BACKGROUND: Sacral slanting is a frequent unique phenomenon in patients with adolescent idiopathic scoliosis (AIS) and may be important for selecting the distal fusion level. However, the reason of the phenomenon remains unknown. The purpose of this study was to determine the association between sacral slanting and adjacent structures in patients with AIS. METHODS: A total of 303 AIS patients who underwent both whole spine standing anteroposterior (AP) and whole leg standing AP radiography were included. The degree of sacral slanting, pelvic obliquity, lumbar curve angles (L1-L4), and L4 tilt were assessed on whole spine standing AP radiographs. Whole leg standing AP radiographs were used to assess the degree of leg length discrepancy (LLD). Demographic data and radiological parameters were analyzed descriptively. Pearson correlation analysis and partial correlation analysis of the parameters were performed. A p-value of less than 0.05 was considered statistically significant. RESULTS: The proportion of patients with ≥ 5° of sacral slanting among those with < 3° of pelvic obliquity was 8.9% (27/303). Thirty-two patients (10.6%, 32/303) showed more than 10 mm of LLD. Sacral slanting was positively correlated with pelvic obliquity and lumbar curve (r = 0.445 and r = 0.325, respectively). Pelvic obliquity was also correlated with LLD and L4 tilt (r = 0.123 and r = 0.311, respectively). However, partial correlation analysis showed that LLD was not directly correlated with sacral slanting (r = −0.034). CONCLUSIONS: Sacral slanting can be thought to be a compensatory mechanism for large lumbar curves, which is accompanied by pelvic obliquity. In contrast, a congenitally slanted upper sacrum may contribute to scoliosis in some cases. LLD was not directly correlated with sacral slanting.
Adolescent* ; Humans ; Leg ; Leg Length Inequality ; Pelvis ; Radiography ; Sacrum ; Scoliosis* ; Spine

Computed tomography is helpful in delineating the extent and configuration of pelvic fracture. These injuries are frequently complex, and the precise pathologic anatomy is not easily demonstrated by conventional radiographs. In some case CT will reveal a fracture which may not be seen on the radiograph. In addition, the extent of soft tissue damage and joint involvement is precisely demonstrated with CT. The twenty-three patients admitted to our Inchon Christian Hospital with pelvic fracture with or without hip dislocation from October 1981 to October 1984. We could assess the applicability of C-T scan in pelvic fracture and the following conclusions were obtained. 1. The axial plane of CT was shown to be the most suitable for evaluation of pelvic fracture. 2. C-T could detect the pattern of hip fracture including degree of fracture fragment displacement, and rotation, hip joint stability, intra-articular osseous fragment and interposed soft tissues in hip joint. 2. C-T permitted better evaluation of associated injuries in soft tissue and viscera on the pelvic and retroperitoneal cavity, and also gave information about other associate fractures. 4. C-T was more sensitive than plain radiography in detecting fracture involving the sacrum, quadrilateral surface, acetabular roof, and posterior acetabular hip.
Acetabulum ; Diagnosis ; Hip ; Hip Dislocation ; Hip Joint ; Humans ; Incheon ; Joints ; Pelvis ; Radiography ; Sacrum ; Viscera

