• Clinical and Experimental Pediatrics
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• v.61 no.6
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• pp.194-199
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• 2018

Purpose: Sacral dimples are a common cutaneous anomaly in infants. Spine ultrasonography (USG) is an effective and safe screening tool for patients with a sacral dimple. The aim of this study was to determine the clinical manifestations in patients with an isolated sacral dimple and to review the management of spinal cord abnormalities identified with USG. Methods: We reviewed clinical records and collected data on admissions for a sacral dimple from March 2014 through February 2017 that were evaluated with spine USG by a pediatric radiologist. During the same period, patients who were admitted for other complaints, but were found to have a sacral dimple were also included. Results: This study included 230 infants under 6-months-old (130 males and 100 females; mean age $52.8{\pm}42.6days$). Thirty-one infants with a sacral dimple had an echogenic filum terminale, and 57 children had a filar cyst. Twenty-seven patients had a low-lying spinal cord, and only one patient was suspected of having a tethered cord. Follow-up spine USG was performed in 28 patients, which showed normalization or insignificant change. Conclusion: In this study, all but one infant with a sacral dimple had benign imaging findings. USG can be recommended in infants with a sacral dimple for its convenience and safety.

• Journal of Korean Neurosurgical Society
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• v.61 no.2
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• pp.258-266
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• 2018

Objective : The diagnosis of insufficiency fractures of the sacrum in an elder population increases annually. Fractures show very different morphology. We aimed to classify sacral insufficiency fractures according to the position of cortical break and possible need for intervention. Methods : Between January 1, 2008 and December 31, 2014, all patients with a proven fracture of the sacrum following a low-energy or an even unnoticed trauma were prospectively registered : 117 females and 13 males. All patients had a computer tomography of the pelvic ring, two patients had a magnetic resonance imaging additionally : localization and involvement of the fracture lines into the sacroiliac joint, neural foramina or the spinal canal were identified. Results : Patients were aged between 46 and 98 years (mean, 79.8 years). Seventy-seven patients had an unilateral fracture of the sacral ala, 41 bilateral ala fractures and 12 patients showed a fracture of the sacral corpus : a total of 171 fractures were analyzed. The first group A included fractures of the sacral ala which were assessed to have no or less mechanical importance (n=53) : fractures with no cortical disruption ("bone bruise") (A1; n=2), cortical deformation of the anterior cortical bone (A2; n=4), and fracture of the anterolateral rim of ala (A3; n=47). Complete fractures of the sacral ala (B; n=106) : parallel to the sacroiliac joint (B1; n=63), into the sacroiliac joint (B2; n=19), and involvement of the sacral foramina respectively the spinal canal (B3; n=24). Central fractures involving the sacral corpus (C; n=12) : fracture limited to the corpus or finishing into one ala (C1; n=3), unidirectional including the neural foramina or the spinal canal or both (C2; n=2), and horizontal fractures of the corpus with bilateral sagittal completion (C3; n=8). Sixty-eight fractures proceeded into the sacroiliac joint, 34 fractures showed an injury of foramina or canal. Conclusion : The new classification allowes the differentiation of fractures of less mechanical importance and a risk assessment for possible polymethyl methacrylate leaks during sacroplasty in the direction of the neurological structures. In addition, identification of instable fractures in need for laminectomy and surgical stabilization is possible.

• Journal of Korean Neurosurgical Society
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• v.44 no.3
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• pp.174-177
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• 2008

Symptomatic sacral perineural cysts are uncommon. Several hypotheses have been proposed to explain the etiologies of perineural cysts, but the accurate etiologies remain unclear. We experienced two cases of symptomatic sacral perineural cysts (Tarlov cysts) in one family, who presented with perianal paresthesia. Both of them were operated and postoperatively their symptoms were disappeared immediately. We experienced the excellent treatment outcome with the surgical management of symptomatic perineural cysts in the sacral region. We assume that the theory of congenital origin including a familial tendency is the most plausible of the hypotheses that have been proposed.

