• Title/Summary/Keyword: Sacral

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Therapeutic Considerations of Percutaneous Sacroplasty for the Sacral Insufficiency Fracture

  • Choi, Kyung-Mi;Song, Joon-Ho;Ahn, Sung-Ki;Choi, Hyun-Chul
    • Journal of Korean Neurosurgical Society
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    • v.47 no.1
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    • pp.58-63
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    • 2010
  • Sacral insufficiency fracture is a debilitating injury not easily found in general radiologic examinations and is rarely diagnosed, since its symptoms are obscure. It is known to frequently occur in patients with osteoporosis, but the treatment has not yet been established and various kinds of treatment methods are being attempted. Sacroplasty is sometimes performed by applying percutaneous vertebroplasty which is known to be a less invasive treatment. Since the course of diagnosis of sacral insufficiency fracture is difficult and clear guidelines for treatments have not yet been established, many spine surgeons fail to diagnose patients or speculate on treatment methods. We report our experience in diagnosing a sacral insufficiency fracture in a 54-year-old healthy female patient using MRI and treating her with sacroplasty. From a therapeutic point of view, we then cover the usefulness, effects and characteristics relating to the complications of sacroplasty, along with literature review.

Foot Pressure Analysis of Chronic Low Back Pain Patients by Foot Analyzer (Foot analyzer를 이용한 만성 요통 환자들의 족저 압력 분석)

  • Kim, Eun-Joo;Cho, Yu-Jeong;Song, Mi-Yeon
    • Journal of Korean Medicine Rehabilitation
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    • v.19 no.4
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    • pp.115-126
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    • 2009
  • Objectives : The aim of this study was to evaluate whether the foot pressure distribution correlates with the lumbo-sacral curvature, and the Oswestry Disability Index in chronic low back pain patients. Methods : We measured the fore foot pressure and the rare foot pressure using the foot analyzer in 28 women subjects with chronic low back pain. The lumbo-sacral curvature and the Oswestry Disability Index(ODI) were also measured. Results : 1. Subjects with higher ODI(%) had significantly lower Fore foot pressure/Rare foot pressure ratio(F/R ratio) (p<0.01). 2. Lumbar lordotic angle and Ferguson angle were inversely related to ODI(%) (p<0.05, p<0.01). 3. Lumbar lordotic angle and Ferguson angle were positively related to F/R ratio (all p<0.05). Conclusions : Using the Foot Analyzer(FA-48S, Tech storm Inc.) we have shown that F/R ratio has significant correlation with the lumbo-sacral curvature and the Oswestry Disability Index. These result suggest that the Foot analyzer may be used in assessing back pain in chronic low back pain patients.

A Case of Sacral Tuberculosis Mimicking Metastatic Bone Tumor with Elevated CA 19-9 (CA 19-9 상승을 동반한 전이성 골종양으로 오인된 골결핵 1예)

  • Chang, Kyung-Yoon;Ha, Kyung-Sun;Park, Kyung-Seon;Sim, Eun-Hui;Byun, Jae-Ho
    • Journal of Yeungnam Medical Science
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    • v.28 no.2
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    • pp.196-201
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    • 2011
  • A 73-year-old male presented a six-month history of buttock pain radiating into his thigh. The MRI revealed a large enhancing mass lesion involving the sacrum, with extension into the sacral canal. The tumor markers were measured to distinguish skeletal metastasis of carcinoma from primary bone tumor. The CA 19-9 was elevated. Despite the investigation, the primary site of cancer could not be found. Sacral bone biopsy was done. The pathologic examination revealed necrosis, chronic granulomatous inflammation, and multinucleated giant cells, consistent with tuberculosis. Sacral tuberculosis is rare in patients with no history of tuberculosis. Such solitary osteolytic lesions involving the subarticular region of large joints may mimic bone neoplasms and may be called "tuberculous pseudotumors." This case report intends to emphasize that bone tuberculosis should be a differential diagnosis in the presence of atypical clinical and radiological features. As tuberculous lesions may be mistaken for neoplasms, a small amount of fresh tissue should be sent for culture even if clinical diagnosis of a tumor seems likely. Described herein is a case of sacral tuberculosis mimicking metastatic bone tumor with elevated CA 19-9.

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Internal Iliac Artery Ligation with Pad Packing for Hemodynamic Unstable Open Comminuted Sacral Fracture

  • Kim, Sung Kyu;Park, Yun Chul;Jo, Young Goun;Kang, Wu Seong;Kim, Jung Chul
    • Journal of Trauma and Injury
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    • v.30 no.4
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    • pp.238-241
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    • 2017
  • A 52-year-old man experienced blunt trauma upon falling from a height of 40 m while trying to repair the elevator. The patient's systolic blood pressure and hemoglobin levels were 60 mmHg and 7.0 g/dL, respectively, upon admission. A large volume of bloody discharge was observed in the open wound of the perianal area and sacrum. A computed tomography scan revealed an open comminuted sacral fracture with multiple contrast blushes. He underwent emergency laparotomy. Both internal iliac artery ligations were performed to control bleeding from the pelvis. Protective sigmoid loop colostomy was performed because of massive injury to the anal sphincters and pelvis. Pad packing was performed for a sacral open wound and perineal wound at the prone position. After resuscitation of massive transfusion, he underwent the second operation 2 days after the first operation. The pad was removed and the perineal and sacral open wounds were closed. After the damage-control surgery, he recovered safely. In this case, the hemodynamically unstable, open comminuted sacral fracture was treated safely by internal iliac artery ligation with pad packing.

