Anatomy and clinical significance of sacral variations: a systematic review

• Autorzy: Nastoulis E. , Karakasi M-V , Pavlidis P. , Thomaidis V. , Fiska A.
• Języki publikacji: EN

Abstrakty

EN

The sacrum is a large trilateral bone located at the base of the vertebral column serving to transfer the body weight from the trunk to the pelvis and lower extremities. Over the years, an abundance of sacral anatomical divergences has been reported, including numerical and/or morphological variations of sacral entities. The majority of these anatomical alternations has been incidentally identified during radiological investigations, surgical procedures or discovered in anatomical, anthropological and forensic research studies. Throughout international literature, however, there is a scarcity of an integrative recording of all known anatomical variations of the sacrum in a single study. This constitutes the objective of the present paper: to provide an exhaustive systematic review of the relevant literature, as well as to thoroughly describe all the recognised deviations of the sacrum structure, while highlighting the aspects of their clinical significance. (Folia Morphol 2019; 78, 4: 651–667)

• Wydawca: -
• Czasopismo: Folia Morphologica
• Rocznik: 2019
• Tom: 78
• Numer: 4
• Opis fizyczny: p.651-667,fig.,ref.

Twórcy

autor

Nastoulis E.

• Department of Anatomy, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece

autor

Karakasi M-V

• Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece

autor

Pavlidis P.

• Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece

autor

Thomaidis V.

• Department of Anatomy, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece

autor

Fiska A.

