Skip to main content
Top
Published in: Surgical and Radiologic Anatomy 8/2016

01-10-2016 | Original Article

Implications of structural variations in the human sacrum: why is an anatomical classification crucial?

Author: Niladri Kumar Mahato

Published in: Surgical and Radiologic Anatomy | Issue 8/2016

Login to get access

Abstract

Purpose

An array of diversity in sacral anatomy including lumbosacral transitional variations is commonly found in the general population. These anatomical variations involve alterations in number of sacral segments, auricular surface area, and neural arch dimensions and are associated with biomechanical, surgical and obstetric implications.

Methods

The present study reports screening >300 dried human sacral specimens and grouping them based on the common variations observed specifically in context of the number of sacral segments, position of the auricular surfaces, and type of the neural arch components.

Results

Screening and grouping of the samples presented a five-group classification and coding system that incorporates specific structural characteristic in a sacrum.

Conclusion

The grouping and coding system developed in this study classifies variabilities associated with sacral anatomy along a common-to-rare anatomical spectrum that may provide handy information needed in a clinical, biomechanical, obstetric or medico-legal context.
Literature
3.
go back to reference Abumi K, Panjabi MM, Duranceau J (1989) Biomechanical evaluation of spinal fixation devices. Part III. Stability provided by six spinal fixation devices and interbody bone graft. Spine 14:1249–1255CrossRefPubMed Abumi K, Panjabi MM, Duranceau J (1989) Biomechanical evaluation of spinal fixation devices. Part III. Stability provided by six spinal fixation devices and interbody bone graft. Spine 14:1249–1255CrossRefPubMed
4.
go back to reference Abumi K, Panjabi MM, Kramer KM, Duranceau J, Oxland T, Crisco JJ (1990) Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine 15:1142–1147CrossRefPubMed Abumi K, Panjabi MM, Kramer KM, Duranceau J, Oxland T, Crisco JJ (1990) Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine 15:1142–1147CrossRefPubMed
7.
go back to reference Berlemann U, Jeszenszky DJ, Buhler DW, Harms J (1999) The role of lumbar lordosis, vertebral end-plate inclination, disc height, and facet orientation in degenerative spondylolisthesis. J Spinal Disord 12:68–73CrossRefPubMed Berlemann U, Jeszenszky DJ, Buhler DW, Harms J (1999) The role of lumbar lordosis, vertebral end-plate inclination, disc height, and facet orientation in degenerative spondylolisthesis. J Spinal Disord 12:68–73CrossRefPubMed
8.
go back to reference Brault JS, Smith J, Currier BL (2001) Partial lumbosacral transitional vertebra resection for contralateral facetogenic pain. Spine 26:226–229CrossRefPubMed Brault JS, Smith J, Currier BL (2001) Partial lumbosacral transitional vertebra resection for contralateral facetogenic pain. Spine 26:226–229CrossRefPubMed
9.
go back to reference Bron JL, van Royen BJ, Wuisman PI (2007) The clinical significance of lumbosacral transitional anomalies. Acta Orthop Belg 73:687–695PubMed Bron JL, van Royen BJ, Wuisman PI (2007) The clinical significance of lumbosacral transitional anomalies. Acta Orthop Belg 73:687–695PubMed
11.
go back to reference Castellvi AE, Goldstein LA, Chan DP (1984) Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine 9:493–495CrossRefPubMed Castellvi AE, Goldstein LA, Chan DP (1984) Lumbosacral transitional vertebrae and their relationship with lumbar extradural defects. Spine 9:493–495CrossRefPubMed
13.
go back to reference Connolly LP, d’Hemecourt PA, Connolly SA, Drubach LA, Micheli LJ, Treves ST (2003) Skeletal scintigraphy of young patients with low-back pain and a lumbosacral transitional vertebra. J Nucl Med Off Publ Soc Nucl Med 44:909–914 Connolly LP, d’Hemecourt PA, Connolly SA, Drubach LA, Micheli LJ, Treves ST (2003) Skeletal scintigraphy of young patients with low-back pain and a lumbosacral transitional vertebra. J Nucl Med Off Publ Soc Nucl Med 44:909–914
17.
