Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Feb;121(2 Pt 1):285-290.
doi: 10.1097/AOG.0b013e31827c61de.

Preventing L5-S1 discitis associated with sacrocolpopexy

Meadow M Good  1 , Travis A Abele, Sunil Balgobin, Joseph I Schaffer, Paul Slocum, Donald McIntire, Marlene M Corton
Affiliations

Preventing L5-S1 discitis associated with sacrocolpopexy

Meadow M Good et al. Obstet Gynecol. 2013 Feb.

Abstract

Objective: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Level of evidence: II.

PubMed Disclaimer

References

    1. Cheung WY, Luk KDK. Pyogenic spondylitis. Int Orthop 2012;36:397–404.
    1. Skaf GS, Domloj NT, Fehlings MG, Bouclaous CH, Sabbagh AS, Kanj SS. Pyogenic spondylodiscitis: an overview. J Infect Public Health 2010;3:5–16.
    1. Grimes CL, Tan-Kim J, Garfin SR, Nager CW. Sacral colpopexy followed by refractory candida albicans osteomyelitis and discitis requiring extensive spinal surgery. Obstet Gynecol 2012;120:464–8.
    1. Rajamaheswari N, Agarwai S, Seethalakshmi K. Lumbosacral spondylodiscitis: an unusual complication of abdominal sacrocolpopexy. Int Urogynecol J 2012;23:375–7.
    1. Voelker A, Hoeckel M, Heyde C. Lumbosacral spondylodiscitis after sacral colpopexy of a sigmoid neovagina in a patient with vaginal melanoma. Surg Infect 2012;13:134–5.

LinkOut - more resources