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Ali K. Ozturk, Patricia Zadnik Sullivan and Vincent Arlet

, 12 , 16 , 17 While these techniques are successfully used for clinical and radiographic improvement, shortcomings may occur in situations of sagittal imbalance in the setting of lumbar hyperlordosis, or an extremely elevated PI. 2 , 10 In this paper we report the case of a woman with severe positive sagittal imbalance despite prior anterior and posterior reconstructive surgery with lordotic cages and lumbar PSO who underwent a sacral (S-1) PSO with excellent improvement in her overall alignment and quality of life. We also provide a description of the technique

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Farideh Nejat and Syed Shuja Kazmi

cosmetic aspects. Skin-covered lesions are managed in an elective manner when CSF leakage is not present. Meningoceles often increase in size. A girl born via cesarean section at term to a 24-year-old Gravida 1 mother was noted to have a large, skin-covered, soft-tissue mass protruding from her sacral region in the dorsal midline. Prenatal ultrasonography performed 1 month before delivery had revealed a large sacral meningocele, 7 cm in diameter without other abnormalities. The infant had no obvious neurological deficits. Spinal magnetic resonance (MR) imaging revealed

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James D. Lin, Lee A. Tan, Chao Wei, Jamal N. Shillingford, Joseph L. Laratta, Joseph M. Lombardi, Yongjung J. Kim, Ronald A. Lehman Jr. and Lawrence G. Lenke

with a description of the technique, demonstrating safe and reliable placement of 100 consecutive S2AI screws with no neurovascular complications. 16 However, freehand placement of S2AI screws can be challenging, especially in the setting of transitional lumbosacral anatomy, where unilateral lumbarization/sacralization of the transitional vertebra introduces asymmetry in the dorsal sacral landmarks and occasionally elevates the hemipelvis ( Fig. 1 ). In this special setting, using the “one size fits all” starting point caudal to the S1 dorsal foramen can result in

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Thomas Mendel, Florian Radetzki, Stefan Schwan, Gunther Olaf Hofmann and Felix Goehre

P ercutaneous sacroiliac (SI) screw fixation is an established technique for stabilizing selected types of fractures in unstable pelvic injuries. It is the only minimally invasive method for treating instabilities of the posterior pelvic ring. Indications for the use of percutaneous SI screw fixation include SI joint dislocations, transiliac and transsacral fracture dislocations, and sacral fractures. However, for a strict percutaneous procedure, fractures need to be nondisplaced or to be reducible in a closed manner. Because of the low morbidity rate

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Mohamad Bydon, Vance Fredrickson, Rafael De la Garza-Ramos, Yiping Li, Ronald A. Lehman Jr., Gregory R. Trost and Ziya L. Gokaslan

S acral fractures are uncommon lesions that often are under- or undiagnosed, leading to inadequate treatment and possible neurological damage. An accurate understanding of sacral anatomy, its injury mechanisms and types, as well as treatment options is pivotal to preventing neurological sequelae, such as lower-extremity weakness and urinary, rectal, or sexual dysfunction. The purpose of this article is to clinically summarize important sacral anatomy, its injury classifications, and the treatments of those injuries. Incidence and Epidemiology Sacral

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Sacral agenesis

Case report

Herbert Lourie

I solated partial or total sacral agenesis is an uncommon anomaly that invariably causes urinary incontinence. Although this anomaly has important neurological implications, there have been few reports of this entity in the neurosurgical literature. 1 The purpose of this report is to alert neurosurgeons to this condition, and to describe the associated clinical and radiological features. Case Report This 10-year-old boy was referred for evaluation of lifelong urinary and fecal incontinence. He had weighed 5 lbs at birth and had been the product of an

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Wei Xu, Yu Wang, Jing Wang, Xinghai Yang, Weibo Liu, Wang Zhou, Tielong Liu and Jianru Xiao

G iant cell tumor (GCT) of bone is one of the most common tumors, accounting for approximately 3%–5% of all primary bone tumors. 4 , 17 It usually occurs in the 3rd decade of life, predominantly in the female sex. The sacrum is the fourth most common site of all GCTs in the reported series, ranging from 2% to 8%. 4 , 15 , 28 Clinically, sacral GCTs often present with few symptoms in the early stage of development, and tend to be quite large and vascular when diagnosed, 14 rendering treatment extremely difficult. Although classified as benign, GCTs can be

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Peter Dyck and Charles B. Wilson

A nterior sacral meningocele is a rare congenital lesion. Since its description by Bryant in 1838, 5 fewer than 100 cases have been reported in the world literature. 3, 7, 8, 11 Haddad 7 extensively reviewed this topic in 1958, and added his own two cases. He observed that 43 of the 51 reported lesions were found in females. In some instances, the presacral meningocele was associated with anomalies of the genitourinary system or rectum. 1, 3 A familial tendency exists, 6, 9 with up to five cases being reported in the same family by Solopaev, et al. 10

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Christopher C. Gillis, John T. Street, Michael C. Boyd and Charles G. Fisher

neither radiation therapy nor chemotherapy has been shown to be effective or to have influence on the patient’s prognosis. 2 The goal of surgical treatment is en bloc excision with wide margins. When these lesions involve the sacrum, a total or partial sacrectomy is then required to achieve en bloc excision with margins. 14 When the tumor also involves the lumbar spine, the technical difficulty of both resection to achieve clear margins and postresection reconstruction increases considerably. 5 Following en bloc excision of a sacral chondrosarcoma, the patient may

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Amgad Saddik Hanna and Xavier Morandi

A nterior sacral meningocele is a congenital anterior herniation of the dura mater and arachnoid either through a sacral defect or an enlarged intervertebral foramen. 9, 11 The pathogenesis is still unclear. Nine cases have already been diagnosed in pregnant women mostly because of obstructed labor. 9–11 We present the first MR imaging illustration of ASM in pregnancy. Case Report This 27-year-old woman, who had been pregnant three times, given birth once, and had one abortion, presented for her routine 22 weeks' gestation visit. Her second pregnancy