ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2026
CT-based feasibility of transsacral osseous corridors in older adults: the impact of lumbosacral transitional anatomy and sacral dysmorphism.
Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo 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.
methodsA 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.
resultsLSTV 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.
conclusionsIn 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.
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