Type of Article: Original Research
Year: 2016 | Volume 4 | Issue 1 | Page No. 1758-1764
Date of Publication: 31-01-2016
DEFICIENT SACRAL HIATUS CAUSE MECHANICAL LOW BACK PAIN: A RADIOLOGICAL STUDY
Ganesh Elumalai *1, Malarvani Thangamani 2, Sanjoy Sanyal 1, Palani Kanagarajan 3.
*1 Department of Anatomy & Neuroscience, Texila American University, Georgetown, South America.
2 Department of Anatomy, National Medical College, Birgunj, Nepal.
3 Department of Comunity Medicine, Texila American University, Georgetown, South America.
Address: Dr. Ganesh Elumalai, Department of Anatomy & Neuroscience, Texila American University, Georgetown, South America.
Objectives: The study was designed to identify whether there is any association between the variations of sacral hiatus with low back pain (LBP) using the pelvic radiographs of the LBP patients.
Methods: One hundred and fifty digital radiographs include age group of patients between 15 to 50 years of both male and female patients were included in this study. Out of which 100 digital radiographs were of patients with history of LBP positive and 50 digital radiographs are from the LBP negative persons. The morphometry of radiographs were measured using Image-J software and then the measurements of LBP positive radiographs were compared with the measurements of radiographs with LBP negative persons.
Results: In 86 % of LBP negative radiographs, the sacral hiatus was inverted -U shape and in 14 % the sacral hiatus was inverted -V shape. Deficient dorsal wall of the sacrum was not observed in LBP negative radiographs. The apex of the sacral hiatus in LBP negative radiographs was observed the most at S4 level. Deficient dorsal wall was found in 3 % (1% in Partial and 2% in complete) patients presented with LBP positive. Absence of sacral hiatus, a rare phenomenon was observed in 2% of cases in LBP positive radiographs. The apex of the sacral hiatus in the LBP positive patients observed at the S3 level were 52 % and 34 % in S2 level respectively
Conclusion: The patients with LBP positive radiographs had a higher percentage of deficient dorsal walls in comparison to the LBP negative radiographs.
KEY WORDS: Sacral Hiatus, Deficient dorsal wall, Low Back Pain, Lumbo-Pelvic Radiographs.
- Sugar O. How the sacrum got its name. Jama and Archives 1987; 257(15):1.
- The Sacrum – The Holy Bone, Oct 2003.
- Standring S. Gray’s Anatomy, 39th Ed, Elsevier Churchill Livingstone, London, 2005; p: 731 & 749-754.
- Datta AK. Essentials of human osteology, 1st Ed, Current Books International, Calcutta, 1997;53.
- Ernest J Frazer. Anatomy of the Human skeleton. J and A Churchill ltd, London, 1914;37-42.
- Letterman GS, Trotter M. Variations of the male sacrum: Their significance in caudal analgesia. Surg. Gynecol. Obstet 1944;78(5):551-555.
- Brailsford JF. Deformities of lumbosacral region of spine. Br J Surg1929; 16: 562 627. Published Online: December 6 2005 8:16AM. DOI: 10.1002/bjs.1800166405.
- Newell RLM. In Gray s Anatomy. The Anatomical Basis of Clinical Practice. 39 th edition: Churchill Livingstone, London, 2005; pp. 1430-1431..
- Saberski L, Kitahata L. Direct visualization of lumbosacral epidural space through the sacral hiatus. Anaesth Analg 1995;80:839-840.
- Chen PC, Tang STF, Hsu, et al. Ultrasound guidance in caudal epidural needle placement. Anaesthesiology 2004;101:181-184.
- Esses SE, Botsford DJ: Surgical Anatomy and Operative Approaches to the sacrum,in Frymoyer JW, Ducker TB, Hadler NM et al(eds): The Adult Spine: principles and practise, 2nd Ed. Philadelphia: Lippincott-Raven, 1997;2:2329-2341.
- Estin D, Cohen AR. Caudal agenesis and associated caudal spinal cord malformations. Neurosurg Clin N Am 1995;6:377-391.
- Lanier VS, Mcknight HE, Trotter M. Caudal analgesia: An experimental and anatomical study. American journal of Obstetrics and Gynaecology 1944;47(5):633-641.
- N.Senoglu, et al. Landmarks of the sacral hiatus for caudal epidural block: An Anatomical study. British Journal of Anaesthesia 2005;95(5):692-695.
- David L Brown. Regional Anaesthesia and Analgesia, Saunders and Company, 1986;346-347.
- Thompson JE. An Anatomical and Experimental study of sacral anaesthesia. Ann. Surg 1917;66:718-727.
- Edwards WB, Hingson RA. Continuous caudal anaesthesia in obstetrics. American Journal of Surgery 1942;57:459-464.
- Sekiguchi M, Yabuki S, Satoh K, Kikuchi S. An Anatomical study of the sacral hiatus: A basis for successful caudal epidural block. Clinical journal of pain 2004;20(1):51-54.
- Hollinshead WH. Anatomy for Surgeons. 2nd Ed, Harper and Row publishers, Philadelphia, 1969;176-180.
- Bernard Rosner. Fundamentals of Biostatistics, 5th Ed, Duxbury, 2000.
- Venkataswamy Reddy. Statistics fir mental health care research, NIMHANS publication, India, 2002.
- Nagar SK. A study of sacral hiatus in dry human sacra. Journal of Anatomical Society of India 2004;53(2):18-21.
- Vishal kumar et al. Sacral hiatus in relation to low back pain in South Indian population: Anatomico – Radiological study. Bratisl Lek Listy 2009;110(7):436-441.
- Rajapur parashuram. Morphometrical study of sacral hiatus using isolated dry human sacra: Dissertation 2008.
- Trotter M. and Letterman GS. Variations of the female sacrum: Their significance in continuous caudal anaesthesia. Surg. Gynecol. Obstet 1944;78(4):419-424.
- Trotter M. Variations of the sacral canal: Their significance in the administration of caudal analgesia. Anaesth. Analg 1947;26(5):192-202.
- Vinod kumar et al. Morphometrical study of sacral hiatus. Journal of Anatomical society of India 1992;41(1):7-13.
Ganesh Elumalai, Malarvani Thangamani, Sanjoy Sanyal, Palani Kanagarajan. DEFICIENT SACRAL HIATUS CAUSE MECHANICAL LOW BACK PAIN: A RADIOLOGICAL STUDY. Int J Anat Res 2016;4(1):1758-1764. DOI: 10.16965/ijar.2015.326