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• W3008850709 abstract "This abstract was published but not presented at SGS 2019. It will be presented at SGS 2020. Technical challenges with mesh fixation during robotic-assisted laparoscopic sacrocolpopexy include difficulty finding and visualizing the sacral promontory (most superior portion of the S1). This may lead to mesh placement above in the L5-S1 and L4-L5 vertebral discs and subsequent catastrophic complications including discitis and osteomyelitis. The objective of this study was to further characterize the relevant relationships of the bony anatomy relevant to the sacral promontory to use as a guide for safe mesh placement. The anatomical relationships in of the lumbar and sacral spine were reviewed in 25 female patient’s computed tomography (CT) studies for benign indications. Anatomy quantified included 1) angle of descent between the anterior surfaces of the L4 and L5 vertebra 2) angle of descent between the anterior surfaces of the L5 and S1 vertebra 3) L4-L5 disc height and width 4) L5-S1 disc height and width 5) L4, L5, S1 vertebral heights 6) distance between ASIS 7) distance between midpoint of pubic symphysis and sacral promontory. The mean age of the female patients was 54.7 years. The mean height, weight, and BMI was 64.4 inches, 93.8 kg, 34.7, respectively. The patients were 64% white and 36% Black. The mean L4-L5 angle of descent was 19.9 degrees (range 0.5-40.8 degrees) and mean L5-S1 angle was 57.2 degrees (27.8-70.1). Eight of 25 (32%) women had an L4-L5 angle >30 with L5-S1 angle of <40 degrees. The mean heights (range) included: L4-L5 disc 1.1 cm (0.68-1.7), L5-S1 disc 1.12 cm (0.3-1.9), L4 vertebra 2.7 cm (2.1-3.1), L5 vertebra was 2.8 cm (2.1-3.0), and S1 was 3.3 cm (2.7-3.6). The mean distance between the ASIS was 21.3 cm (16-25.8 cm), the mean distance between midpoint of pubic symphysis and sacral promontory was 12.1 cm (9.9-14). There was a positive correlation between the L5-S1 angle of descent and the L5-S1 disc height (0.716 (95% CI 0.53-0.897). There was a negative correlation between the L4-L5 angle of descent and the L5-S1 angle of descent (95% CI -0.37 to -0.84) (Figures 1 and 2). The majority of women have steep 60 degree L5-S1 angle of descent in comparison to the 20-degree L4-L5 angle. As described in this study, 32% of women may have conditions such as degenerative disc disease causing decreased L5-S1 disc height, increased L4-L5 and decreased L5-S1 angle of descent, leading to the “double-hump” anatomical relationship. In these cases, the L4-L5 may be the most prominent structure in the lower lumbosacral spine and the surgeon may inadvertently attach mesh above the true sacral promontory and attach mesh to the disc. Awareness of this relationship may assist intraoperative localization of the “good point” on the sacral promontory (12 centimeters from the pubic symphysis), for safe mesh attachment.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W3008850709 date "2020-03-01" @default.
• W3008850709 modified "2023-09-25" @default.
• W3008850709 title "16: The double-hump: Clinical significance in sacrocolpopexy" @default.
• W3008850709 doi "https://doi.org/10.1016/j.ajog.2019.12.055" @default.
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