Morphological and Morphometrical Study of Sacral Hiatus of Human Sacrum
Morphological and Morphometrical Study of Sacral Hiatus of Human Sacrum
DOI:
https://doi.org/10.70284/njirm.v9i4.2385Keywords:
Sacral Hiatus (SH), Caudal Epidural Block (CEB), Sacral CanalAbstract
Introduction: For successful epidural caudal anesthesia it is very important to know the anatomy of sacral
hiatus. Caudal opening of sacral canal is sacral hiatus (SH).Methods: Eleven direct morphometric measurements were
done on sacral vertebrae and hiatus of 56 adult dry human sacral bones of unknown age and gender. Morphological
features shape, level of apex and base of SH were noted. Data were expressed as mean (SD), analysis were
performed using SPSS. Results: Most common shape of SH was inverted ‘U’ in 34 (60.7%) sacrum. In 28 (50%) sacra
apex was present at the level of S4. The level of base of sacral hiatus- in 46 (82.1%) sacra it was at S5 vertebrae. The
length of SH was 21.73 + 8.92mm, width was11.59 + 3.25mm and the depth was 5.02 + 2.09 mm. Distance from SH
apex to S2 level was 30.30 + 11.01 mm, from SH base to S2 level was 52.03 + 6.54 mm and between upper border S1
and sacral apex was 59.58 + 14.66 mm. The distance between the two superolateral crest was 61.16 + 5.42 mm,
between right superolateral crest and apex of SH was 57.54 + 10.02 mm, the distance between left superolateral
crest and apex of SH was 58.32 + 10.59 mm, between the right superolateral crest and sacral apex was 86.22 + 9.52
mm and between left superolateral crest and apex of sacral apex was 87.19 + 9.85 mm. Conclusion: The given
landmark in this study results in the formation of equilateral triangle, which can provide the practical benefit to the
clinician for localization of SH in CEB. [A Singh, Natl J Integr Res Med, 2018; 9(4):65-73]
References
2. Susan Standring.The Anatomical Basis of Clinical Practice. Gray’s Anatomy, Elsevier Churchill Livingstone, London. 40th edition: 724-28, 760-61.
3. PatilDhananjay S, Jadav H R, Binod K, Mehta C D, Patel Vipul D. Anatomical Study of Sacral Hiatus for Caudal Epidural Block. National Jor of Medical Research. 2012; 2(3): 272-75.
4. Rammurti K S, Anil K Reddy Y. Anatomical Study of Sacral Hiatus for Successful Caudal Epidural Block. Int J Med Res Health Sci. 2013; 2(3): 496-500.
5. Mourgela S, Sakellaropoulos A, Anagnostopoulou S, Warnke J P. The Dimension of sacral Spinal Canal in Thecaloscopy: A Morphometric MRI Study. Neuroanatomy. 2009; 8: 1-3.
6. Sheila B Jones, Shaw D W W, Lawrence E Jacpbson. A Transsacral Approach Through the Sacral Hiatus for Myelography. AJR. 1997; 169: 1179-1181.
7. Bentley A. Caudal Epidural Steroid Injections. Pain Physician. 2000; 3(3): 305-312.
8. Eirch O Richter, Abramova M V, Canta F, Andres J D, Peter L, Manchiaro P et al. Anterior Epiduroscopic Neural Decompression: Eight Center Experiences in 154 Patients. Europian J of Pain Supplements. 2011; 5: 401-407.
9. Paolo Busoni, Armando Sarti. Sacral Intervertebral Epidural Block. Anaesthesiology.1987; 67: 993 – 995.
10. Shu-Yam Wong et al.,Caudal Epidural Block for Minor Gynecologic Procedures in Outpatient Surgery. Chang Gung Med J. 2004; 27(2): 116-121.
11. Carl P. C. Chen et al. Ultrasound Guidance in Caudal Epidural Needle Placement. Anesthesiology. 2004; 101: 181– 4.
12. William R. Meeker. Sacral Nerve Block Aneshesia:The anatomy involved, Techniqe and Clinical Application . Annals of Surgery. 1924; 80(5): 739-772.
13. Qudusia S, Shariff MH, Jacob M, Rao CP, Avadhani R. A Morphological study of Sacral Hiatus with its Clinical Implications. Indian Journal of Applied Research. 2014; 4(2): 34-7.