• Department of Anatomy, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece

Bibliografia

• 1. Abukawa Y, Hiroki K, Morioka N, et al. Ultrasound versus anatomical landmarks for caudal epidural anesthesia in pediatric patients. BMC Anesthesiol. 2015; 15: 102, doi: 10.1186/s12871-015-0082-0, indexed in Pubmed: 26169595.
• 2. Aggarwal A, Aggarwal A, Sahni D. Morphometry of sacral hiatus and its clinical relevance in caudal epidural block. Surg Radiol Anat. 2009; 31(10): 793–800, doi: 10.1007/s00276-009-0529-4, indexed in Pubmed: 19578805.
• 3. Akhtar J, Madhukar K, Fatima N, et al. A morphometric study of complete agenesis of dorsal wall in human sacrum. Indian J Applied Res (IJAR). 2015; 5(4): 449–451.
• 4. Alappat JP. Scimitar sacrum. Neurol India. 2004; 52(2): 288, indexed in Pubmed: 15269512.
• 5. Ali S, Azeemi A, Shoukat S. The prevalence of spina bifida occulta in Pakistani population: A study of dry human sacra. Anaesth, Pain Intensive Care. 2014; 18(2): 157–161.
• 6. Asghar A, Naaz S. The volume of the caudal space and sacral canal in human sacrum. J Clin Diagn Res. 2013; 7(12): 2659–2660, doi: 10.7860/JCDR/2013/6287.3724, indexed in Pubmed: 24551603.
• 7. Avrahami E, Frishman E, Fridman Z, et al. Spina bifida occulta of S1 is not an innocent finding. Spine. 1994; 19(1): 12–15, doi: 10.1097/00007632-199401000-00003, indexed in Pubmed: 8153797.
• 8. Bagheri H, Govsa F. Anatomy of the sacral hiatus and its clinical relevance in caudal epidural block. Surg Radiol Anat. 2017; 39(9): 943–951, doi: 10.1007/s00276-017-1823-1, indexed in Pubmed: 28247084.
• 9. Bardeen CR. Numerical vertebral variations in the human adult and embryo. Anat Anz. 1904; 25: 497–519.
• 10. Bardeen CR. Studies of the development of the human skeleton. A. The development of the lumbar, sacral and coccygeal vertebrae. Am J Anat. 1905; 4: 265–302.
• 11. Barnes E. Developmental defects of the axial skeleton in paleopathology. University Press of Colorado 1994.
• 12. Başaloğlu H, Turgut M, Taşer FA, et al. Morphometry of the sacrum for clinical use. Surg Radiol Anat. 2005; 27(6): 467–471, doi: 10.1007/s00276-005-0036-1, indexed in Pubmed: 16211321.
• 13. Beckman C, Ling F. Obstetrics and gynecology. Sixth Ed. ACOG 2010.
• 14. Bertolotti M. Contributo alla conoscenza dei vizi differenzazione regionle del rachid con speciale riguardo all’assimilazione sacrale edlla v lombare. La Radiologia Medica. 1917; 4: 113–144.
• 15. Bhattacharya S, Majumdar S, Chakraborty P, et al. A morphometric study of sacral hiatus for caudal epidural block among the population of West Bengal. IJBAMR. 2013; 7(2): 660–667.
• 16. Boulet C, Schiettecatte A, De Mey J, et al. Case report: imaging findings in a. Acta Neurol Belg. 2011; 111(4): 344–348, indexed in Pubmed: 22368979.
• 17. Bron JL, van Royen BJ, Wuisman PI. The clinical significance of lumbosacral transitional anomalies. Acta Orthop Belg. 2007; 73(6): 687–695, indexed in Pubmed: 18260478.
• 18. Castellvi AE, Goldstein LA, Chan DP. Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine. 1984; 9(5): 493–495, doi: 10.1097/00007632-198407000-00014, indexed in Pubmed: 6495013.
• 19. Chauhan P, Kalra S. A rare osseous growth on sacrum. Int J Anat Var. 2010; 3: 218–219.
• 20. Chen CPC, Tang SFT, Hsu TC, et al. Ultrasound guidance in caudal epidural needle placement. Anesthesiology. 2004; 101(1): 181–184, doi: 10.1097/00000542-200407000-00028, indexed in Pubmed: 15220789.
• 21. Cheng JS, Song JK. Anatomy of the sacrum. Neurosurg Focus. 2003; 15(2): E3, indexed in Pubmed: 15350034.
• 22. Crighton IM, Barry BP, Hobbs GJ. A study of the anatomy of the caudal space using magnetic resonance imaging. Br J Anaesth. 1997; 78(4): 391–395, doi: 10.1093/bja/78.4.391, indexed in Pubmed: 9135359.