BACKGROUNDS: Due to the low sensitivity of plain radiography, the diagnosis of early stage ankylosing spondylitis (AS) is often difficult since many patients do not meet the radiographic criteria. The objective of our study was to investigate the diagnostic value of performing multidetector computed tomography (MDCT) of the sacroiliac (SI) joint in the evaluation of AS patients. METHODS: Thirty seven patients with definite or probable AS were evaluated. Plain radiography and MDCT imaging of the pelvis were performed for evaluating the SI joints. Two radiologists analyzed the images, and they graded the sacroiliitis on a scale of 0-4 according to the modified NY criteria. The clinical variables we analyzed included the disease duration, the treatment duration, the prescribed drugs, peripheral joint involvement, enthesopathy, the functional limitations and the BASDAI.. RESULTS: MDCT detected more bilateral sacroiliitis as compared to the plain radiography (86.5% vs. 75.7%, respectively), and MDCT yielded a higher grade of disease in 32.4% (right SI joint) and 24.3% (left SI joint) of the patients. More patients satisfied the modified NY criteria with using MDCT as compared with that when using the plain radiography (81.1% vs. 54.1%, respectively, p=0.002). CONCLUSIONS: Visualization of the sacroiliac joint by MDCT provided a better diagnosis of AS, and especially during the early stage of the disease.
Adolescent ; Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Sacroiliac Joint/*radiography ; Sacrum/*radiography ; Sensitivity and Specificity ; Severity of Illness Index ; Spondylitis, Ankylosing/*radiography ; Tomography, X-Ray Computed/methods

PURPOSE: To evaluate clinical features and the effect of parathyroid hormone (PTH) on treatment outcomes of patients with pelvic insufficiency fractures. MATERIALS AND METHODS: Fifteen patients diagnosed with pelvic insufficiency fractures were evaluated retrospectively. All patients had osteoporosis with mean lumbar T score of −3.9 (range, −3.1 to −6.4) and the mean age was 76.5 years. In all cases, simple radiography and computed tomography was used for final diagnosis; additional magnetic resonance imaging and technetium bone scans were used to confirm the diagnosis in 2 and 6 patients, respectively. Initial conservative treatment was used in all cases; treatment with PTH was applied in 5 cases. Radiological follow-up was done every 4 weeks up to 6 months and every 3 months thereafter. Symptom improvement was measured using visual analogue scale (VAS) score. RESULTS: Fractures were located: i) sacrum and pubis (9 cases), ii) isolated sacrum (4 cases) and iii) isolated pubis (2 cases). One case showed fracture displacement and pain aggravation at 4 week follow-up which was treated with percutaneous sacro-iliac fixation using cannulated screws. Duration of bone union was significantly shorter in the patients who used PTH (P<0.05). VAS scores were also lower in the group treated with PTH; however, statistical significance was not reached. CONCLUSION: In patients with osteoporosis, a pelvic insufficiency fracture should be considered if pain is experienced in the pelvic area in the absence of major trauma. While nonoperatic has been shown to be sufficient for treatment, our study shows that PTH therapy shortens treatment period and could be a favorable treatment option.
Diagnosis ; Follow-Up Studies ; Fractures, Stress* ; Humans ; Magnetic Resonance Imaging ; Osteoporosis* ; Parathyroid Hormone ; Pubic Bone ; Radiography ; Retrospective Studies ; Sacrum ; Technetium

PURPOSE: To evaluate the characteristic MRI findings of pubic insufficiency fracture. MATERIALS AND METHODS: In nine cases of pubic insufficiency fracture, the findings of plain radiography (n=9), MRI (n=9), and bone scintigraphy (n=8) were reviewed. We retrospectively analyzed, with regard to fracture site, the destructive pattern revealed by plain radiography, and uptake by other pelvic bones, as demonstrated by RI bone scanning. The MR findings evaluated were the fracture gap and its signal intensity, the site and signal intensity of the soft tissue mass, and other pelvic bone fractures. RESULTS: Plain radiography revealed osteolysis and sclerosis of pubic bone in eight of nine cases (89%), and parasymphyseal fractures in seven (78%). RI indicated uptake by the sacrum in six cases (66%), and by the ilium in three (33%). MR findings of fracture gap (seven cases, 78%) were hypo to isointensity on T1WI, hyper-intensity on T2WI and the absence of contrast enhancement. Soft tissue masses were found in seven cases (78%); in four of these the location was parasymphyseal, and in three, surrounding muscle was involved. Hypo to isointensity was revealed by T1WI, hyperintensity by T2WI, and there was peripheral enhancement. Other associated pelvic bone fractures involved the sacrum in seven cases and the ilium in four. CONCLUSION: The characteristic MR findings of pubic insufficiency fracture were parasymphyseal location, fracture gap, peripherally enhanced soft tissue mass formation, and fractures of other pelvic bones, namely the sacrum and ilium.
Fractures, Stress* ; Ilium ; Magnetic Resonance Imaging* ; Osteolysis ; Pelvic Bones ; Pubic Bone ; Radiography ; Radionuclide Imaging ; Retrospective Studies ; Sacrum ; Sclerosis