go back to reference Dar G, Peleg S, Masharawi Y, Steinberg N, Rothschild BM, Peled N, Hershkovitz I (2005) Sacroiliac joint bridging: demographical and anatomical aspects. Spine 30:E429–E432CrossRefPubMed Dar G, Peleg S, Masharawi Y, Steinberg N, Rothschild BM, Peled N, Hershkovitz I (2005) Sacroiliac joint bridging: demographical and anatomical aspects. Spine 30:E429–E432CrossRefPubMed
18.
19.
go back to reference Farfan HF, Sullivan JD (1967) The relation of facet orientation to intervertebral disc failure. Can J Surg 10:179–185PubMed Farfan HF, Sullivan JD (1967) The relation of facet orientation to intervertebral disc failure. Can J Surg 10:179–185PubMed
21.
go back to reference Hanson EH, Mishra RK, Chang DS, Perkins TG, Bonifield DR, Tandy RD, Cartwright PE, Peoples RR, Orrison WW (2010) Sagittal whole-spine magnetic resonance imaging in 750 consecutive outpatients: accurate determination of the number of lumbar vertebral bodies. J Neurosurg Spine 12:47–55. doi:10.3171/2009.7.SPINE09326 CrossRefPubMed Hanson EH, Mishra RK, Chang DS, Perkins TG, Bonifield DR, Tandy RD, Cartwright PE, Peoples RR, Orrison WW (2010) Sagittal whole-spine magnetic resonance imaging in 750 consecutive outpatients: accurate determination of the number of lumbar vertebral bodies. J Neurosurg Spine 12:47–55. doi:10.​3171/​2009.​7.​SPINE09326 CrossRefPubMed
23.
go back to reference Kim NH, Suk KS (1997) The role of transitional vertebrae in spondylolysis and spondylolytic spondylolisthesis. Bulletin 56:161–166 Kim NH, Suk KS (1997) The role of transitional vertebrae in spondylolysis and spondylolytic spondylolisthesis. Bulletin 56:161–166
25.
go back to reference Lee CH, Park CM, Kim KA, Hong SJ, Seol HY, Kim BH, Kim JH (2007) Identification and prediction of transitional vertebrae on imaging studies: anatomical significance of paraspinal structures. Clin Anat 20:905–914. doi:10.1002/ca.20540 CrossRefPubMed Lee CH, Park CM, Kim KA, Hong SJ, Seol HY, Kim BH, Kim JH (2007) Identification and prediction of transitional vertebrae on imaging studies: anatomical significance of paraspinal structures. Clin Anat 20:905–914. doi:10.​1002/​ca.​20540 CrossRefPubMed
26.
go back to reference Lee JJ, Rosenbaum SL, Martusiewicz A, Holcombe SA, Wang SC, Goulet JA (2015) Transsacral screw safe zone size by sacral segmentation variations. J Orthop Res 33:277–282CrossRefPubMed Lee JJ, Rosenbaum SL, Martusiewicz A, Holcombe SA, Wang SC, Goulet JA (2015) Transsacral screw safe zone size by sacral segmentation variations. J Orthop Res 33:277–282CrossRefPubMed
27.
go back to reference Mahato NK (2010) Association of rudimentary sacral zygapophyseal facets and accessory and ligamentous articulations: implications for load transmission at the L5-S1 junction. Clin Anat 23:707–711. doi:10.1002/Ca.21009 CrossRefPubMed Mahato NK (2010) Association of rudimentary sacral zygapophyseal facets and accessory and ligamentous articulations: implications for load transmission at the L5-S1 junction. Clin Anat 23:707–711. doi:10.​1002/​Ca.​21009 CrossRefPubMed
34.
go back to reference Mahato NK (2013) Pars inter-articularis and laminar morphology of the terminal lumbar vertebra in lumbosacral transitional variations. N Am J Med Sci 5:357CrossRefPubMedPubMedCentral Mahato NK (2013) Pars inter-articularis and laminar morphology of the terminal lumbar vertebra in lumbosacral transitional variations. N Am J Med Sci 5:357CrossRefPubMedPubMedCentral
35.
go back to reference Miller AN, Routt MLC (2012) Variations in sacral morphology and implications for iliosacral screw fixation. J Am Acad Orthop Surg 20:8–16PubMed Miller AN, Routt MLC (2012) Variations in sacral morphology and implications for iliosacral screw fixation. J Am Acad Orthop Surg 20:8–16PubMed
36.
go back to reference Otani K, Konno S, Kikuchi S (2001) Lumbosacral transitional vertebrae and nerve-root symptoms. J Bone Jt Surg Br 83:1137–1140CrossRef Otani K, Konno S, Kikuchi S (2001) Lumbosacral transitional vertebrae and nerve-root symptoms. J Bone Jt Surg Br 83:1137–1140CrossRef
38.
go back to reference Pal GP, Routal RV (1987) Transmission of weight through the lower thoracic and lumbar regions of the vertebral column in man. J Anat 152:93–105PubMedPubMedCentral Pal GP, Routal RV (1987) Transmission of weight through the lower thoracic and lumbar regions of the vertebral column in man. J Anat 152:93–105PubMedPubMedCentral
40.