• 23. Currarino G, Coln D, Votteler T. Triad of anorectal, sacral, and presacral anomalies. AJR Am J Roentgenol. 1981; 137(2): 395–398, doi: 10.2214/ajr.137.2.395, indexed in Pubmed: 6789651.
• 24. Deepa TK, John M. A study of lumbarisation of first sacral vertebra among the South Indians. Int J Med Res Health Sci. 2014; 3(1): 1–4, doi: 10.5958/j.2319-5886.3.1.001.
• 25. Demir M, Mavi A, Gümüsburun E, et al. Anatomical variations with joint space measurements on CT. Kobe J Med Sci. 2007; 53(5): 209–217, indexed in Pubmed: 18204297.
• 26. Diel J, Ortiz O, Losada RA, et al. The sacrum: pathologic spectrum, multimodality imaging, and subspecialty approach. Radiographics. 2001; 21(1): 83–104, doi: 10.1148/radiographics.21.1.g01ja0883, indexed in Pubmed: 11158646.
• 27. Duhamel B. From the mermaid to anal imperforation: the syndrome of caudal regression. Arch Dis Child. 1961; 36(186): 152–155, doi: 10.1136/adc.36.186.152, indexed in Pubmed: 21032381.
• 28. Dunaway CL, Williams JP, Brogdon BG. Case report 222. Sacral and coccygeal supernumerary ribs (pelvic ribs). Skeletal Radiol. 1983; 9(3): 212–214, indexed in Pubmed: 6844944.
• 29. Ebraheim NA, Xu R, Biyani A, et al. Morphologic considerations of the first sacral pedicle for iliosacral screw placement. Spine. 1997; 22(8): 841–846, doi: 10.1097/00007632-199704150-00002, indexed in Pubmed: 9127914.
• 30. Ehara S, el-Khoury GY, Bergman RA. The accessory sacroiliac joint: a common anatomic variant. Am J Roentgenol. 1988; 150(4): 857–859, doi: 10.2214/ajr.150.4.857, indexed in Pubmed: 3258099.
• 31. Erken E, Ozer HTE, Gulek B, et al. The association between cervical rib and sacralization. Spine. 2002; 27(15): 1659–1664, doi: 10.1097/00007632-200208010-00013, indexed in Pubmed: 12163729.
• 32. Fidas A, MacDonald HL, Elton RA, et al. Prevalence and patterns of spina bifida occulta in 2707 normal adults. Clin Radiol. 1987; 38(5): 537–542, doi: 10.1016/s0009-9260(87)80150-2, indexed in Pubmed: 3311565.
• 33. Fortin JD, Ballard KE. The frequency of accessory sacroiliac joints. Clin Anat. 2009; 22(8): 876–877, doi: 10.1002/ca.20772, indexed in Pubmed: 19173249.
• 34. Galen. De usu partium, ed. G. Helmreich, Galeni de usu partium libri xvii. Leipzig: Teubner, 1:1907; 2:1909 (repr. Amsterdam: Hakkert, 1968), (Cod: 202,076: Med.).
• 35. Galloway NT, Tainsh J. Minor defects of the sacrum and neurogenic bladder dysfunction. Br J Urol. 1985; 57(2): 154–155, doi: 10.1111/j.1464-410x.1985.tb06410.x, indexed in Pubmed: 3986449.
• 36. Ganseman Y, Broos P. Leonardo da Vinci and Andreas Vesalius; the shoulder girdle and the spine, a comparison. Acta Chir Belg. 2008; 108(4): 477–483, indexed in Pubmed: 18807610.
• 37. García-Coronado JM, Espinosa-Uribe AG, Vílchez-Cavazos F, et al. Comments on: Implications of structural variations in the human sacrum: why is an anatomical classification crucial? Surg Radiol Anat. 2017; 39(2): 233, doi: 10.1007/s00276-016-1724-8, indexed in Pubmed: 27431439.
• 38. Goswami P, Yadav Y, Chakradhar V. Sacral Foramina: Anatomical variations and clinical relevance in North Indians. Eur J Acad Essays (EJAE). 2014; 1(4): 29–33.
• 39. Guille JT, Benevides R, DeAlba CC, et al. Lumbosacral agenesis: a new classification correlating spinal deformity and ambulatory potential. J Bone Joint Surg Am. 2002; 84(1): 32–38, doi: 10.2106/00004623-200201000-00006, indexed in Pubmed: 11792777.
• 40. Hadley LA. Accessory sacroiliac articulations with arthritic changes. Radiology. 1950; 55(3): 403–409, doi: 10.1148/55.3.403, indexed in Pubmed: 14781347.