• Journal of the Korean Society of Physical Medicine
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• v.2 no.1
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• pp.49-59
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• 2007

Objective : To purpose of this study was the most of the ladies wear high-heeled shoes at lease 4 to 5 day a week but the effect of it's height on the lumbo-sacral legion angle has not been clearly defined. Method : Subject were 20 young ladies, who had majored in physical therapy of the Dae-gu Health College. Method 1. PACS system X-ray was used to measure the lumbo-sacral legion angle under the condition of bare foot, 3cm, 7cm high-heeled at standing position. 2. Spinal Mouse was used to measure the spinal segment motion angle and length under the condition of bare foot, 3cm, 7cm high-heeled at being Flexion-Extension position Result : The result of this study were as follow I. Significant statistical increase in lumbar lordosis was observed as the heel height was increased from bare foot to 7cm high-heeled(p<.05), but there was no significant difference in the lumbo-sacral angle & sacral angle(p>.05). 2. The Height and the weight of the subjects, their preference on the shoes didn't affect the lumbo-sacral lesion angle(p>.05) 3. The variation of the heel height didn't affect the spinal segment motion angle and length(p>.05). Conclusion : There is strong relationship between the high of heel with increasing the lumbar lordosis(p<.05).

• The Korean Journal of Pain
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• v.29 no.1
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• pp.23-28
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• 2016

Background: Sacral nerve stimulation is a therapeutic option with demonstrated efficacy for conditions presenting with perineal pain caused by different etiologies. We aimed to assess whether a sacral electrode ($Interstim^{(R)}$, Medtronic, Minneapolis, MN, USA) inserted through the caudal pathway is able to offer an acceptable level of sacral stimulation and rate of catheter migration. Methods: We present 12 patients with pelvic pain who received sacral neuromodulation via the sacral hiatus with the InterStim electrode. We evaluated patient satisfaction as well as migration and removal of the electrode, if necessary. Results: Our experience included 12 patients, 10 women and two men, with a mean age of 60 years. In eight of the 12 patients, the initial therapy was effective, and the final system implantation was performed. During subsequent follow-up, patient satisfaction was good. To date, there have been no cases of electrode displacement or migration. Conclusions: The caudal insertion of the InterStim electrode, with its own fixation system, and initially designed for transsacral insertion, appears in our experience to be a satisfactory option which can minimize electrode displacements, achieving similar results in therapeutic efficacy and causing no difficulties in removal.

• Journal of Yeungnam Medical Science
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• v.28 no.2
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• pp.196-201
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• 2011

A 73-year-old male presented a six-month history of buttock pain radiating into his thigh. The MRI revealed a large enhancing mass lesion involving the sacrum, with extension into the sacral canal. The tumor markers were measured to distinguish skeletal metastasis of carcinoma from primary bone tumor. The CA 19-9 was elevated. Despite the investigation, the primary site of cancer could not be found. Sacral bone biopsy was done. The pathologic examination revealed necrosis, chronic granulomatous inflammation, and multinucleated giant cells, consistent with tuberculosis. Sacral tuberculosis is rare in patients with no history of tuberculosis. Such solitary osteolytic lesions involving the subarticular region of large joints may mimic bone neoplasms and may be called "tuberculous pseudotumors." This case report intends to emphasize that bone tuberculosis should be a differential diagnosis in the presence of atypical clinical and radiological features. As tuberculous lesions may be mistaken for neoplasms, a small amount of fresh tissue should be sent for culture even if clinical diagnosis of a tumor seems likely. Described herein is a case of sacral tuberculosis mimicking metastatic bone tumor with elevated CA 19-9.

• The Journal of Pediatrics of Korean Medicine
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• v.17 no.2
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• pp.161-171
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• 2003

This study was to investigate the relationship of headache and back shape using the Moire interferometer and Questionnaire investigations. In this study the subjects consisted of 317 pupils[168 boys(53%), 149girls(47%)] attending S high school in Sungnamsi, Kyoungkido in 2002, and their ages ranged from sixteen to eighteen. The results are following. 1. In questionnaire investigation, we observed that the ratio of headache was more than 70% and the ratio of girls are more than that of boys. The inclination for ages was not shown. 2. In moire topography, the remainder values of scapular region were from 0.5 cm to 1.1 cm in boys, and from 0.45 cm to 1 cm in girls. The remainder values of gluteal region were from 0.2 cm to 0.8 cm in boys, and from 0.4 cm to 0.6 cm in girls. The reminder values of the vertical lines of cervical and buttock region were from 0.71 cm to 1.51 cm in boys, and from 0.96 cm to 1.43 cm in girls. More frequent findings of reminder value of the vertical lines of cervical and buttock region were observed that the vertical lines of cervical region were inclined to left than the vertical lines of buttock 3. Through the Pearson's Correlation analysis of headache and Moire topography, we found the close relationship of headache and the remainder values of scapular region(Pearson correlation coefficient : 0.116, P<0.05) and gluteal region(Pearson correlation coefficient : 0.153, P<0.01). But the relevances to headache and the remainder values of neck lines, sacral lines and neck-sacral lines were not found.

