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Predictors of Continence
Published in Marc A. Levitt, Pediatric Colorectal Surgery, 2023
The sacrum is a good indicator of the development of the pelvis. If the sacrum has formed well, it is likely that so too have the surrounding muscles and nerves. ARM patients have varying degrees of associated sacral hypodevelopment. What is important to notice in this case is that, in the AP view, it appears as if no sacrum is present; however, the lateral view demonstrates a reasonably good sacrum (Figure 2.1). The difference is because the tilt of the pelvis can give a falsely low sacral ratio in the AP projection. The AP view of the sacrum is really only used to check for a hemisacrum. The lateral image is needed for accurate sacral ratio calculation (Figure 2.2).
Hip Pain
Published in Benjamin Apichai, Chinese Medicine for Lower Body Pain, 2021
The Sacroiliac joint is the articulation of the sacrum and the ilium. The bones are tethered together by strong ligaments just like other joints. There are two joints, one on each side of the sacrum. Both joints are generally considered as an immovable joint.
Spinal Cord and Reflexes
Published in Nassir H. Sabah, Neuromuscular Fundamentals, 2020
In humans, the vertebral column normally consists of 33 vertebrae divided into five subdivisions (Figure 11.1), based on some distinguishing characteristics of the vertebrae in each subdivision. The five subdivisions are, rostrally to caudally: Cervical, or neck, region comprising 7 vertebrae, denoted as C1 to C7. The C1 vertebra supports the skull, and the C2 vertebra serves as a pivot for C1.Thoracic, or chest, region comprising 12 vertebrae, denoted as T1 to T12. These vertebrae support the 12 pairs of ribs, which are joined ventrally at the sternum, or breastbone.Lumbar, or lower back, region comprising 5 vertebrae, denoted as L1 to L5.Sacral, or thigh, region comprising 5 fused vertebrae (the sacrum) having a roughly triangular shape. The sacrum articulates laterally with the hip bones. The vertebrae in this region are denoted as S1 to S5.Coccyx, or tailbone, region comprising 4 fused, rudimentary vertebrae.
The reliability of palpatory examinations for pelvic landmarks to determine pelvic asymmetry: a systematic review and meta-analysis
Published in Physical Therapy Reviews, 2022
Koya Mine, Kenta Ono, Nobuhito Tanpo
Although the notion of pelvic malalignment as a contributing factors to pain disorders or physical impairments is prevalent amongst health professionals [7, 34], this view has not been validated by research evidence, and some authors challenge this belief system [2, 35]. In fact, one cross-sectional study reported that there was no significant difference in mobility between symptomatic and asymptomatic sacroiliac joints [32]. Another roentgen stereophotogrammetric study investigated whether sacroiliac joint manipulation could change the relative position between the ilium and the sacrum [9]. Although subjective findings in positional tests changed from positive to negative after the manipulation, the objective roentgen measurements did not find any changes. This research implies that examiners were biased, assuming that manipulation could alter pelvic alignment. This mode of thinking might be confounding and reinforce clinicians’ beliefs regarding the validity of palpatory tests for determining the relationship between pelvic alignment and symptoms [36, 37].
Oxford’s clinical experience in the development of high intensity focused ultrasound therapy
Published in International Journal of Hyperthermia, 2021
Ishika Prachee, Feng Wu, David Cranston
In China, HIFU therapy for soft tissue sarcoma is also an established treatment method [1]. A chordoma is a form of low-grade soft tissue sarcoma, which arises from the remnants of the notochord. This tumour subtype is rare, with a prevalence of less than one case per million per annum. The critical problem with treating this tumour type is the location as it is adjacent to many critical pelvic structures. Hence the mainstay treatment option, curative surgical resection, is not always feasible. Another key problem is delayed presentation as the symptoms are slowly progressive and non-specific during the early stages of the disease. Symptoms include bladder and bowel dysfunction, sacral and lower limb pain, as well as pelvic masses. Alongside surgery, adjuvant radiotherapy is given. Radiotherapy has a maximum dose and so repeated cycles are not always possible. HIFU is able to overcome some of these challenges and has been shown to successfully treat sacral chordomas in four patients at the Churchill Hospital, Oxford [11,26].
Lumbopelvic Fixation Versus Novel Adjustable Plate for Sacral Fractures: A Retrospective Comparative Study
Published in Journal of Investigative Surgery, 2020
Ruipeng Zhang, Yingchao Yin, Shilun Li, Ao Li, Zhiyong Hou, Yingze Zhang
It was reported that unilateral lumbopelvic fixation could provide adequate stability for sacral fractures [13, 20, 24]. Then, fixation failure was not observed in the patients fixed with lumbopelvic technique. A biomechanical study demonstrated that both vertical and torsional stability of Tile C pelvic fractures could be obtained through novel adjustable plate fixation [25]. For the patients associated with sacral fractures, the stability of sacroiliac joint may be maintained because major traumatic energy was imposed on sacrum and there were lots of powerful ligaments (including anterior and posterior sacroiliac ligaments) surrounding the sacroiliac joint. Disruption of sacroiliac joint was not observed in the patient presented in Figure 5. Thus, the reduction force imposed on PSISs could transmit to fracture sites via sacroiliac joint. For the patients with comminuted fragments in sacral wing, screw insertion in sacrum was not recommended to avoided secondary displacement and screw misplacement. Thus, screw fixation was not involved in sacrum bilaterally. The stability of posterior pelvic ring was restored and maintained by the inserted device (bilayer cortical screw fixation), bilateral sacroiliac joints and surrounding ligaments. Thus, fixation failure was not observed.