• 41. Hasenboehler EA, Stahel PF, Williams A, et al. Prevalence of sacral dysmorphia in a prospective trauma population: Implications for a. Patient Saf Surg. 2011; 5(1): 8, doi: 10.1186/1754-9493-5-8, indexed in Pubmed: 21569232.
• 42. Hippocrate. Des Articulations, ed. É. Littré, Oeuvres complètes d’Hippocrate, vol. 4. Baillière, Paris 1844.
• 43. Hsieh CY, Vanderford JD, Moreau SR, et al. Lumbosacral transitional segments: classification, prevalence, and effect on disk height. J Manipulative Physiol Ther. 2000; 23(7): 483–489, doi: 10.1067/mmt.2000.108817, indexed in Pubmed: 11004653.
• 44. Kaiser SP, Gardner MJ, Liu J, et al. Anatomic determinants of sacral dysmorphism and implications for safe iliosacral screw placement. J Bone Joint Surg Am. 2014; 96(14): e120, doi: 10.2106/JBJS.M.00895, indexed in Pubmed: 25031382.
• 45. Kamal A, Ara S, Ashrafuzzaman Md, et al. Morphometry of sacral hiatus and its clinical relevance in caudal epidural block. J Dhaka Med Coll. 2015; 23(1): 31–36, doi: 10.3329/jdmc.v23i1.22690.
• 46. Kanchan T, Shetty M, Nagesh KR, et al. Lumbosacral transitional vertebra: clinical and forensic implications. Singapore Med J. 2009; 50(2): e85–e87, indexed in Pubmed: 19296021.
• 47. Kapetanakis S, Giovannopoulou E, Nastoulis E, et al. Butterfly vertebra. A case report and a short review of the literature. Folia Morphol. 2016; 75(1): 117–121, doi: 10.5603/FM.a2015.0066, indexed in Pubmed: 26365862.
• 48. Karachalios T, Zibis AH, Zintzaras E, et al. An anatomical update on the morphologic variations of S1 and S2. Orthopedics. 2010; 33(10): 733, doi: 10.3928/01477447-20100826-12, indexed in Pubmed: 20954663.
• 49. Katsuura Y, Kim HJo. Butterfly vertebrae: a systematic review of the literature and analysis. Global Spine J. 2019; 9(6): 666–679, doi: 10.1177/2192568218801016, indexed in Pubmed: 31448202.
• 50. Khan JM, Lara DL, Marquez-Lara A, et al. Intraoperative CT and surgical navigation for iliosacral screws: technique for patients with sacral dysmorphism. J Orthop Trauma. 2018; 32 Suppl 1: S24–S25, doi: 10.1097/BOT.0000000000001213, indexed in Pubmed: 29985900.
• 51. Khanna J, Chauhan R. Anatomical variations and clinical relevance of dorsal sacral foramina in North Indians. Int J Res Med Sci. 2013; 1(3): 263–266, doi: 10.5455/2320-6012.ijrms20130820.
• 52. Kilicaslan A, Keskin F, Babaoglu O, et al. Morphometric analysis of the sacral canal and hiatus using multidetector computed tomography for interventional procedures. Turk Neurosurg. 2015; 25(4): 566–573, doi: 10.5137/1019-5149.JTN.10942-14.0, indexed in Pubmed: 26242333.
• 53. Kim DW, Lee SJ, Choi EJ, et al. Morphologic diversities of sacral canal in children; three-dimensional computed tomographic study. Korean J Pain. 2014; 27(3): 253–259, doi: 10.3344/kjp.2014.27.3.253, indexed in Pubmed: 25031811.
• 54. Kubavat D, Nagar S, Lakhani C, et al. A study of sacrum with three pairs of sacral foramina in western India. IJMSH. 2012; 1(2): 127–132, doi: 10.5455/ijmsph.2012.127-131.
• 55. Kumar A, Vishwakarma N. An anthropometric analysis of dry human sacrum: Gender Discrimination. IJSR. 2015; 4(4): 1306–1310.
• 56. Kumar P, Lokanadham S, Kothandaraman U. A study of anterior sacral foramina and their variations in South Indian population. Sch J App Med Sci. 2015; 3(3): 1196–1198.
• 57. Kumar KP, Dhoot M, Thaduri N, et al. A study of sacrum with five pairs of sacral foramina in Bhopal population. IJPRBA. 2015; 4(5).
• 58. Kumar V, Pandey SN, Bajpai RN, et al. Morphometrical study of sacral hiatus. J Anat Soc India. 1992; 41(1): 7–13.
• 59. Laishram D, Ghosh A, Shastri D. A study on the variations of sacrum and its clinical significance. IOSR- JDMS. 2016; 15(6): 8–14.
