Central Sagittal Angle of the Sacrum as a New Risk Factor for Patients with Persistent Low Back Pain after Caesarean Section

STUDY DESIGN: Retrospective. PURPOSE: This study investigated the possible association of persistent low back pain (LBP) with caesarean section (CS) under spinal anesthesia. OVERVIEW OF LITERATURE: Many women suffer from LBP after CS, which is commonly performed under spinal anesthesia. However, this type of LBP is poorly understood, and there is poor consensus regarding increased risk after spinal anesthesia. METHODS: We examined two groups of patients who underwent cesarean delivery under spinal anesthesia. Group I included patients who presented to a neurosurgical clinic complaining of LBP for at least 6 months. Group II was a control group with patients without LBP. We analyzed clinical and sagittal angle parameters, including age, body mass index, parity, central sagittal angle of the sacrum (CSAS), and sacral slope (SS). RESULTS: Fifty-three patients participated in this study: 23 (43.1%) in Group I and 30 (56.9%) in Group II. Non-parametric Mann–Whitney U-tests showed that age, parity, and CSAS significantly differed between the two groups at 6 months. CONCLUSIONS: Age, parity, and CSAS appear to be associated with increased risk for LBP after CS under spinal anesthesia. Future prospective studies on this subject may help validate our results.

The Role of Extra-Anatomic Bypass in the Surgical Treatment of Acute Abdominal Aortic Occlusion

BACKGROUND: Aortic occlusion is rare catastophic pathology with high rates of mortality and severe morbidity. In this study, we aimed to share our experience in the management of aortic occlusion and to assess the outcomes of extra-anatomic bypass procedures. METHODS: Eighteen patients who had undergone extra-anatomic bypass interventions in the cardiovascular surgery department of our tertiary care center between July 2009 and May 2013 were retrospectively evaluated. All patients were preoperatively assessed with angiograms (conventional, computed tomography, or magnetic resonance angiography) and Doppler ultrasonography. Operations consisted of bilateral femoral thromboembolectomy, axillobifemoral extra-anatomic bypass and femoropopliteal bypass and were performed on an emergency basis. RESULTS: In all patients during early postoperative period successful revascularization outcomes were obtained; however, one of these operated patients died on the 10th postoperative due to multiorgan failure. The patients were followed up for a mean duration of 21.2+/-9.4 months (range, 6 to 36 months). Amputation was not warranted for any patient during postoperative follow-up. CONCLUSION: To conclude, acute aortic occlusion is a rare but devastating event and is linked with substantial morbidity and mortality in spite of the recent advances in critical care and vascular surgery. Our results have shown that these hazardous outcomes may be minimized and better rates of graft patency may be achieved with extra-anatomic bypass techniques tailored according to the patient.

Introducing a New Risk Factor for Lumbar Disc Herniation in Females : Vertical Angle of the Sacral Curvature

OBJECTIVE: To characterize the importance of the vertical angle of the sacral curvature (VASC) in lumbar disc herniations. METHODS: Morphological data derived from lumbar sagittal MRI imaging. The statistical significance of the findings are discussed. The angles of 60 female patients with lumbar disc herniations (LDH) were compared with the 34 female patients without LDH. RESULTS: 128 of the 185 patients met our inclusion criteria. The vertical angle of sacral curvature is statistically significantly bigger in females with lumbar disc herniations when compared to subjects in control group, 28.32 and 25.4, respectively. (p=0.034<0.05). Same difference was not seen in males. CONCLUSION: The vertical angle of sagittal sacral curvature may be another risk factor in females with lumbar disc herniations.