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VOLUME 1 , ISSUE 2 ( July-December, 2018 ) > List of Articles

ORIGINAL ARTICLE

Anatomical Variations and Clinical Correlations of Sacral Hiatus and Sacral Canal

Ruchi Dhuria, Vandana Dave, Manish Ahuja

Keywords : Caudal epidural block, Caudal epidural anesthesia, Sacrum, Sacral hiatus, Sacral canal

Citation Information : Dhuria R, Dave V, Ahuja M. Anatomical Variations and Clinical Correlations of Sacral Hiatus and Sacral Canal. Journal of Medical Academics 2018; 1 (2):75-80.

DOI: 10.5005/jp-journals-10070-0016

License: NA

Published Online: 01-12-2018

Copyright Statement:  NA


Abstract

Background: Sacral hiatus is nonfusion of the lamina of a fifth sacral vertebra in midline on the dorsal surface. The caudal epidural block is a common technique to introduce a needle into epidural space through sacral hiatus for surgical anesthesia and analgesia. Aim: The objective was to study the morphological and morphometric variations of sacral hiatus and sacral canal in human sacra and to provide bony parameters for localization of sacral hiatus as an important landmark to access the epidural space for various clinical procedures successfully. Materials and methods: The study was executed on 88 dry adult human sacra to scrutinize certain parameters of sacral hiatus and sacral canal including the shape of sacral hiatus, level of apex and base of sacral hiatus, length of sacral hiatus, anteroposterior distance at apex of sacral hiatus and intercornual distance at the base of hiatus. Results: Inverted ‘U’ shape was most frequent (35.22%) followed by inverted ‘V’ shape (29.24%). The apex and base of sacral hiatus were commonly found at fourth (57.54%) and fifth (92.04%) sacral vertebral level respectively. The mean length of sacral hiatus was 28.17 ± 16.62 mm, the anteroposterior diameter at the apex of sacral hiatus was 6.66 ± 2.71 mm, and the intercornual distance at the base was 16.39 ± 3.44 mm. Conclusion: Thorough knowledge of relevant anatomy and anatomical variations of sacral hiatus are imperative for clinicians for successful caudal epidural anesthesia. Clinical significance: During caudal epidural anesthesia, incorrect needle placement in sacral hiatus may result in intraosseous drug toxicity and aspiration. Awareness about sacral hiatus and its variations may improve the understanding of disorders related to sacral nerve injuries.


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  1. Nasr AY, Ali YH, Elsawy NA. The Sacral Hiatus: An Anatomical Study on both Cadaveric and Dry Bones. Trans Clin Bio 2014;2(1):4-12.
  2. Standring S, editor. Gray's Anatomy . The Anatomical Basis of Clinical Practice. 40th ed. London: Churchill Livingstone Elsevier; 2008. p. 724.728.
  3. Sekiguchi M, Yabuki S, Satoh K, Kikuchi S. An anatomic study of the sacral hiatus: A basis for successful caudal epidural block. Clin J Pain 2004;20:51.54.
  4. Chen PC, Tang SF, Hsu TC, Tsai WC, Liu HP, Chen MJ, Date E, Lew HI. Ultrasound guidance in caudal epidural needle placement. Anesthesiology 2004;101:181-184.
  5. Edwards WB, Hingson R. Continuous caudal anaesthesia in obstetrics. Am J Surg 1942;57:459-464.
  6. Shinde AA, Manvikar PR, Bharambe VK. Morphometric study of sacral hiatus and its significance in caudal epidural anesthesia. Sahel Med J 2015;18:134-138.
  7. Czarski Z. Treatment of sciatica with hydrocortisone and novocaine injection into the sacral hiatus. Przegl Lek. 1965, 21(7):511-513.
  8. Devulder J, Bogaert L, Castille F, Moerman A, Rolly G. Relevance of epidurography and epiduralysis in chronic failed back surgery patients. Clin J Pain. 1995;11(2):147- 150.
  9. Helm Sznd, Gross JD, Varley KG. Mini surgical approach for spinal endoscopy in the presence of stenosis of the sacral hiatus. Pain Physician. 2004;7(3):323-325.
  10. Kim DW, Lee SJ , Choi EG, Lee PB, Jo YH, Nahm FS. Morphologic Diversities of Sacral Canal in Children; Three- Dimensional Computed Tomographic Study. Korean J Pain 2014;27(3):253-259.
  11. Saha D, Bhattacharya S, Uzzaman A, Mazumdar S, Mazumdar A. Morphometric study of variations of sacral hiatus among West Bengal population and clinical implications. Italian Journal of Anatomy and Embryology. 2016, p. 165-171,
  12. Amin R, Shahdad S, Ali U, Nazir M, Aslam B. Study of variations of sacral hiatus. Indian Journal of Research. 2018;7(4): 82-84.
  13. Nagar SK. A study of sacral hiatus in dry human sacra. J Anat Soc India 2004;3(2):18-21.
  14. Seema, Singh M, Mahajan A. An anatomical study of variations of sacral hiatus in sacra of north indian origin and its clinical significance. Int J Morphol. 2013;31(1):110-114.
  15. Sinha MB, Rathore M, Sinha HR. A study of variation of sacral hiatus in dry bone in central Indian region. Int J of Healthcare and Biomedical Research. 2014;2(4):46-52.
  16. Nadeem G. Importance of knowing the level of sacral hiatus for caudal epidural anaesthesia. Int J Morphol. 2014;31(1): 9-13.
  17. Ukoha UU, Okafor JI, Anyabolu AE, Ndukwe GU, Eteudo AN, Okwudiba NJ. Morphometric study of the sacral hiatus in nigerian dry human sacral bones. Int J Med Res Health Sci. 2014;3(1):115-119.
  18. Akhtar J, Fatima N, Ritu, Kumar A, Kumar V. A Morphometric study of sacral hiatus and its importance in caudal epidural anaesthesia. Int J of Anatomy, Radiology and Surgery. 2016;5(1):6-11.
  19. Kumar V, Pandey SN, Bajpai RN, Jain PN, Longia GS. Morphometrical study of sacral hiatus. J Anat Soc India. 1992;41(1): 7-13.
  20. Tsui BC, Tarkkila P, Gupta S, Kearney R. Confirmation of caudal needle placement using nerve stimulation. Anesthesiology 1999;91:374-378.
  21. Chhabra N. An anatomical study of size and position of sacral hiatus; its importance in caudal epidural block. Int J of Health Sciences and Research. 2014;4(12):189-196.
  22. Mustafa MS, Mahmoud OM, Raouf HH, Atef HM. Morphometric study of sacral hiatus in adult human Egyptian sacra: their significance in caudal epidural anaesthesia. Saudi J Anaesthe. 2012;6:350-357.
  23. Galloway NT, Tanish J. Minor defects of the sacrum and neurogenic bladder dysfunction. Br J Urol 1985;57:154-155.
  24. Brailsford JF. Deformaties of lumbosacral region of spine. Br J Surg. 1929;16(64):562-627.
  25. Ogoke BA. Caudal e[idural steroid injections. Pain Physician 2000;3:305-312.
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