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Estimation of the relationship between the sacral hiatus and other dorsal sacral parameters using principle component analysis

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Abstract

Purpose

Correct localization of the sacral hiatus is essential for administering a successful caudal epidural block. The purpose of this study is to create a statistical model of sacral hiatus from dorsal sacral parameters to improve the location of the hiatus and thus, reduce the failure rate. The aim of this investigation was to examine the relationship of sacral hiatus morphology and dimension with sacral curvature. This study further examines the dorsal sacral parameters that could affect the sacral hiatus dimension.

Methods

Adult, human, dry sacra and three-dimensionally reconstructed sacra from computed tomography imaging of normal subjects were included in the study and measured using digital Vernier calipers of 0.01 mm accuracy and Geomagic freeform plus software, respectively.

Result

The most frequent shape of the sacral hiatus was an inverted V (48%) followed by inverted U shape (32%), an irregular shape (12.3%), an M shape (4.7) and an A shape (2.8%). The data were represented by mean and standard deviation. Sacra with M-shaped hiatus had the lowest hiatal length (14.21 ± 5.44 mm), whereas sacra with an inverted V-shaped hiatus had the highest length (25.41 ± 11.3 mm). The anteroposterior diameter of the sacral hiatus at the base in males and females was found to be 3.46 ± 1.48 mm and 2.79 ± 0.83 mm, respectively (P < 0.001). The distance between the caudal end of the median sacral crest and the apex of the sacral hiatus (7.90 ± 6.74 mm, 4.4 ± 5.86 mm) also revealed sexual dimorphism (P < 0.001).

Conclusion

The correlations between most of the dorsal sacral parameters and length of the sacral hiatus are significant. The intercornual distance is also moderately correlated with the distance between right and left lateral sacral crest S1 level. Dorsal sacral parameters predicts variance of the sacral hiatus dimension from 40 to 73% and this could be utilized for statistical model of the sacral hiatus.

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Abbreviations

AP:

Anteroposterior.

CEB:

Caudal epidural block

DICOM:

Digital imaging and communication in medicine

D2P:

Dicom to print software

DSP:

Dorsal sacral parameters

DWD:

Dorsal wall defect

LSTV:

Lumbo-sacral transitional vertebra

LSC:

Lateral sacral crest

MSC:

Median sacral crest

MDCT:

Multi-detector computed tomography

PCA:

Principal component analysis

PSIS:

Posterior superior iliac spine

SF1:

First sacral foramina

SF2:

Second sacral foramina

SH:

Sacral hiatus

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Authors and Affiliations

  1. Department of Anatomy, All India Institute of Medical Sciences, AIIMS Patna, Phulwarisharif, Patna, Bihar, 801507, India

    Binita Chaudhary, Adil Asghar & Abhigyan Satyam

  2. Department of Anaesthesiology, AIIMS Patna, Patna, Bihar, India

    Shagufta Naaz

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  1. Binita Chaudhary
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  2. Adil Asghar
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  3. Shagufta Naaz
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  4. Abhigyan Satyam
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Contributions

BC and AA developed the project, collected and analysed data; drafted the manuscript and approved the final version of manuscript. SN: data collection, manuscript writing. AS: data collection, manuscript writing. Critical revision of the article has been provided by BC, AA, SN, AS.

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Correspondence to Binita Chaudhary.

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Chaudhary, B., Asghar, A., Naaz, S. et al. Estimation of the relationship between the sacral hiatus and other dorsal sacral parameters using principle component analysis. Surg Radiol Anat 43, 1545–1554 (2021). https://doi.org/10.1007/s00276-021-02794-7

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  • DOI: https://doi.org/10.1007/s00276-021-02794-7

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