Scholarlink

Background <p>The sacral hiatus is the primary percutaneous access point for caudal epidural blocks and other trans-sacral interventions. Its anatomical variability is a known contributor to procedural failure and complications, yet the prevalence of high-risk morphology in living adults remains incompletely characterized.</p> Purpose <p>This study aimed to classify sacral hiatus morphology using multidetector computed tomography (MDCT) in a diverse adult population and to estimate the prevalence of anatomical variations that could complicate percutaneous trans-hiatal access.</p> Methods <p>This retrospective study included 258 adults (142 men, 116 women; mean age 47.2 ± 14.6) who underwent pelvic MDCT imaging for various non-traumatic indications. Two independent radiologists assessed multiplanar reconstructions for apex level, canal dimensions, and hiatus shape. Challenging anatomy was defined by pre-specified criteria: apex at/above S3, canal depth &lt; 3&#xa0;mm, or absent/irregular hiatus.</p> Results <p>Anatomically challenging features were identified in 34.9% (90/258) of the cohort. The V-shape (38.0%) was most common. A high apex (at/above S3) was observed in 28.4% (73/257 patent cases), with no significant sex difference (<i>p</i> = 0.213). Canal depth was ≤ 3&#xa0;mm in 31.0% (80/258). Based on composite criteria, 34.9% (90/258) had challenging anatomy. Interobserver agreement for dimensional measurements was robust (<i>r</i> ≥ 0.893), and for categorical classification, it was substantial (<Emphasis Type="BoldItalic">κ</Emphasis> ≥ 0.669).</p> Conclusions <p>MDCT demonstrates a high prevalence of sacral hiatus variants that can complicate trans-hiatal access. Proactive radiologic identification of these features on routine studies provides valuable pre-procedural intelligence, potentially enhancing safety across anesthesia, interventional pain medicine, and orthopedics.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

MDCT-based prevalence of anatomically challenging sacral hiatus morphology in adults: implications for procedural safety

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月30日

查看全文
  • Mohamed Ragab Nouh,
  • Moustafa Ahmed Moustafa,
  • Omnia Ezz Eldin

摘要

Background

The sacral hiatus is the primary percutaneous access point for caudal epidural blocks and other trans-sacral interventions. Its anatomical variability is a known contributor to procedural failure and complications, yet the prevalence of high-risk morphology in living adults remains incompletely characterized.

Purpose

This study aimed to classify sacral hiatus morphology using multidetector computed tomography (MDCT) in a diverse adult population and to estimate the prevalence of anatomical variations that could complicate percutaneous trans-hiatal access.

Methods

This retrospective study included 258 adults (142 men, 116 women; mean age 47.2 ± 14.6) who underwent pelvic MDCT imaging for various non-traumatic indications. Two independent radiologists assessed multiplanar reconstructions for apex level, canal dimensions, and hiatus shape. Challenging anatomy was defined by pre-specified criteria: apex at/above S3, canal depth < 3 mm, or absent/irregular hiatus.

Results

Anatomically challenging features were identified in 34.9% (90/258) of the cohort. The V-shape (38.0%) was most common. A high apex (at/above S3) was observed in 28.4% (73/257 patent cases), with no significant sex difference (p = 0.213). Canal depth was ≤ 3 mm in 31.0% (80/258). Based on composite criteria, 34.9% (90/258) had challenging anatomy. Interobserver agreement for dimensional measurements was robust (r ≥ 0.893), and for categorical classification, it was substantial (κ ≥ 0.669).

Conclusions

MDCT demonstrates a high prevalence of sacral hiatus variants that can complicate trans-hiatal access. Proactive radiologic identification of these features on routine studies provides valuable pre-procedural intelligence, potentially enhancing safety across anesthesia, interventional pain medicine, and orthopedics.