• 60. Lanier PF, Trotter M. The volume of the sacral canal. Am J Phys Anthropol. 1946; 4(2): 227–234, indexed in Pubmed: 20990836.
• 61. Lawrence JS. Rheumatism in Populations. William Heinemann Medical Books, London 1977.
• 62. Lendon RG. Studies on the embryogenesis of spina bifida in the rat. Dev Med Child Neurol. 1968; Suppl(16): 54–61, doi: 10.1111/j.1469-8749.1968.tb04847.x, indexed in Pubmed: 4896359.
• 63. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339: b2700, doi: 10.1136/bmj.b2700, indexed in Pubmed: 19622552.
• 64. Lierse W. Applied Anatomy of the Pelvis. Springer-Verlang Berlin Heidelberg 1984.
• 65. Lundy JK. Sacralization of a sixth lumbar vertebra and its effect upon the estimation of living stature. J Forensic Sci. 1988; 33(4): 1045–1049, indexed in Pubmed: 3171499.
• 66. Mahato NK. Transitional female sacrum: dimensions, alterations in dorsal pelvic structure, and potential obstetric implications. Oman Med J. 2018; 33(1): 22–28, doi: 10.5001/omj.2018.05, indexed in Pubmed: 29467995.
• 67. Mahato NK. Implications of structural variations in the human sacrum: why is an anatomical classification crucial? Surg Radiol Anat. 2016; 38(8): 947–954, doi: 10.1007/s00276-016-1667-0, indexed in Pubmed: 27014779.
• 68. Malarvani T, Ganesh E, Nirmala P, et al. Study of sacral hiatus in dry human sacra in Nepal. Int J Anat Res. 2015; 3(1): 848–855, doi: 10.16965/ijar.2014.527.
• 69. Mayuri J, Vijay G, Vasudha N, et al. Anatomical Study Of Sacral Hiatus In Dry Isolated Sacra. J Res Med Den Sci. 2014; 2(2): 43–46, doi: 10.5455/jrmds.20142210.
• 70. Mendel T, Noser H, Kuervers J, et al. The influence of sacral morphology on the existence of secure S1 and S2 transverse bone corridors for iliosacroiliac screw fixation. Injury. 2013; 44(12): 1773–1779, doi: 10.1016/j.injury.2013.08.006, indexed in Pubmed: 24004615.
• 71. Miller AN, Routt ML. Variations in sacral morphology and implications for iliosacral screw fixation. J Am Acad Orthop Surg. 2012; 20(1): 8–16, doi: 10.5435/JAAOS-20-01-008, indexed in Pubmed: 22207514.
• 72. Miyakoshi N, Kobayashi A, Hongo M, et al. Sacral rib: an uncommon congenital anomaly. Spine J. 2015; 15(6): e35–e38, doi: 10.1016/j.spinee.2013.08.055, indexed in Pubmed: 24268667.
• 73. Moore KL, Persaud T. The developing human, clinically oriented embryology. 7th edn. WB Saunders Co., Philadelphia, PA 2003.
• 74. Nadeem G. Importance of knowing the level of sacral hiatus for caudal epidural anesthesia. J Morphol Sci. 2014; 31(1): 9–13, doi: 10.4322/jms.ao053913.
• 75. Nagar SK. A study of sacral hiatus in dry human sacra. J Anat Soc India. 2004; 53(2): 18–21.
• 76. Nagendrappa R, Jayanthi KS. Study of dorsal wall of sacrum. Int J Res Med Sci. 2014; 2(4): 1325–1328, doi: 10.5455/2320-6012.ijrms20141115.
• 77. Nasr A, Ali Y, ElSawy N. The sacral hiatus: an anatomic study on both cadaveric and dry bones. Trans Clin Biol. 2014; 2(1): 4, doi: 10.14259/tcb.v2i1.124.
• 78. Njihia BN, Awori KO, Gikenye G. Morphology of the Sacral Hiatus in an African Population – Implications for Caudal Epidural Injections. Ann African Surg. 2011; 7(1), doi: 10.4314/aas.v7i1.67024.
• 79. Okutan O, Kaptanoglu E, Solaroglu I, et al. Pedicle morphology of the first sacral vertebra. Neuroanatomy. 2003; 2: 16–19.
• 80. Osunwoke EA, Oladipo GS, Alison TA, et al. A study of sacral hiatus in dry human sacra in Southern Nigeria. J Biol Agriculture Healthcare (JBAH). 2014; 4(5): 43–48.
• 81. Pang D. Sacral agenesis and caudal spinal cord malformations. Neurosurgery. 1993; 32(5): 755–78; discussion 778, doi: 10.1227/00006123-199305000-00009, indexed in Pubmed: 8492851.
