• Journal of Trauma and Injury
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• 제30권4호
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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.

• Journal of Korean Neurosurgical Society
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• 제56권4호
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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.

• The Korean Journal of Pain
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• 제20권2호
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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.

• Asian Spine Journal
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• 제12권6호
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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.

• The Korean Journal of Pain
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• 제36권1호
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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.

• Journal of Korean Neurosurgical Society
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• 제30권4호
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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.

• The Korean Journal of Pain
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• 제26권4호
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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.

• 척추신경추나의학회지
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• 제15권1호
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• pp.115-119
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• 2020

Objectives : This study aimed to introduce a new sacral lumbar joint distraction technique in the prone position in Chuna manual therapy for effective lumbar distraction. Methods : The patient was placed in the prone position. Next, clinicians contacted the sacrum and L1, L2, L3, L4 and L5 spinal processes. Then they were pulled in the direction of the head and leg respectively while pressing down with 30% force to maintain the lumbar lordosis. This is a more effective and safer lumbar distraction technique according to the latest knowledge. Conclusions : This technique can be used for lumbar disc herniation in addition to relaxing the existing lumbar muscles, and is suggested to be used as a safe and effective Chuna manual therapy.

• Archives of Reconstructive Microsurgery
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• 제23권1호
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• pp.25-28
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• 2014

One of the most frequently used flaps for coverage of sacral skin and soft-tissue defects is the gluteus maximus musculocutaneous flap. These authors encountered two cases of sacral pressure sore, for which reconstructive surgery was performed, using the hatchet-shaped gluteus maximus musculocutaneous flap - a modified flap type. We report on our experience in treatment of these two cases, with an excellent outcome.

• Journal of Korean Neurosurgical Society
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• 제37권1호
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• pp.63-66
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• 2005

The authors report a case of Currarino triad which had a congenital anorectal stenosis associated with a sacral defect and a presacral mass. A 1-year-old female presented with constipation since birth. Neurological deficits were not found on admission. She had had a diverting colostomy due to anorectal stenosis at another hospital before admission. Lumbar X-ray films showed bony defect caudal to the third sacral vertebra. Magnetic resonance image demonstrated a round cystic pelvic mass which was connected with a dural sac via anterior sacral defect. Posterior approach with Intradural removal of the presacral cystic mass was performed and followed by anoplasty by a pediatric surgeon. The cystic mass was verified histologically as mature teratoma with cystic change. Postoperatively, the urinary function and bowel movement remained intact. Currarino triad should be suspected and evaluated physically and radiographically in a case of congenital anorectal stenosis. Prompt recognition and close cooperation between pediatric surgeons and neurosurgeons is advisable to ensure adequate surgical treatment.