• Archives of Plastic Surgery
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• v.34 no.2
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• pp.191-196
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• 2007

Purpose: Gluteal perforator is easily identified in the gluteal region and gluteal perforator flap is a very versatile flap in sacral sore reconstruction. We obtained satisfying results using the gluteal perforator flap, so we report this clinical experiences with a review of the literature. Methods: Between November of 2003 and April 2006, the authors used 16 gluteal perforator flaps in 16 consecutive patients for coverage of sacral pressure sores. The mean age of the patients was 47.4 years (range, 14 to 78 years), and there were 9 male and 7 female patients. All flaps in the series were supplied by musculocutaneous arteries and its venae comitantes penetrating the gluteus maximus muscle and reaching the intrafascial and suprafascial planes, and the overlying skin forming a rich vascular plexus arising from gluteal muscles. Patients were followed up for a mean period of 11.5 months. Results: All flaps survived except one that had undergone total necrosis by patient's negligence. Wound dehiscence was observed in three patients and treated by secondary closure. There was no recurrence during the follow-up period. Conclusion: Gluteal perforator flaps allow safe and reliable options for coverage of sacral pressure sores with minimal donor site morbidity, and do not sacrifice the gluteus maximus muscle and rarely lead to post-operative complications. Freedom in flap design and easy-to perform make gluteal perforator flap an excellent choice for selected patients.

• The Journal of Korean Physical Therapy
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• v.13 no.1
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• pp.127-137
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• 2001

Low back pain is significant problem in today's society, with lifetime incidence rate reported between 50% and 90%. Many factors associated with LBP are reported. The purpose of this studies were to be evaluated static standing posture aberrations in chronic LBP in comparison with healthy individuals. The samples including 80 subjects recruited to the following two groups:patients and control(normal) Questionnaires were completed by 40 LBP patients and 40 controls at the department of Physical Therapy, Saejong neurosurgical clinic in Taegu city from October 1, 1999 to March 30, 2000. The angle of lumbar lordosis was measured on lateral x-ray films with standing position. In LBP groups. the mean degree of lumbar lordosis, sacral inclination, and lumbosacral joint angle were 29.9 ${\pm}$ 9.3, 34.8 ${\pm}$ 8.2, and 12.7 ${\pm}$ 5.7 respectively. Control groups, the mean degree of lumbar lordosis, sacral inclination and lumbosacral joint angle were 35.3 ${\pm}$ 7.8, 34.9 ${\pm}$ 6.4 and 12.5 ${\pm}$ 4.3 respectively. there were significantly decreaseds in lumbar lordosis in Low back pain group. lumbar lordosis on the working posture had significant differences among groups(sitting position patients 31.4 ${\pm}$ 9.3, standing position patients 29.4 ${\pm}$ 9.3, sitting position control 35.0 ${\pm}$ 6.4, standing position control 35.5 ${\pm}$ 8.8, respectively) (p=0.034). sacral inclination on the working posture had differences among groups(sitting position patients 35.9 ${\pm}$ 8.7.standing position patients 33.6 ${\pm}$ 7.6, sitting position control 33.9 ${\pm}$ 5.9. standing position control 35.6 ${\pm}$ 6.8, respectively). lumbersacral joint angle on the working Posture had differences among groups(sitting position patients 12.0 ${\pm}$ 5.6, standing position patients 13.4 ${\pm}$ 5.9, sitting position control 11.2 ${\pm}$ 3.0. standing position control 13.4$^{\circ}$, respectively).

• Obstetrics & gynecology science
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• v.61 no.6
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• pp.693-697
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• 2018

Aggressive angiomyxoma (AA) is a very rare mesenchymal tumor most commonly found in the pelvic and perineal regions. For the complete excision of retrorectal tumors, with extension through the levator muscle into the ischioanal space, open anterior and posterior approaches are typically required. Herein, we report our experience with robotic excision of a giant presacral AA with extralevator extension into the ischioanal space and extraction via Pfannenstiel incision, which we found to be technically feasible, efficacious, and safe to perform. Mayo Clinic Institutional Review Board exemption status was obtained for this study.