go back to reference Panjabi MM (1992) The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord 5:390–396 (discussion 397) CrossRefPubMed Panjabi MM (1992) The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord 5:390–396 (discussion 397) CrossRefPubMed
42.
go back to reference Peleg S, Dar G, Medlej B, Steinberg N, Masharawi Y, Latimer B, Jellema L, Peled N, Arensburg B, Hershkovitz I (2007) Orientation of the human sacrum: anthropological perspectives and methodological approaches. Am J Phys Anthropol 133:967–977. doi:10.1002/ajpa.20599 CrossRefPubMed Peleg S, Dar G, Medlej B, Steinberg N, Masharawi Y, Latimer B, Jellema L, Peled N, Arensburg B, Hershkovitz I (2007) Orientation of the human sacrum: anthropological perspectives and methodological approaches. Am J Phys Anthropol 133:967–977. doi:10.​1002/​ajpa.​20599 CrossRefPubMed
46.
go back to reference Snijders CJ, Vleeming A, Stoeckart R (1993) Transfer of lumbosacral load to iliac bones and legs Part 1: biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin Biomech 8:285–294. doi:10.1016/0268-0033(93)90002-Y CrossRef Snijders CJ, Vleeming A, Stoeckart R (1993) Transfer of lumbosacral load to iliac bones and legs Part 1: biomechanics of self-bracing of the sacroiliac joints and its significance for treatment and exercise. Clin Biomech 8:285–294. doi:10.​1016/​0268-0033(93)90002-Y CrossRef
47.
go back to reference Snijders CJ, Vleeming A, Stoeckart R (1993) Transfer of lumbosacral load to iliac bones and legs Part 2: loading of the sacroiliac joints when lifting in a stooped posture. Clin Biomech 8:295–301. doi:10.1016/0268-0033(93)90003-Z CrossRef Snijders CJ, Vleeming A, Stoeckart R (1993) Transfer of lumbosacral load to iliac bones and legs Part 2: loading of the sacroiliac joints when lifting in a stooped posture. Clin Biomech 8:295–301. doi:10.​1016/​0268-0033(93)90003-Z CrossRef
48.
go back to reference Stradalova V (1974) Proceedings: determination of sex from metrial characteristics of the sacrum. Folia Morphol 22:408–412 Stradalova V (1974) Proceedings: determination of sex from metrial characteristics of the sacrum. Folia Morphol 22:408–412
49.
go back to reference Tague RG (2009) High assimilation of the sacrum in a sample of American skeletons: prevalence, pelvic size, and obstetrical and evolutionary implications. Am J Phys Anthropol 138:429–438. doi:10.1002/ajpa.20958 CrossRefPubMed Tague RG (2009) High assimilation of the sacrum in a sample of American skeletons: prevalence, pelvic size, and obstetrical and evolutionary implications. Am J Phys Anthropol 138:429–438. doi:10.​1002/​ajpa.​20958 CrossRefPubMed
50.
go back to reference Tini PG, Wieser C, Zinn WM (1977) The transitional vertebra of the lumbosacral spine: its radiological classification, incidence, prevalence, and clinical significance. Rheumatol Rehabil 16:180–185CrossRefPubMed Tini PG, Wieser C, Zinn WM (1977) The transitional vertebra of the lumbosacral spine: its radiological classification, incidence, prevalence, and clinical significance. Rheumatol Rehabil 16:180–185CrossRefPubMed
51.
go back to reference Wagner H, Anders C, Puta C, Petrovitch A, Morl F, Schilling N, Witte H, Blickhan R (2005) Musculoskeletal support of lumbar spine stability. Pathophysiol Off J Int Soc Pathophysiol ISP 12:257–265. doi:10.1016/j.pathophys.2005.09.007 Wagner H, Anders C, Puta C, Petrovitch A, Morl F, Schilling N, Witte H, Blickhan R (2005) Musculoskeletal support of lumbar spine stability. Pathophysiol Off J Int Soc Pathophysiol ISP 12:257–265. doi:10.​1016/​j.​pathophys.​2005.​09.​007
52.
go back to reference Willis A, Oxenham MF (2013) A case of maternal and perinatal death in Neolithic Southern Vietnam, c. 2100–1050 BCE. Int J Osteoarchaeol 23:676–684CrossRef Willis A, Oxenham MF (2013) A case of maternal and perinatal death in Neolithic Southern Vietnam, c. 2100–1050 BCE. Int J Osteoarchaeol 23:676–684CrossRef
Metadata
Title
Implications of structural variations in the human sacrum: why is an anatomical classification crucial?
Author
Niladri Kumar Mahato
Publication date
01-10-2016
Publisher
Springer Paris
Published in
Surgical and Radiologic Anatomy / Issue 8/2016
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI
https://doi.org/10.1007/s00276-016-1667-0

Other articles of this Issue 8/2016

Surgical and Radiologic Anatomy 8/2016 Go to the issue