BACKGROUNDA quantitative and accurate measurement of the range of hip joint flexion (RHF) is necessarily required in the evaluation of disordered or artificial hip joint function. This study aimed to assess a novel method to measure RHF more accurately and objectively.

METHODSLateral radiographs were taken of 31 supine men with hip joints extended or flexed. Relevant angles were measured directly from the radiographs. The change in the sacrofemoral angle (SFA) (the angle formed between the axis of the femur and the line tangent to the upper endplate of S1) from hip joint extension to hip joint flexion, was proposed as the RHF. The validity of this method was assessed via concomitant measurements of changes in the femur-horizontal angle (between the axis of the femur and the horizontal line) and the sacrum-horizontal angle (SHA) (between the line tangent to the upper endplate of S1 and the horizontal line), the difference of which should equal the change in the SFA.

RESULTSThe mean change in the SFA was 112.5 ± 7.4°, and was independent of participant age, height, weight, or body mass index. The mean changes in the femur-horizontal and SHAs were 123.0 ± 6.4° and 11.4 ± 3.0°, respectively. This confirmed that the change of SFA between hip joint extension and hip joint flexion was equal to the difference between the changes in the femur-horizontal and SHAs.

CONCLUSIONSUsing the SFA, to evaluate RHF could prevent compromised measurements due to the movements of pelvis and lumbar spine during hip flexion, and is, therefore, a more accurate and objective method with reasonable reliability and validity.

Adult ; Hip Joint ; diagnostic imaging ; surgery ; Humans ; Male ; Radiography ; Range of Motion, Articular ; physiology ; Sacrum ; diagnostic imaging ; surgery ; Young Adult

OBJECTIVETo investigate the relationship between lumbosacral transitional vertebra and the lumbar disc herniation (LDH).

METHODSThe X-ray photographs of lumbar vertebra were retrospectively studied of patients with and without LDH confirmed by surgery, furthermore, the differential incidence of LDH between the two groups and the relationship between transitional vertebra and the position of disc herniation were statistically analyzed.

RESULTSThe incidence of lumbosacral transitional vertebra was 18.3% in the control group, 52.7% in the LDH group, the difference was statistically significant. In the group with single lumbosacral transitional vertebra, there was 75.9% of LDH occurred on the same side of the transitional vertebra, 81.8% of which occurred at the upper one disc of the transitional vertebra; whereas 17.2% of LDH on the opposite side of the transitional vertebra, 80.0% of which occurred at the lower one disc of the transitional vertebra.

CONCLUSIONSThere is a closer relationship between lumbosacral transitional vertebra and the LDH, and the lumbosacral transitional vertebra is one of the important factors in the emergence of LDH.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Female ; Humans ; Intervertebral Disc Displacement ; etiology ; Lumbar Vertebrae ; diagnostic imaging ; Male ; Middle Aged ; Radiography ; Sacrum ; diagnostic imaging ; Spondylolisthesis ; complications

OBJECTIVETo investigate the way of sacral tumors surgical treatment.

METHODSThis retrospective study included 119 cases of sacral tumors surgically treated from July, 1996 to December, 2001. The age of patients ranged from 18 to 80 years (mean 57 years), including of 72 male and 47 female. Out of the patients, there were 52 chordomas, 16 giant cell tumor, 5 neurofibroma, 23 metastases tumors, 9 myeloma, 2 osteoblastomas, 5 aneurysmal bone cysts, 3 osteosarcomas, 4 chondrosarcomas. Posterior approach and combined anterior-posterior approach were used in 83 and 36 cases respectively. Twenty-nine patients had received surgical management at least once and 16 of them had received radiation therapy before came to our department.

