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Plessis AMD, Wessels Q, Schoor AV, Keough N. Congenital malformations in the vertebral column: associations and possible embryologic origins. Anat Cell Biol 2022; 55:399-405. [PMID: 36071544 PMCID: PMC9747346 DOI: 10.5115/acb.22.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/01/2022] [Accepted: 07/05/2022] [Indexed: 01/02/2023] Open
Abstract
Cases of associations between random spinal congenital defects have previously been reported, yet several questions remain unanswered. Firstly, why are associations between what seems to be random combinations of vertebral malformations observed? Secondly, is there a common event or pattern that connects the associated defects? Therefore, this study aimed to identify congenital defects in the vertebral column and also to determine whether any associations, if present, between vertebral malformations exist. This article consequently discusses the possible embryological disruptions that may lead to the formation of various defects in the vertebral column. A random skeletal sample (n=187) was selected from the Pretoria Bone Collection housed in the Department of Anatomy, University of Pretoria (Ethics 678/2018). The sample was evaluated to determine the frequencies of spinal congenital defects in each set of remains. Identifiable congenital malformations were observed in 48.1% (n=90/187) of the sample. The results demonstrated a high probability of association between the different defects observed in the vertebral column. Findings are of value as they provide a reasonable explanation to why seemingly random cases of associations have been reported by several authors. This study is clinically relevant as severe spinal defects have been shown to have high morbidity in patients and mortality in infants.
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Affiliation(s)
- Anneli M. Du Plessis
- Department of Anatomy, Health Science Campus, University of Pretoria, South Africa,Department Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia,Corresponding author: Anneli M. Du Plessis, Department of Anatomy, School of Medicine, University of Namibia, Windhoek 9000, Namibia, E-mail: /
| | - Quenton Wessels
- Department Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Albert Van Schoor
- Department of Anatomy, Health Science Campus, University of Pretoria, South Africa
| | - Natalie Keough
- Department of Anatomy, Health Science Campus, University of Pretoria, South Africa,Department of Anatomy and Cellular Biology, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
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Naznin RA, Moniruzzaman M, Sumi SA, Benzir M, Jahan I, Ahmad R, Haque M. Sacralization of Coccygeal Vertebra: A Descriptive Observational Study in Bangladesh. Cureus 2022; 14:e27496. [PMID: 35919212 PMCID: PMC9339143 DOI: 10.7759/cureus.27496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/25/2022] Open
Abstract
Background: In the sacrococcygeal region, anatomical variation is due to the sacralization of the coccygeal vertebra, which is the due union of/fusion of the fifth sacral with the first coccygeal vertebra of five couples of sacral foramina under-detected or asymptomatic beyond radiological assessment. That is why it is challenging to know the cause of coccydynia, caudal block failure, the difficult second stage of labor, and perineal tears. The present study aims to improve knowledge about the anatomical variation of sacralization of the coccygeal vertebra. Additionally, to find the prevalence of sacralization of coccygeal vertebra in Sylhet, Bangladesh. Methods: This study was performed on 60 parched, totally calcified, typical sacra of mature-age individuals of undetermined sexes, fulfilling the inclusion criteria from the bone bank of the osteology museum of the Department of Anatomy, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh, from July 2017 to June 2018. Sex determination of the collected unknown sacra was conducted using discriminant function analysis. It was found that 50% (30) were male and 50% (30%) were female. The unpaired t-tests and chi-square were utilized to determine the statistical significance. Results: Out of 60 sacra, eight (13.33%) samples presented with sacralization. This study found that males had significantly higher straight (p=0.05) and curved (p=0.05) lengths of sacrococcygeal vertebrae. The sacrococcygeal curvature index (SCI) showed statistically significant (p=0.05) differences between the sexes. Conclusion: Sacralization may exert an impact on the caudal block. It could extend the second stage of the labor process with perineal tears. Therefore, knowledge about the anatomical variation of the coccygeal vertebra is essential.
