Virtual autopsy to assess sacral anatomy: Conditions for a minimal invasive approach to the spinal canal through the hiatus sacralis.

Bodmer, Andrea; Ross, Steffen; Raabe, Andreas; Beck, Jürgen; Ulrich, Christian Thomas; Schucht, Philippe (2017). Virtual autopsy to assess sacral anatomy: Conditions for a minimal invasive approach to the spinal canal through the hiatus sacralis. Surgical neurology international, 8(290), p. 290. Wolters Kluwer Medknow 10.4103/sni.sni_313_17

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Background Despite multiple advantages of minimally invasive techniques in spinal surgery, the currently used approaches may lead to postoperative pain and spinal instability. As a natural orifice, the hiatus sacralis offers a nontransmuscular alternative entry point for endoscopic approaches. In this study, we collected data about the complex anatomical conditions of the sacral canal as a basis for the development of a sacral endoscope. Methods We retrospectively evaluated 192 postmortem human cadaveric specimens with computed tomography (CT). The anatomical conditions of the sacrum and lumbar spine were analyzed, including assessment of the lateral and anteroposterior diameters, measurement of the cross-sectional area of the sacral canal at the lumbosacral transition, hiatus sacralis, and the narrowest point of the sacral canal. Results The narrowest anteroposterior diameter was >2.3 mm in 95% of the cases; the width was >13 mm in 95% of the cases. The narrowest point was located at the hiatus in 72% of the cases. The angle of sacral kyphosis was less than 30° and less than 50° in lumbar lordosis in 95% of the cases. A length shorter than 288 mm was measured in 95% of the cases. Anatomical conditions in male and female sacra were comparable. Conclusions The narrow anteroposterior diameter is the key limiting feature for using the canalis sacralis as a natural entry point into the spinal canal. Sacroscopy will require endoscopes with a flattened shape, with parallel arrangement of instruments and flexibility to accommodate the varied dorsal and ventral curvatures.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Ross, Steffen; Raabe, Andreas; Beck, Jürgen; Ulrich, Christian Thomas and Schucht, Philippe

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2229-5097

Publisher:

Wolters Kluwer Medknow

Language:

English

Submitter:

Nicole Söll

Date Deposited:

28 Feb 2018 11:07

Last Modified:

29 Mar 2018 16:54

Publisher DOI:

10.4103/sni.sni_313_17

PubMed ID:

29285406

Uncontrolled Keywords:

Chronic lumbar pain endoscopy minimally invasive surgery sacral anatomy sacroscopy spinal surgery

BORIS DOI:

10.7892/boris.108597

URI:

https://boris.unibe.ch/id/eprint/108597

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