RESULTSThree patients died on the complication around the surgery. Most of the patients with metastases tumor or multiple myeloma died 1 to 3 years after the surgery. Out of three osteosarcoma patients, 2 died and one alive with tumor. Three chondrosarcoma patients died, and one alive with tumor. Out of 52 chordoma patients, 3 patients had died of metastatic chordoma, 3 patients died of many times recurrence. Among the other 46 patients who were stay alive, 31 were free from disease with average follow-up time of 42 months. In the patients whose sacral nerve roots had been reserved bilaterally at and above S(3) level, the sphincter muscle function of bladder and bowl was good. While the function of sphincter muscle impaired in 2 patients with nerve roots reserved only at and above S(1) level. To manage these 2 patients, indwelling bladder catheters were used, but colostomy had not been performed.

CONCLUSIONSComplete resection of tumor (radical surgery when possible) is the most effective way to manage sacral tumors. Postoperative adjuvant radiation therapy can reduce the tumor recurrence rate, but it also can cause troubles that would hinder further surgical managements. Even if the tumor is relatively huge and the upper resection margin is as high as at S(1) or S(2) level, the tumor can be removed successfully by posterior approach and the postoperative complications could be accepted. To the patients with aneurysmal cyst or giant cell tumor on sacrum, for control bleeding purpose, anterior approach should be performed to ligate the bilateral internal iliac artery.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Prognosis ; Radiography ; Retrospective Studies ; Sacrum ; surgery ; Spinal Neoplasms ; diagnostic imaging ; surgery

PURPOSE: The purpose of this study was to describe the MR findings of the spectrum of the Currarino triad and to discuss the potential role of MR imaging in evaluating these anomalies. MATERIALS AND METHODS: Seven children (age range: 2-12 months) with Currarino triad were evaluated using MR imaging, plain radiography, and barium study. In addition, CT scans (n=3) and sonography (n=2) were performed. We retrospectively analyzed MR imaging findings and correlated these with the findings of other imaging modalities. RESULTS: Anorectal anomalies included anorectal stenosis in five patients and an imperforate anus in two. MR imaging findings of anorectal stenosis included an elongated thick-walled anorectal canal and dilatation of the proximal segment of the rectum. In the patients with an imperforate anus, the location of the blind rectal pouch and sphincteric musculature was delineated. In one case, a transcolostomy enema revealed a fistula not evident on MR images. Presacral masses included four teratomas and three lipomas associated with various spinal anomalies. On MR imaging, which gave better results than CT or sonography, a detailed evaluation of presacral masses and associated anomalies was possible. Sacral anomalies included a typical scimitar-shaped sacral defect in five patients, abnormal curvature in one, and malsegmentation in one. In all cases, MR imaging showed the abnormal sacrum, but plain radiography more clearly demonstrated its anomalous shape. CONCLUSION: Various anorectal anomalies, presacral masses, and other associated anomalies were demonstrated by MR imaging. When the Currarino triad is suspected, MR imaging should therefore follow plain radiographs.
Anal Canal ; Anus, Imperforate ; Barium ; Child ; Constriction, Pathologic ; Dilatation ; Enema ; Fistula ; Humans ; Lipoma ; Magnetic Resonance Imaging* ; Radiography ; Rectum ; Retrospective Studies ; Sacrum ; Teratoma ; Tomography, X-Ray Computed

Abnormalities, Multiple ; diagnostic imaging ; Female ; Humans ; Infant ; Lumbar Vertebrae ; abnormalities ; Neural Tube Defects ; diagnostic imaging ; Radiography ; Sacrum ; abnormalities ; Scoliosis ; diagnostic imaging