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Krenn VA, Fornai C, Webb NM, Woodert MA, Prosch H, Haeusler M. The morphological consequences of segmentation anomalies in the human sacrum. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 177:690-707. [PMID: 36787761 PMCID: PMC9303760 DOI: 10.1002/ajpa.24466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 04/27/2023]
Abstract
OBJECTIVES Despite the high frequency of segmentation anomalies in the human sacrum, their evolutionary and clinical implications remain controversial. Specifically, inconsistencies involving the classification and counting methods obscure accurate assessment of lumbosacral transitional vertebrae. Therefore, we aim to establish more reliable morphological and morphometric methods for differentiating between sacralizations and lumbarizations in clinical and paleontological contexts. MATERIALS AND METHODS Using clinical CT data from 145 individuals aged 14-47 years, vertebral counts and the spatial relationship between the sacrum and adjoining bony structures were assessed, while the morphological variation of the sacrum was assessed using geometric morphometrics based on varied landmark configurations. RESULTS The prevalence of lumbosacral and sacrococcygeal segmentation anomalies was 40%. Lumbarizations and sacralizations were reliably distinguishable based on the spatial relationship between the iliac crest and the upward or downward trajectory of the linea terminalis on the sacrum. Different craniocaudal orientations of the alae relative to the corpus of the first sacral vertebra were also reflected in the geometric morphometric analyses. The fusion of the coccyx (32%) was frequently coupled with lumbarizations, suggesting that the six-element sacra more often incorporate the coccyx rather than the fifth lumbar vertebra. CONCLUSIONS Our approach allowed the consistent identification of segmentation anomalies even in isolated sacra. Additionally, our outcomes either suggest that homeotic border shifts often affect multiple spinal regions in a unidirectional way, or that sacrum length is highly conserved perhaps due to functional constraints. Our results elucidate the potential clinical, biomechanical, and evolutionary significance of lumbosacral transitional vertebrae.
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Affiliation(s)
- Viktoria A Krenn
- Institute of Evolutionary Medicine, University of Zurich, Zürich, Switzerland
- Department of Evolutionary Anthropology, University of Vienna, Vienna, Austria
| | - Cinzia Fornai
- Institute of Evolutionary Medicine, University of Zurich, Zürich, Switzerland
- Department of Evolutionary Anthropology, University of Vienna, Vienna, Austria
- VieSID, Vienna School of Interdisciplinary Dentistry, Klosterneuburg, Austria
| | - Nicole M Webb
- Institute of Evolutionary Medicine, University of Zurich, Zürich, Switzerland
- Department of Palaeoanthropology, Senckenberg Research Institute and Natural History Museum Frankfurt, Frankfurt, Germany
- Institute of Archaeological Sciences, Senckenberg Centre for Human Evolution and Palaeoenvironment, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Mirella A Woodert
- Institute of Evolutionary Medicine, University of Zurich, Zürich, Switzerland
| | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martin Haeusler
- Institute of Evolutionary Medicine, University of Zurich, Zürich, Switzerland
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Tague RG. Proximate cause, anatomical correlates, and obstetrical implication of a supernumerary lumbar vertebra in humans. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2017; 165:444-456. [PMID: 29159938 DOI: 10.1002/ajpa.23361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Three issues are considered on variation in number of presacral vertebrae (PSV) in humans: (1) sexual difference in number of PSV, (2) inactivation of Hoxd-11 gene as etiology for a supernumerary lumbar vertebra, and (3) anatomical correlates of a supernumerary lumbar vertebra, including lumbar-sacral nearthrosis, and pelvic size. MATERIALS AND METHODS Sample was 407 skeletonized females and 1,318 males from United States; ages at death were 20 to 49 years. Two subsamples of males were used: (1) 98 with modal numbers of cervical, thoracic, lumbar, and sacral vertebrae (PSV = 24) and (2) 45 with a supernumerary lumbar vertebra but modal numbers for other vertebral segments (PSV = 25). Measurements were taken of ulna, second metacarpal, vertebrae, femur, and pelvis; presence of lumbar-sacral nearthrosis was observed. RESULTS Although 90% of females and males have 24 PSV, females have higher frequency of 23 PSV and males have higher frequency of 25 PSV. Compared to males with 24 PSV, males with 25 PSV and supernumerary lumbar vertebra show (1) no difference in anatomies associated with inactivation of Hoxd-11, and (2) higher frequency of lumbar-sacral nearthrosis and smaller pelvic inlet circumference. DISCUSSION Sexual difference in number of PSV may be due to tempo of somite formation and Hox gene activation. Hypothesis is not supported that a supernumerary lumbar vertebra is due to inactivation of Hoxd-11. The presence of a supernumerary lumbar vertebra is associated with small pelvic inlet circumference, which can be obstetrically disadvantageous.
