Preventing L5-S1 Discitis Associated With Sacrocolpopexy
ABSTRACT : To further characterize the anatomy of the fifth lumbar to first sacral (L5-S1) disc space and to provide anatomic landmarks that can be used to predict the locations of the disc, sacral promontory, and surrounding structures during sacrocolpopexy.
: The lumbosacral anatomy was examined in 25 female cadavers and 100 computed tomography (CT) studies. Measurements were obtained using the midpoint of the sacral promontory as a reference. Data were analyzed using Pearson χ, unpaired Student's t test, and analysis of covariance.
: The average height of the L5-S1 disc was 1.8±0.3 cm (range 1.3-2.8 cm) in cadavers and 1.4±0.4 cm (0.3-2.3) on CT (P<.001). The average angle of descent between the anterior surfaces of L5 and S1 was 60.5±9 degrees (39.5-80.5 degrees) in cadavers and 65.3±8 degrees (42.6-88.6 degrees) on CT (P=.016). The average shortest distance between the S1 foramina was 3.4±0.4 cm in cadavers and 3.0±0.4 cm on CT (P<.001). The average height of the first sacral vertebra (S1) was 3.0±0.2 cm in cadavers and 3.0±0.3 on CT (P=.269).
: In the supine position, the most prominent structure in the presacral space is the L5-S1 disc, which extends approximately 1.5 cm cephalad to the "true" sacral promontory. During sacrocolpopexy, awareness of a 60-degree average drop between the anterior surfaces of L5 and S1 vertebra should assist with intraoperative localization of the sacral promontory and avoidance of the L5-S1 disc. The first sacral nerve can be expected approximately 3 cm from the upper surface of the sacrum and 1.5 cm from the midline.
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ABSTRACT: Pelvic organ prolapse (POP) is a common condition that negatively affects women's' quality of life. Sacrocolpopexy is an abdominal procedure designed to treat apical compartment prolapse, including uterine or vaginal vault prolapse, as well as multi-compartment prolapse. Although traditionally performed as an open abdominal procedure, minimally invasive sacrocolpopexy, laparoscopic or robotic, has been successfully adopted to the practice of many pelvic reconstructive surgeons. Many variations to this procedure exist, with different levels of evidence to support each one of them. In this article we review the current literature on sacrocolpopexy, with an emphasis on the minimally invasive approach. Procedural steps and controversies are examined in light of the existing literature and recommendations made based on the level of the existing evidence.Journal of Minimally Invasive Gynecology 01/2014; 21(4). DOI:10.1016/j.jmig.2014.01.004 · 1.58 Impact Factor
The Spine Journal 08/2014; DOI:10.1016/j.spinee.2014.08.004 · 2.80 Impact Factor
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ABSTRACT: Pyogenic spondylodiscitis includes a spectrum of spinal infections such as discitis, osteomyelitis, epidural abscess, meningitis, subdural empyema, and spinal cord abscess. This is a rare complication of sacral colpopexy, but can lead to devastating consequences for the patient. We present two cases of pyogenic spondylodiscitis following sacral colpopexy. In addition, we discuss 26 cases of pyogenic spondylodiscitis reported in the literature from 1957 to 2012. Techniques to decrease rates of infection include proper identification of the S1 vertebra, awareness of the suture placement depth at the level of the sacrum and at the vagina, and early treatment of post-operative urinary tract and vaginal infections. Awareness of symptoms, timely diagnosis and multidisciplinary approach to management is essential in preventing long-term complications.International Urogynecology Journal 06/2013; 25(1). DOI:10.1007/s00192-013-2138-3 · 2.16 Impact Factor