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Purpose <p>To quantify S1 and S2 transsacral corridor dimensions in an older adult non-fracture control population and to evaluate the impact of lumbosacral transitional vertebrae (LSTV) and sacral dysmorphic morphology on corridor feasibility.</p> Methods <p>A retrospective CT-based anatomical study was performed in 72 non-fracture controls aged 65 years or older. Axial, coronal, and longitudinal dimensions of potential S1-S3 transsacral corridors were measured. LSTV was classified according to the Castellvi classification. Sacral dysmorphic morphology was assessed independently from corridor measurements using five CT-based features: mammillary bodies, tongue-in-groove morphology, residual S1-S2 intervertebral disc, dysmorphic upper sacral foramina, and steeply descending sacral alae. Corridor feasibility was assessed using axial diameter thresholds of 7.0 and 7.3&#xa0;mm.</p> Results <p>LSTV was present in 19/72 patients (26.4%). Absence of a measurable S1 corridor occurred in 17/72 (23.6%) overall and was strongly associated with LSTV (12/19 (63.2%) vs. 5/53 (9.4%), <i>p</i> &lt; 0.001). Sacral dysmorphic features were present in 49/72 (68.1%) controls and were also associated with absence of the S1 corridor (16/49 (32.7%) versus. 1/23 (4.3%), <i>p</i> = 0.008). Increasing dysmorphism burden showed a stepwise increase in absent or subthreshold S1 corridors, with 68.8% of patients with ≥ 3 dysmorphic features lacking a measurable S1 corridor (<i>p</i> &lt; 0.001). S2 corridors remained consistently identifiable and frequently exceeded conventional transsacral fixation thresholds, even in patients without measurable S1 corridors.</p> Conclusions <p>In older adults, lumbosacral transitional vertebrae and clustered sacral dysmorphic morphology are strongly associated with absence or critical narrowing of the S1 transsacral corridor, whereas S2 corridors remain consistently preserved. These findings highlight the importance of systematic preoperative CT-based corridor assessment and caution against assuming S1 feasibility without individualized anatomical evaluation.</p> <p><i>Level of Evidence</i>: III</p>

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CT-based feasibility of transsacral osseous corridors in older adults: the impact of lumbosacral transitional anatomy and sacral dysmorphism

  • 期刊论文

  • 发表日期：

    2026年6月15日

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  • Martin Naisan,
  • Simon Harsch,
  • Yazan Noufal,
  • Felix Schmitz,
  • Philipp Drees,
  • Philipp Hartung,
  • Marcus Richter

摘要

Purpose

To quantify S1 and S2 transsacral corridor dimensions in an older adult non-fracture control population and to evaluate the impact of lumbosacral transitional vertebrae (LSTV) and sacral dysmorphic morphology on corridor feasibility.

Methods

A retrospective CT-based anatomical study was performed in 72 non-fracture controls aged 65 years or older. Axial, coronal, and longitudinal dimensions of potential S1-S3 transsacral corridors were measured. LSTV was classified according to the Castellvi classification. Sacral dysmorphic morphology was assessed independently from corridor measurements using five CT-based features: mammillary bodies, tongue-in-groove morphology, residual S1-S2 intervertebral disc, dysmorphic upper sacral foramina, and steeply descending sacral alae. Corridor feasibility was assessed using axial diameter thresholds of 7.0 and 7.3 mm.

Results

LSTV was present in 19/72 patients (26.4%). Absence of a measurable S1 corridor occurred in 17/72 (23.6%) overall and was strongly associated with LSTV (12/19 (63.2%) vs. 5/53 (9.4%), p < 0.001). Sacral dysmorphic features were present in 49/72 (68.1%) controls and were also associated with absence of the S1 corridor (16/49 (32.7%) versus. 1/23 (4.3%), p = 0.008). Increasing dysmorphism burden showed a stepwise increase in absent or subthreshold S1 corridors, with 68.8% of patients with ≥ 3 dysmorphic features lacking a measurable S1 corridor (p < 0.001). S2 corridors remained consistently identifiable and frequently exceeded conventional transsacral fixation thresholds, even in patients without measurable S1 corridors.

Conclusions

In older adults, lumbosacral transitional vertebrae and clustered sacral dysmorphic morphology are strongly associated with absence or critical narrowing of the S1 transsacral corridor, whereas S2 corridors remain consistently preserved. These findings highlight the importance of systematic preoperative CT-based corridor assessment and caution against assuming S1 feasibility without individualized anatomical evaluation.

Level of Evidence: III