Neelu Prasad1, Mahesh Prasad2
BACKGROUND
The sacrum on the other hand is also a vertebra. It actually is formed by the fusion of the five sacral vertebrae. The lateral mass is nothing but the fused transverse processes, similarly the body is also because of the fusion of the bodies of the five sacral vertebrae. The sacral foramen is a result of the fusion of all the five vertebral foramen. The spines of the vertebra fuse posteriorly but the hiatus at the lower end lamina of the fifth sacral vertebra may be due to incomplete fusion of laminas at this level. Posteriorly, the hiatus is seen in a vast majority of cases also at the fourth sacral vertebra due to incomplete fusion of the laminas at this level. In rare incidences, there might be complete non-fusion of the median crest. Back pain is the most common complaint in the modern life. In some posterior sacra, malformations (Anatomical) seem to be the most common cause for backache. Clinically, the hiatus is very important because it is used for epidural analgesia. But if these kinds of anatomical defects are encountered, then they might lead to the total failure of epidural analgesia procedures. In fact the success of these procedures depends on the anatomical normalcy of these bones. All these conditions may result in chronic backache.
A sincere effort has been put in this study to understand the hiatal openings of the sacrum. This study is intended to help the clinicians, orthopaedicians and the general practitioners to understand and if possible intervene before the natural progression of the disease sets in. It is also important anthropologically as there might be anthropological and racial variations. This might spark an interest in the world of Forensic sciences as well as it can be used in identification. Papers have been presented and it has been ruled that in diabetic mothers, the caudal malformations are common. The link between diabetic mothers and chronic lower backache has still not been established. This study so can be taken as a base study and the study can be further studied to find the definitive cause for the above-mentioned malformations.
METHODS
The aim of the study is to find out the incidence of opening of sacral hiatus at each level of sacral vertebra and to find out any other malformations associated with it. The study has been done in the Department of Anatomy, Nalanda Medical College, Patna. The study was done from June 2015 to May 2016. One hundred sacra were studied and the level of the hiatus was noted and also the associated malformations were noted if any.
RESULTS
In the present study, in one sacrum total non-fusion of lamina was seen. This may result in complete herniation of the lower parts of conus medullaris or at least the cauda equina parts of the spinal cord. This may in turn result in the stretching of the lower fibres of the cauda equina resulting in the symptoms of lower limbs like pain and paralysis of lower limbs as well as in chronic lower backache. The hiatus is seen in more frequencies as it progresses lower down the sacral levels. It has been observed in 11 cases at the level of S3, 31 cases at the level of S4 and in 57 cases at the level of S5.
CONCLUSION
The level at which the hiatus opens is successfully studied in this study. This study is intended to help the clinicians, orthopaedicians and the general practitioners to understand and if possible intervene before the natural progression of the disease sets in. It is also important anthropologically as there might be anthropological and racial variations. This might spark an interest in the world of Forensic sciences as well as it can be used in identification. Papers have been presented and it has been ruled that in diabetic mothers the caudal malformations are common. The link between diabetic mothers and chronic lower backache has still not been established. This study so can be taken as a base study and the study can be further studied to find the definitive cause for the above-mentioned malformations.