• 82. Parashuram R. Morphometrical study of sacral hiatus in dry human sacra. Int J Res Med Sci. 2015: 1726–1733, doi: 10.18203/2320-6012.ijrms20150260.
• 83. Patel ZK, Thummar B, Rathod SP, et al. Multi-centric morphometric study of dry human sacrum of Indian population in Gujarat region. NJIRM. 2011; 2: 31–35.
• 84. Patil DS, Jadav HR, Chauhan KB, et al. Anatomical study of the sacrum for transsacral block of sacral nerves. Nat J Med Res. 2012; 2(4): 501–503.
• 85. Phalgunan V, Baskaran S. Morphometric analysis of sacral hiatus and its clinical significance. Health Agenda. 2013; 1: 10–15.
• 86. Plockochi JH. Morphometric age- related change in the adult human sacrum. Thesis. Wichita State Univ, Wichita KS 1999.
• 87. Plochocki JH. Sexual dimorphism of anterior sacral curvature. J Forensic Sci. 2011; 56(1): 161–164, doi: 10.1111/j.1556-4029.2010.01455.x, indexed in Pubmed: 20487142.
• 88. Prassopoulos PK, Faflia CP, Voloudaki AE, et al. Sacroiliac joints: anatomical variants on CT. J Comput Assist Tomogr. 1999; 23(2): 323–327, doi: 10.1097/00004728-199903000-00029, indexed in Pubmed: 10096348.
• 89. Price CM, Rogers PD, Prosser AS, et al. Comparison of the caudal and lumbar approaches to the epidural space. Ann Rheum Dis. 2000; 59(11): 879–882, doi: 10.1136/ard.59.11.879, indexed in Pubmed: 11053065.
• 90. Rajeev R, Surekha D, Medha A, et al. Variations in anatomical features of the sacral hiatus in Indian dry sacra. Int J Med Res Health Sci. 2014; 3(3): 634–638.
• 91. Rashid M, Khalid M, Malik N. Sacral rib: a rare congenital anomaly. Acta Orthop Belg. 2008; 74(3): 429–432, indexed in Pubmed: 18686476.
• 92. Renshaw TS. Sacral agenesis. J Bone Joint Surg Am. 1978; 60(3): 373–383, indexed in Pubmed: 649642.
• 93. Romanes GJ. unninghams Textbook of Anatomy, Twelfth Ed. Oxford University Press 1981: 98–102.
• 94. Routt ML, Simonian PT, Mills WJ. Iliosacral screw fixation: early complications of the percutaneous technique. J Orthop Trauma. 1997; 11(8): 584–589, indexed in Pubmed: 9415865.
• 95. Sachdeva K, Singla R, Kalsey G, et al. Role of sacrum in sexual dimorphism: a morphometric study. J Indian Acad Forensic Med. 2011; 33(3).
• 96. Sadler TW. Langman’s medical embryology. 11th ed. Lippincot Williams and Wilkins, Philadelphia 2009: 302–303.
• 97. Schmorl G, Junghanns H. The human spine in health and disease (2nd American Edition). Edited and translated by Besemann EF. Grune & Stratton, New York 1971.
• 98. Schweitzer ME, Balsam D, Weiss R. Spina bifida occulta. Incidence in parents of offspring with spina bifida cystica. Spine. 1993; 18(6): 785–786, indexed in Pubmed: 8516715.
• 99. Seema S, Singh M, Mahajan A. An anatomical study of variations of sacral hiatus in sacra of north indian origin and its clinical significance. Int J Morphol. 2013; 31(1): 110–114, doi: 10.4067/s0717-95022013000100017.
• 100. Sekiguchi M, Yabuki S, Satoh K, et al. An anatomic study of the sacral hiatus: a basis for successful caudal epidural block. Clin J Pain. 2004; 20(1): 51–54, indexed in Pubmed: 14668657.
• 101. Senoglu N, Senoglu M, Oksuz H, et al. Landmarks of the sacral hiatus for caudal epidural block: an anatomical study. Br J Anaesth. 2005; 95(5): 692–695, doi: 10.1093/bja/aei236, indexed in Pubmed: 16155035.
• 102. Shewale S, Laeeque M, Kulkarni P, et al. Morphological and Morphometrical study of sacral hiatus. IJRTSAT. 2013; 6(1): 48–52.
• 103. Shinde V, Bhusaraddi P. A study of variations of sacral hiatus of dry human sacra in north interior Karnataka region. Nat J Clinl Anat (NJCA). 2014; 3(4): 215–219.
• 104. Shingh DI, Ajita R, Singh N. Variation in the number of sacral pieces. IOSR- JDMS. 2015; 14(12): 106–108.