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Affiliation(s)
- Robert G Tague
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, Louisiana, 70803
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Coccygeal Morphology on Multislice Computed Tomography in a Tertiary Hospital in India. Asian Spine J 2017; 11:694-699. [PMID: 29093777 PMCID: PMC5662850 DOI: 10.4184/asj.2017.11.5.694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/06/2017] [Accepted: 02/18/2017] [Indexed: 12/02/2022] Open
Abstract
Study Design A retrospective, cross-sectional study of 213 patients who presented for abdominal computed tomography (CT) scans to assess coccygeal morphology in the Indian population. Purpose There have been relatively few studies of coccygeal morphology in the normal population and none in the Indian population. We aimed to estimate coccygeal morphometric parameters in the Indian population. Overview of Literature Coccygeal morphology has been studied in European, American, Korean, and Egyptian populations, with few differences in morphology among populations. Methods A retrospective analysis of 213 abdominal CT scans (114 males and 99 females; age, 7–88 years; mean age, 47.3 years) was performed to evaluate the number of coccygeal segments, coccyx type, sacrococcygeal and intercoccygeal fusion and subluxation, coccygeal spicules, sacrococcygeal straight length, and sacrococcygeal and intercoccygeal curvature angles. Results were analyzed for differences in morphology with respect to sex and coccyx type. Results Types I and II coccyx were the most common. Most subjects had four coccygeal vertebrae; 93 subjects (43.66%) had partial or complete sacrococcygeal fusion. Intercoccygeal fusion was common, occurring in 193 subjects. Eighteen subjects had coccygeal spicules. The mean coccygeal straight length was 33.8 mm in males and 31.5 mm in females; the mean sacrococcygeal curvature angle was 116.6° in males and 111.6° in females; the mean intercoccygeal curvature angle was 140.94° in males and 145.10° in females. Conclusions Type I was the most common coccyx type in our study, as in Egyptian and Western populations. The number of coccygeal vertebrae and prevalence of sacrococcygeal and intercoccygeal fusion in the Indian population were similar to those in the Western population. The mean coccygeal straight length and mean sacrococcygeal curvature angle were higher in males, whereas the intercoccygeal curvature angle was higher in females. Information on similarities and differences in coccygeal morphology between different ethnic populations could be useful in imaging and treating patients presenting with coccydynia.
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Tague RG. Sacral Variability in Tailless Species: Homo sapiens
and Ochotona princeps. Anat Rec (Hoboken) 2017; 300:798-809. [DOI: 10.1002/ar.23555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/05/2016] [Accepted: 11/26/2016] [Indexed: 12/29/2022]
Affiliation(s)
- Robert G. Tague
- Department of Geography and Anthropology; Louisiana State University; Baton Rouge Louisiana
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Yoon MG, Moon MS, Park BK, Lee H, Kim DH. Analysis of Sacrococcygeal Morphology in Koreans Using Computed Tomography. Clin Orthop Surg 2016; 8:412-419. [PMID: 27904724 PMCID: PMC5114254 DOI: 10.4055/cios.2016.8.4.412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/08/2016] [Indexed: 11/15/2022] Open
Abstract
Background The sacrococcygeal morphology of Arabs and Europeans has been studied using computed tomography (CT) or magnetic resonance imaging to determine the cause of coccydynia. Studies have suggested differences in sacrococcygeal morphology among ethnic groups. However, there are no data on the sacrococcygeal anatomy of Koreans. Methods We conducted a retrospective analysis of 606 pelvic CT scans that were taken at Cheju Halla General Hospital between 2008 and 2014. Fractures of the sacrum or coccyx were excluded. Differences in the sacrococcygeal morphology among age groups stratified by decade of life and between genders were analyzed using sagittal plane pelvic CT scans. The morphological parameters studied were the sacral and coccygeal curved indexes, sacrococcygeal angle, intercoccygeal angle, coccygeal type, coccygeal segmental number, and sacrococcygeal fusion. Results The average sacral and coccygeal curved indexes were 6.15 and 7.41, respectively. The average sacrococcygeal and intercoccygeal angles were 110° and 49°, respectively. Type II coccyx was most common, and the rate of sacrococcygeal fusion was 34%. There was a moderate positive correlation between age and the sacral curved index (r = 0.493, p = 0.000) and a weak negative correlation between age and the coccyx curved index (r = −0.257, p = 0.000). There was a weak negative correlation between age and the intercoccygeal angle (r = −0.187, p = 0.000). The average intercoccygeal angle in males and females was 53.9° and 44.7°, respectively. Conclusions The sacrum tended to be more curved and the coccyx straighter with age. The coccyx was straighter in females than males. Knowledge of the sacrococcygeal anatomy of Koreans will promote better understanding of anatomical differences among ethnicities and future studies on coccydynia.