Postoperative Flat Back : Contribution of Posterior Accessed Lumbar Interbody Fusion and Spinopelvic Parameters

  • Kim, Jin Kwon;Moon, Byung Gwan;Kim, Deok Ryeng;Kim, Joo Seung
    • Journal of Korean Neurosurgical Society
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    • v.56 no.4
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    • pp.315-322
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    • 2014
  • Objective : Posterior accessed lumbar interbody fusion (PALIF) has a clear objective to restore disc height and spinal alignment but surgeons may occasionally face the converse situation and lose lumbar lordosis. We analyzed retrospective data for factors contributing to a postoperative flat back. Methods : A total of 105 patients who underwent PALIF for spondylolisthesis and stenosis were enrolled. The patients were divided according to surgical type [posterior lumbar inter body fusion (PLIF) vs. unilateral transforaminal lumbar interbody fusion (TLIF)], number of levels (single vs. multiple), and diagnosis (spondylolisthesis vs. stenosis). We measured perioperative index level lordosis, lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, and disc height in standing lateral radiographs. The change and variance in each parameter and comparative group were analyzed with the paired and Student t-test (p<0.05), correlation coefficient, and regression analysis. Results : A significant perioperative reduction was observed in index-level lordosis following TLIF at the single level and in patients with spondylolisthesis (p=0.002, p=0.005). Pelvic tilt and sacral slope were significantly restored following PLIF multilevel surgery (p=0.009, p=0.003). Sacral slope variance was highly sensitive to perioperative variance of index level lordosis in high sacral sloped pelvis. Perioperative variance of index level lordosis was positively correlated with disc height variance ($R^2=0.286$, p=0.0005). Conclusion : Unilateral TLIF has the potential to cause postoperative flat back. PLIF is more reliable than unilateral TLIF to restore spinopelvic parameters following multilevel surgery and spondylolisthesis. A high sacral sloped pelvis is more vulnerable to PALIF in terms of a postoperative flat back.

Diagnosis and Treatment of Sacral Asymlocation in Back Pain Patients - Clinical Application of Prolotherapy - (요통 환자에서 엉치뼈 비대칭위치의 진단과 치료 - 프롤로테라피의 임상 적용 -)

  • Kim, Hyeun Sung;Jung, Ki Ho;Park, In Ho;Ryu, Jae Kwang;Sun, Kwang Jin;Lim, Kyung Joon;Jo, Dae Hyun
    • The Korean Journal of Pain
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    • v.20 no.2
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    • pp.130-137
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    • 2007
  • Background: We evaluated the role and effects of prolotherapy in patients presenting with lower back pain and detected sacral asymlocation, by retrospectively analyzing the results of prolotherapy performed at our institute. Methods: Twenty-three patients with referred pain in the lower back rather than distinct radiculopathy, were detected to have sacral asymlocation by simple X-ray from May 2004 through July 2005. The patients were treated with prolotherapy and manipulation by the Ongley's method around the lumbosacral junction, iliolumbar ligament, and sacroiliac joint. They were treated for approximately one to two week intervals, and during this period were rechecked by X-ray and evaluated using the visual analogue scale (VAS). Results: A total of 23 patients were included in the study (10 male and 13 female), and the average age was 41 years. The average VAS at the time of visit was B.5, the average treatment time was 4,7 days, and the average VAS after treatment was 2.1. Conclusions: Back pain, and associated leg and buttock pain, originate from several causes. In these case analyses, instability around the lumbosacral area and sacral asymlocation might have been important causes of patient back pain and associated buttock and leg pain. We therefore applied prolotherapy as well as manipulation techniques devised by Ongley to these patients, and obtained good results.

Biomechanical Study of Posterior Pelvic Fixations in Vertically Unstable Sacral Fractures: An Alternative to Triangular Osteosynthesis