• 105. Singh R. Classification and analysis of fifth pair of sacral foramina in indian dry sacra. Int J Morphol. 2014; 32(1): 125–130, doi: 10.4067/s0717-95022014000100021.
• 106. Singh R. Classification, causes and clinical implications of sacral spina bifida occulta in Indians. Basic Sci Med. 2013; 2(1): 14–20.
• 107. Singh R. A new foramen on posterior aspect of ala of first sacra vertebra. IJAV. 2012; 5: 29–31.
• 108. Singh R. Sacrum with five pairs of sacral foramina. IJAV. 2011; 4: 139–140.
• 109. Solonen KA. The sacroiliac joint in the light of anatomical, roentgenological and clinical studies. Acta Orthop Scand Suppl. 1957; 27: 1–127, indexed in Pubmed: 13478452.
• 110. Stanley JK, Owen R, Koff S. Congenital sacral anomalies. J Bone Joint Surg Br. 1979; 61-B(4): 401–409, indexed in Pubmed: 500747.
• 111. Steer CM. Moloy’s Evaluation of the Pelvis in Obstetrics. Plenum Publishing Corporation 1975: 77–94.
• 112. Sugar O. How the sacrum got its name. JAMA. 1985; 257(15): 2061–2063, indexed in Pubmed: 3550163.
• 113. Suwanlikhid N, Lakchayapakorn K, Mahakkanukrauh P. The position and size of sacral size of sacral hiatus in Thai dry human sacra. Thammasat Med J. 2013; 13(3): 313–319.
• 114. Tague RG. Fusion of coccyx to sacrum in humans: prevalence, correlates, and effect on pelvic size, with obstetrical and evolutionary implications. Am J Phys Anthropol. 2011; 145(3): 426–437, doi: 10.1002/ajpa.21518, indexed in Pubmed: 21541925.
• 115. Tanaka N, Kinoshita H, Jamal M, et al. A forensic case of sacralization of the sixth lumbar vertebra in skeletal remains. Bangladesh J Med Sci. 2013; 12(2): 224–226, doi: 10.3329/bjms.v12i2.14977.
• 116. Taskaynatan MA, Izci Y, Ozgul A, et al. Clinical significance of congenital lumbosacral malformations in young male population with prolonged low back pain. Spine. 2005; 30(8): E210–E213, doi: 10.1097/01.brs.0000158950.84470.2a, indexed in Pubmed: 15834319.
• 117. Trotter M. A common anatomical variation in the sacroiliac region. J Bone Joint Surg. 1940; 22: 293–299.
• 118. Trotter M, Letterman GS. Variations of the female sacrum; their significance in continuous caudal analgesia. Surg Gynaecol Obstet. 1944; 78(4): 419–424.
• 119. Valojerdy MR, Hogg DA. Anatomical note: The occurrence of accessory sacroiliac joints in man. Clin Anat. 1990; 3(4): 257–260, doi: 10.1002/ca.980030403.
• 120. Vasuki D, Nirmaladevi D, Hebzibah M, et al. Morphology of sacrum and its variations. IOSR-JDMS. 2016; 15(08): 129–142, doi: 10.9790/0853-150802129142.
• 121. Vesalius A. De humani corporis fabrica libri septem. Oporinus, Basel 1543.
• 122. Woon JTK, Stringer MD. The anatomy of the sacrococcygeal cornual region and its clinical relevance. Anat Sci Int. 2014; 89(4): 207–214, doi: 10.1007/s12565-013-0222-x, indexed in Pubmed: 24343170.
• 123. Wu LP, Li YK, Li YM, et al. Variable morphology of the sacrum in a Chinese population. Clin Anat. 2009; 22(5): 619–626, doi: 10.1002/ca.20809, indexed in Pubmed: 19484801.
• 124. Xu R, Ebraheim NA, Gove NK. Surgical anatomy of the sacrum. Am J Orthop. 2008; 37(10): E177–E181, indexed in Pubmed: 19081888.
• 125. Xu R, Ebraheim NA, Yeasting RA, et al. Morphometric evaluation of the first sacral vertebra and the projection of its pedicle on the posterior aspect of the sacrum. Spine. 1995; 20(8): 936–940, doi: 10.1097/00007632-199504150-00010, indexed in Pubmed: 7644959.
• 126. Zwingmann J, Konrad G, Mehlhorn AT, et al. Percutaneous iliosacral screw insertion: malpositioning and revision rate of screws with regards to application technique (navigated vs. Conventional). J Trauma. 2010; 69(6): 1501–1506, doi: 10.1097/TA.0b013e3181d862db, indexed in Pubmed: 20526214.

Identyfikatory

DOI

10.5603/FM.a2019.0040