Classification and analysis of fifth pair of sacral foramina in indian dry sacra / Clasificación y análisis del quinto par de forámenes en huesos sacros secos de indios

A sacrum with five pairs of foramina is an anatomical variant resulting from sacralisation of lumbar vertebra at cranial end or sacralisation of coccyx vertebra at caudal end. An unusual gross variation nurtures interest of anatomists and causes concern for clinicians when it mimics pathology. A sacrum with fifth anomalous pair of sacral foramina has been observed which prompted the author to examine the available sacra in the osteology lab of Department of Anatomy KG Medical University Lucknow, UP, India. Of the total sixty six observed sacra, those with five pairs of sacral foramina due to sacralisation of lumbar vertebra were found in eleven cases (16.6%) while those due to sacralisation of coccygeal vertebra were observed in nine cases (13.6%). These sacralisations were classified in five categories to systematise the anatomical study, causes and clinical complications. Sacralisation of lumbar vertebra may compress the fifth sacral nerve causing sciatica and back pain. It may also cause herniation of disc above sacralisation. Sacralisation of coccygeal vertebra may influence the caudal block anaesthesia in surgical procedures and also results in prolonged second stage of labor and perineal tears.

Un sacro con cinco pares de forámenes es una variante anatómica que resulta de la sacralización de la vértebra lumbar al extremo craneal o sacralización de la vértebra coxis al extremo caudal. Esta variación inusual es de interés para los anatomistas como también motivo de preocupación para los médicos al asemejar una patología. Un sacro con un quinto par anómalo de forámenes fue observado, por lo que se examinaron otros sacros del laboratorio de osteología del Departamento de Anatomía Médica de la Universidad de Lucknow, India. De un total de 66 sacros estudiados, en 11 casos (16,6%) se observaron cinco pares de forámenes sacros, debido a la sacralización de la vértebra lumbar; mientras que en 9 casos (13,6%), se observó la sacralización de la vértebra caudal. Estos fueron clasificados en cinco categorías para sistematizar el estudio anatómico, sus causas y complicaciones clínicas. La sacralización de la vértebra lumbar puede comprimir el quinto nervio, causando ciática sacra y dolor de espalda. También puede causar una hernia discal superior a la sacralización. La sacralización de la vértebra caudal, puede influir en la anestesia de bloqueo caudal en procedimientos quirúrgicos y también dar lugar a una prolongada etapa del trabajo de parto y desgarros perineales.

Sirenomelia apus with vestigial tail.

Sirenomelia is an exceptionally rare congenital malformation characterized by complete or near complete fusion of lower limbs. A newborn with clinical features of sirenomelia including fused lower limbs in medial position, absent fibula, anal atresia, complete absence of urogenital system (bilateral renal agenesis, absent ureters, urinary bladder, absent internal and external genitalia), a single umbilical artery and a vestigial tail is reported. Association of vestigial tail with sirenomelia is not described in the literature.

Syringomyelia in caudal dysplasia sequence.

Caudal dysplasia sequence (CDS) comprises developmental anomalies of the caudal vertebrae, neural tube, urogenital and digestive organs, and hind limbs, the precursors of all of which are derived from the caudal eminence. Although the syndrome is well recognized, the etiology and pathogenetic mechanisms are poorly understood. We report syringomyelia in association with the CDS, which has not been described previously and recommends inclusion of this entity in the spectrum of abnormalities encountered in this syndrome.

Usefulness of radiology and MRI in caudal regression syndrome

We report three patients with sacral and coccygeal agenesis based on observations of painful haematuria, urinary tract infection, and urine incontinence. All patients were examined by conventional radiology [urography and micturating urethrography] and imaging such as ultrasound and MRI. Neuropathic urinary bladder and pronounced reflux to the kidneys were observed. MRI of spine revealed conus medullaris located high [Th 11 and Th 12] and different from the expectations with respect to the patients' age. Neither tether cord nor intrathecal tumours were observed in our patients. In one patient, deformed and bulky cauda equina was described and in another the cauda equina was small and atrophic. In all patients, absence of a part of sacrum and coccyx and nerve roots innervating urinary bladder and sphincters were observed. MRI revealed good anatomical and pathological check up of kidneys and urinary tracts in the children suffering from chronic urosepsis

Cocciogodinia: tratamento cirúrgico

Coccigodinia constitui uma condição clínica caracterizada por edema e dor na região coccígea, podendo estar associada com trauma ou à conformação anatômica deste segmento, sendo mais freqüente no gênero feminino. o tratamento deve ser iniciado por meios conservadores e, na falha destes, o tratamento cirúrgico pode ser indicado com bons resultados. Objetivo deste estudo é avaliar o tratamento cirúrgico pela coccigectomia, sendo avaliados 12 pacientes com obtenção de bons resultados em 10 casos, 2 casos com avaliação regular e nenhum mau resultado.

Child with a tail.

An interesting case of a child with a tail is reported. The child had a tail like structure in the back since birth, increasing with age. It was 20 cm. long, the longest tail so far described in the English literature. There was no functional complain. The result was excellent after excision as the problem was only cosmetic.

Afecciones originadas en defectos disraficos lumbosacros congénitos: dermal sinus, meningioma, teratoma sacrocoxígeo / Affections caused in lumbosacral dysraphic defects congenital: dermal sinus, meningocele, sacrococcygeal teratoma

Se presenta la patología originada en defectos disráficos lumbosacros. Se relatan 6 observaciones correspondientes a un período de 20 años: 2 dermal sinus, 3 teratomas sacrocxígeos y 1 meningocele. Se insiste sobre la necesidad de conocer esta patología y del tratamiento quirúrgico precoz, con el fin de evitar las graves complicaciones que origina. En los casos de dermal sinus con conducto fistuloso, cuando no existen síntomas neurológicos ni secreción por orificio cutáneo, es aconsejable efectuar la operación despues de los 18 meses de edad