14. Osunwoke E, Oladipo G, Allison TA, Orlu E. A Study of Sacral Hiatus in Dry Human Sacra in Southern Nigeria. Journal of Biology, Agriculture and Healthcare. 2014; 4(5 : 43-8.
15. Kumar V, Pandey SN, Bajpai RN, Jain PN, Longia GS. Morphometric Study of Sacral Hiatus. JASI 1992; 41(1):7-13.
16. Naser A Y, Ali Y H, Naser A E. The Sacral Hiatus: An Anatomical Study of Both Cadeveric and Dry bones. Translational Clinical Biology. 2014; 2(1): 4-12.
17. Nagar SK. A Study of Sacral Hiatus in Dry Human Sacra. J. Anat. Soc. India. 2004; 53(2): 18-21.
18. Dipali Rani Pal, Rahman M A, Fatema K. Morphometric Study of Sacral Hiatus: A Basis for Successful Caudal Epidural Block. Bangladesh J of Anatomy. 2012; 10(1): 5-10.
19. Clarista MQ, Gautham K. Morphometrical Study of Sacral Hiatus In Dry Human Sacra in West Indian Population. Journal of Surgery 2013; 2(2):56-63.
20. Manisha B Sinha, Rathor M, Sinha H P. A Study of Variation of Sacral Hiatus in Dry Bone in Central Indian Region. International Jour of Healthcare and Biomedical Research. 2014; 2(4): 46-52.
21. Mishra M, Singh A K, Jha S, Satyavathi P, Sah N. Sacral Hiatus in Dry Human Sacra. Janki Medical College Journal of Medical sciences.2014; 2(1): 17-22.
22. Patel ZK, Thummar B, Rathod SP, Singel TC, Patel S, Zalawadia A. Multi-centric Morphometric Study of Dry Human Sacrum of Indian Population in Gujarat Region. NJIRM. 2011; 2(2): 31-35.
23. Mohamed SM, Omayma MM, El Raouf HHA, Hosam MA. Morphometric Study of Sacral Hiatus in Adult Human Egyptian Sacra: Their Significance in Caudal Epidural Anesthesia. Saudi Journal of Anaesthesia. 2012; 6(4): 350-7.
24. VijishaPhalgunan, Baskaran S. Morphometrical Analysis of Sacral Hiatus and its Clinical Significance. The Health Agenda. 2013; 1(1): 10-15.
25. Deepa S, Rajesekar S S. Anatomical Study of Sacral Hiatus. Int J of healthcare and Bioresearch. 2014; 3(1): 31-35.
26. Sekiguchi M, Yabuki S, Saton K, Kikuchi S. An anatomical Study of the Sacral Hiatus: A Basis for Successful Caudal Epidural Block. Clin J Pain. 2004; 20: 51–4.
27. Senoglu N, Senoglu M, Oksuz H, Gumusalan Y, Yuksel KZ, Zencirci B et al. Landmarks of the Sacral Hiatus for Caudal Epidural Block: An Anatomical Study. British Journal of Anaesthesia. 2005; 95 (5): 692–5.
28. Aggarwal A, Aggarwal A, Harjeet, Sahni D. Morphometry of Sacral Hiatus and its Clinical Relevance in Caudal Epidural Block. Surgical and Radiological Anatomy. 2009; 31(10):793-800.
29. Blanchais A, Le Goff B, Guillot P, Berthelot JM, Glemarec J, Maugars Y. Feasibility and Safety of Ultrasound - guided Caudal Epidural
Glucocorticoid Injections. Joint Bone Spine. 2010; 77(5): 440-444.
30. Crighton IM, Barry BP, HobbsGJ. A Study of the Anatomy of the Caudal Space Using Magnetic Resonance Imaging. Br J Anaesth.1997; 78(4):391-395.
31. Lakshmi TrikkurAnantharaman, AzraJabeen. Surgically Relevant Morphometry of Sacral Hiatus. Anatomica Karnataka. 2013; 7 (1): 52-56 .
32. Santanu B, Majumdar S, Chakraborty P, MajumdarSibanu, Mazumdar A. A Morphometric Study of Sacral Hiatus for Caudal Epidural Block among the Population of West Bengal. Indian Journal of Basic and Applied Medical Research. 2013; 7(2): 660-67.
