male and female patients, respectively, with an age range of 11 to 19 years (mean age, 15.0 years). Almost all patients were athletes, and 29 patients performed their sport ≥5 times a week. Long-distance runners were the most commonly affected, comprising 7 patients, and participants in other common sports such as baseball (6 patients), basketball (4 patients), and soccer (3 patients) were also affected. Physical examination revealed tension sign (Lasègue test) on the affected side in 6 patients and tight hamstrings in 24 patients. Imaging findings included 18 patients with right-side involvement, 12 with left-side involvement, and 4 with involvement on both sides. In 11 patients, spina bifida occulta was observed at S1 and 8 patients had a history of lumbar spondylolysis with 4 patients having concurrent sacral fatigue fractures. Physical therapy was performed concurrently with the cessation of exercise, and return to exercise was permitted if the pain had been relieved after 1 month. All patients returned to sports at a median of 48 days (range, 20-226 days) after symptom onset. However, 2 patients experienced recurrence (1 patient on the ipsilateral side and 1 patient on the contralateral side). CONCLUSION: Sacral stress fractures are not limited to long-distance runners in this population and can manifest as lower back pain or buttock pain in athletes participating in a variety of sports. Although the course of treatment was generally good, the possibility of recurrence must always be considered.
Asunto(s)
Traumatismos en Atletas , Fracturas por Estrés , Imagen por Resonancia Magnética , Sacro , Humanos , Femenino , Masculino , Adolescente , Sacro/lesiones , Sacro/diagnóstico por imagen , Fracturas por Estrés/terapia , Fracturas por Estrés/diagnóstico por imagen , Adulto Joven , Niño , Traumatismos en Atletas/terapia , Dolor de la Región Lumbar/terapia , Dolor de la Región Lumbar/etiología , Fracturas de la Columna Vertebral/terapia , Espina Bífida Oculta/complicacionesRESUMEN
OBJECTIVE: Contemporary management of sacral chordomas requires maximizing the potential for recurrence-free and overall survival while minimizing treatment morbidity. En bloc resection can be performed at various levels of the sacrum, with tumor location and volume ultimately dictating the necessary extent of resection and subsequent tissue reconstruction. Because tumor resection involving the upper sacrum may be quite destabilizing, other pertinent considerations relate to instrumentation and subsequent tissue reconstruction. The primary aim of this study was to survey the surgical approaches used for managing primary sacral chordoma according to location of lumbosacral spine involvement, including a narrative review of the literature and examination of the authors' institutional case series. METHODS: The authors performed a narrative review of pertinent literature regarding reconstruction and complication avoidance techniques following en bloc resection of primary sacral tumors, supplemented by a contemporary series of 11 cases from their cohort. Relevant surgical anatomy, advances in instrumentation and reconstruction techniques, intraoperative imaging and navigation, soft-tissue reconstruction, and wound complication avoidance are also discussed. RESULTS: The review of the literature identified several surgical approaches used for management of primary sacral chordoma localized to low sacral levels (mid-S2 and below), high sacral levels (involving upper S2 and above), and high sacral levels with lumbar involvement. In the contemporary case series, the majority of cases (8/11) presented as low sacral tumors that did not require instrumentation. A minority required more extensive instrumentation and reconstruction, with 2 tumors involving upper S2 and/or S1 levels and 1 tumor extending into the lower lumbar spine. En bloc resection was successfully achieved in 10 of 11 cases, with a colostomy required in 2 cases due to rectal involvement. All 11 cases underwent musculocutaneous flap wound closure by plastic surgery, with none experiencing wound complications requiring revision. CONCLUSIONS: The modern management of sacral chordoma involves a multidisciplinary team of surgeons and intraoperative technologies to minimize surgical morbidity while optimizing oncological outcomes through en bloc resection. Most cases present with lower sacral tumors not requiring instrumentation, but stabilizing instrumentation and lumbosacral reconstruction are often required in upper sacral and lumbosacral cases. Among efforts to minimize wound-related complications, musculocutaneous flap closure stands out as an evidence-based measure that may mitigate risk.