  • Chaiyamongkol, Weera;Kritsaneephaiboon, Apipop;Bintachitt, Piyawat;Suwannaphisit, Sitthiphong;Tangtrakulwanich, Boonsin
    • Asian Spine Journal
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    • v.12 no.6
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    • pp.967-972
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    • 2018
  • Study Design: Biomechanical study. Purpose: To investigate the relative stiffness of a new posterior pelvic fixation for unstable vertical fractures of the sacrum. Overview of Literature: The reported operative fixation techniques for vertical sacral fractures include iliosacral screw, sacral bar fixations, transiliac plating, and local plate osteosynthesis. Clinical as well as biomechanical studies have demonstrated that these conventional techniques are insufficient to stabilize the vertically unstable sacral fractures. Methods: To simulate a vertically unstable fractured sacrum, 12 synthetic pelvic models were prepared. In each model, a 5-mm gap was created through the left transforaminal zone (Denis zone II). The pubic symphysis was completely separated and then stabilized using a 3.5-mm reconstruction plate. Four each of the unstable pelvic models were then fixed with two iliosacral screws, a tension band plate, or a transiliac fixation plus one iliosacral screw. The left hemipelvis of these specimens was docked to a rigid base plate and loaded on an S1 endplate by using the Zwick Roell z010 material testing machine. Then, the vertical displacement and coronal tilt of the right hemipelves and the applied force were measured. Results: The transiliac fixation plus one iliosacral screw constructions could withstand a force at 5 mm of vertical displacement greater than the two iliosacral screw constructions (p=0.012) and the tension band plate constructions (p=0.003). The tension band plate constructions could withstand a force at $5^{\circ}$ of coronal tilt less than the two iliosacral screw constructions (p=0.027) and the transiliac fixation plus one iliosacral screw constructions (p=0.049). Conclusions: This study proposes the use of transiliac fixation in addition to an iliosacral screw to stabilize vertically unstable sacral fractures. Our biomechanical data demonstrated the superiority of adding transiliac fixation to withstand vertical displacement forces.

Measurement of S1 foramen depth for ultrasound-guided S1 transforaminal epidural injection

  • Ye Sull Kim;SeongOk Park;Chanhong Lee;Sang-Kyi Lee;A Ram Doo;Ji-Seon Son
    • The Korean Journal of Pain
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    • v.36 no.1
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    • pp.98-105
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    • 2023
  • Background: Ultrasound-guided first sacral transforaminal epidural steroid injection (S1 TFESI) is a useful and easily applicable alternative to fluoroscopy or computed tomography (CT) in lumbosacral radiculopathy. When a needle approach is used, poor visualization of the needle tip reduces the accuracy of the procedure, increasing its difficulty. This study aimed to improve ultrasound-guided S1 TFESI by evaluating radiological S1 posterior foramen data obtained using three-dimensional CT (3D-CT). Methods: Axial 3D-CT images of the pelvis were retrospectively analyzed. The radiological measurements obtained from the images included 1st posterior sacral foramen depth (S1D, mm), 1st posterior sacral foramen width (S1W, mm), the angle of the 1st posterior sacral foramen (S1A, °), and 1st posterior sacral foramen distance (S1ds, mm). The relationship between the demographic factors and measured values were then analyzed. Results: A total of 632 patients (287 male and 345 female) were examined. The mean S1D values for males and females were 11.9 ± 1.9 mm and 10.6 ± 1.8 mm, respectively (P < 0.001); the mean S1A 28.2 ± 4.8° and 30.1 ± 4.9°, respectively (P < 0.001); and the mean S1ds, 24.1 ± 2.9 mm and 22.9 ± 2.6 mm, respectively (P < 0.001); however, the mean S1W values were not significantly different. Height was the only significant predictor of S1D (β = 0.318, P = 0.004). Conclusions: Ultrasound-guided S1 TFESI performance and safety may be improved with adjustment of needle insertion depth congruent with the patient's height.

Giant Benign Schwannoma Involving Sacral Bone - A Case Report - (천골부에 발생한 거대 신경초종 - 증 례 보 고 -)

  • Oh, Kyung Seup;Ha, Sung Il;Lee, Hyun Sung;Lee, Jong Soo;Kwak, Seung Su;Yun, Suk Hoon
    • Journal of Korean Neurosurgical Society
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    • v.30 no.4
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    • pp.509-513
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    • 2001
  • Sacral schwannoma is a rare lesion with a tendency to reach large proportions. The benign schwannoma rarely involves the vertebral bodies extensively. The authors report a case of giant intrasacral schwannoma in 30-year-old woman who had intermittent lower back pain during 3 years period. CT and MRI showed a destructive mass lesion within the upper part of sacrum with a large mass extending into the presacral space. The patient underwent combined surgery consisted of anterior transabdominal approach and posterior sacral laminectomy and total removal of tumor. The characteristics of the lesion were discussed with a review of literatures.

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Approach for Epiduroscopic Laser Neural Decompression in Case of the Sacral Canal Stenosis

  • Jo, Dae Hyun;Yang, Hun Ju;Kim, Jae Jung
    • The Korean Journal of Pain
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    • v.26 no.4
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    • pp.392-395
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    • 2013
  • Epiduroscopy is very useful in the treatment of not only low back pain caused by failed back surgery syndrome, epidural scar or herniated disc but also by chronic refractory low back pain which does not respond to interventional conservative treatment including fluoroscopically-directed epidural steroid injections and percutaneous adhesiolysis. Because cauterization using a laser fiber has become recently available, a wider opening is required to enter into the sacral canal in the case of epiduroscopic laser neural decompression (ELND). However, in a few patients, it is difficult to insert a device into the epidural space due to stenosis around the opening, and there is no alternative method. Herein, we report a case where a hiatus rasp specially designed for such patients was used to perform the operation.