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A case report of sacralization of coccygeal vertebra.

INTRODUCTION: Sacrum consists of four pairs of sacral foramina. Coccyx is a small triangular bone formed by fusion of four rudimentary coccygeal vertebrae. Body of first coccygeal vertebra articulates with the apex of the sacrum [1]. When first coccygeal vertebra fuses with the apex of sacrum, this process is known as sacralization of coccygeal vertebra [2,3]. It may be either developmental or congenital anomaly.

CASE REPORT: We observed first coccygeal vertebra was fused with the apex of the sacrum. The transverse process of first coccygeal vertebra was fused with inferior angle of sacrum on both sides, coccygeal cornua of first coccygeal vertebra was also fused. [fig.1 & fig.2] This complete fusion of coccygeal vertebra with sacrum generated the formation of fifth sacral foramina. Five pairs of sacral foramina were present at the ventral surface of sacrum.

DISCUSSION: Normally sacrum is formed by fusion of five sacral vertebrae and it contains 4 pairs of sacral foramina. At the cranial end of sacrum there is fifth lumbar vertebra, which when fused with the first sacral vertebra is known as sacralization of lumbar vertebra. Similarly, at the caudal end, first coccygeal vertebra when fuses with the apex of sacrum is known as sacralization of coccygeal vertebra. Both these condition leads to fifth pair of sacral foramina [2,3].

The appearance of sacrum with five pairs of foramina may be a developmental or congenital defect. Vertebrae are derived from the sclerotome portion of the somites. Patterning of the shapes of the different vertebrae is regulated by HOX GENES. So, probably mutation of HOX GENE leads to sacralization of coccygeal vertebra [4].

In lumbo-sacral spine disorders caudal epidural block is performed. In this procedure sacral cornua are identified. In case of sacralization of coccygeal vertebra, it will be difficult to identify the sacral cornua [5].

In sacralization of coccyx, coccyx becomes fixed and there is no increase in anteroposterior diameter of pelvic outlet. This may lead to prolonged second stage of labor and perineal tears and foetal distress [6].

Thus clinically, the sacralization of coccygeal vertebra is important which demands correct clinical and radiological assessment prior to spinal block and interventional procedures.

ACKNOWLEDGEMENT: We extend our thanks to Bhaskar RVS, Office superintend, Department of Anatomy, NRIIMS, Sangivalasa, Visakhapatnam, A.P (India).

REFERENCES:

[1.] Borley NR. True pelvis, pelvic floor and perineum. In: Standring S editor. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 40th Ed., London, Churchill Livingstone. 2011; 724-728.

[2.] Kanchan T, Shetty M, Nagesh KR, Menezes RG. Lumbosacral transitional vertebra: clinical and forensic implications. Singapore Med J. 2009; 50(2):85-87.

[3.] Platzer W. Color Atlas of Human Anatomy. Volume1: Locomotor System. 6th Ed., Stullgarl, Thieme. 2008;11.

[4.] Sadler TW. Langman's Medical embryology. 11th Ed., Lippincott Williams & Wilkins, Philadelphia 2010;142.

[5.] Sekiguchi M, Yabuki S, Satoh K. An Anatomic study of the sacral hiatus: a basis for successful caudal epidural block. Clin J Pain. 2004; 20:51-54.

[6.] Singh R. Sacrum with five pairs of sacral foramina. Int J Anat Var. 2011;4: 139-140.

Vanju V.V. Lakshmi, Ganesh T. Waghmode

1. Assisstant Professor. Department of Anatomy, NRI Institute of Medical Sciences, Sangivalasa, Vishakhapatnam

2. Associate Professor. Department of Anatomy, NRI Institute of Medical Sciences, Sangivalasa, Vishakhapatnam

CORRESPONDING AUTHOR:

Ganesh T. Waghmode Door no-1-7-62, Near Ramalaym, Akkireddypalem Bhpv post, Vishakhapatnam,Andhra Pradesh. E-mail: kishore.srirangam@gmail.com
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Author:Lakshmi, Vanju V.V.; Waghmode, Ganesh T.
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Clinical report
Geographic Code:9INDI
Date:Apr 1, 2013
Words:558
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