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Affiliation(s)
- Min Geun Yoon
- Department of Orthopedic Surgery and Traumatology, Cheju Halla General Hospital, Jeju, Korea
| | - Myung-Sang Moon
- Department of Orthopedic Surgery and Traumatology, Cheju Halla General Hospital, Jeju, Korea
| | - Bong Keun Park
- Department of Orthopedic Surgery and Traumatology, Cheju Halla General Hospital, Jeju, Korea
| | - Hohyoung Lee
- Department of Orthopedic Surgery and Traumatology, Cheju Halla General Hospital, Jeju, Korea
| | - Dong-Hyeon Kim
- Department of Orthopedic Surgery and Traumatology, Cheju Halla General Hospital, Jeju, Korea
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Williams SA, Russo GA. The fifth element (of Lucy's sacrum): Reply to Machnicki, Lovejoy, and Reno. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2016; 161:374-8. [DOI: 10.1002/ajpa.23035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dunsworth H, Eccleston L. The Evolution of Difficult Childbirth and Helpless Hominin Infants. ANNUAL REVIEW OF ANTHROPOLOGY 2015. [DOI: 10.1146/annurev-anthro-102214-013918] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Holly Dunsworth
- Department of Sociology and Anthropology, University of Rhode Island, Kingston, Rhode Island 02881; ,
| | - Leah Eccleston
- Department of Sociology and Anthropology, University of Rhode Island, Kingston, Rhode Island 02881; ,
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Russo GA, Williams SA. “Lucy” (A.L. 288-1) had five sacral vertebrae. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2014; 156:295-303. [DOI: 10.1002/ajpa.22642] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/10/2014] [Accepted: 10/08/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Gabrielle A. Russo
- Department of Anthropology and IDPAS; Stony Brook University; Stony Brook NY 11794
| | - Scott A. Williams
- Center for the Study of Human Origins, Department of Anthropology; New York University; New York NY 10003
- New York Consortium in Evolutionary Primatology; New York NY 10024
- Evolutionary Studies Institute and Centre for Excellence in PalaeoSciences, University of the Witwatersrand; Wits 2050 South Africa
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Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH. The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 2012; 221:537-67. [PMID: 22994881 PMCID: PMC3512279 DOI: 10.1111/j.1469-7580.2012.01564.x] [Citation(s) in RCA: 283] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 12/28/2022] Open
Abstract
This article focuses on the (functional) anatomy and biomechanics of the pelvic girdle and specifically the sacroiliac joints (SIJs). The SIJs are essential for effective load transfer between the spine and legs. The sacrum, pelvis and spine, and the connections to the arms, legs and head, are functionally interrelated through muscular, fascial and ligamentous interconnections. A historical overview is presented on pelvic and especially SIJ research, followed by a general functional anatomical overview of the pelvis. In specific sections, the development and maturation of the SIJ is discussed, and a description of the bony anatomy and sexual morphism of the pelvis and SIJ is debated. The literature on the SIJ ligaments and innervation is discussed, followed by a section on the pathology of the SIJ. Pelvic movement studies are investigated and biomechanical models for SIJ stability analyzed, including examples of insufficient versus excessive sacroiliac force closure.
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Affiliation(s)
- A Vleeming
- Department of Anatomy, University of New England College of Osteopathic Medicine, Biddeford, ME, USA
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Woon JTK, Perumal V, Maigne JY, Stringer MD. CT morphology and morphometry of the normal adult coccyx. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012. [PMID: 23192732 DOI: 10.1007/s00586-012-2595-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Lack of data on the in vivo morphology and morphometry of the normal adult coccyx hampers understanding of radiological abnormalities in idiopathic coccydynia. The aim of this study was to investigate normal adult sacrococcygeal morphometry. METHODS Retrospective analysis of 112 adult CT scans (mean age 63 ± 14.6 years, 50 males) evaluated the following: number of coccygeal segments; joint fusion; coccygeal spicules, subluxation, sacralization, and scoliosis; sacrococcygeal straight and curved lengths and curvature indices; sacrococcygeal and intercoccygeal angles; and lateral deviation of the coccyx tip. RESULTS Four coccygeal segments were present in 76 % of scans. Sacrococcygeal fusion was present in 57 % and intercoccygeal fusion was increasingly common more caudally; there was no significant association with age or gender. A bony spicule was present in 23 %. Subluxation was rare. Nine of 12 coccyges with a retroverted tip were female. Mean coccygeal curved length was 4.4 ± 0.8 cm in men and 4.0 ± 0.8 cm in women (P < 0.01). Mean angle between first and last coccygeal segments was 138° ± 25° in men and 147° ± 25° in women (P = 0.08). There was no significant correlation between coccygeal length or curvature and stature, age or BMI. CONCLUSIONS In this first detailed study of the CT morphology and morphometry of the adult coccyx, sacrococcygeal and intercoccygeal joint fusion was common. Female coccyges were shorter, straighter, and may be more prone to retroversion, factors that may be relevant to the markedly higher prevalence of idiopathic coccydynia in women.
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Affiliation(s)
- Jason T K Woon
- Department of Anatomy, Otago School of Medical Sciences, University of Otago, PO Box 913, Dunedin, New Zealand
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