The American journal of orthopedics
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Dissection and measurements of the first 2 sacral nerve roots with regard to the commonly used entrance points for S1 and S2 pedicle screw placement were performed to determine the location of the first 2 sacral nerve roots in relation to the pedicle screw entrance points in the upper 2 sacral vertebrae. The sacral nerve roots, dural sac, and pedicles were exposed after laminectomy. The mean distance from the reference point to the adjacent nerve roots superiorly and inferiorly at the S2 pedicle level was smaller than those at the S1 pedicle level. ⋯ Pedicle screw placement in the first 2 sacral vertebral pedicles has been recommended for lumbosacral fusion and internal fixation of sacral fractures. No anatomic study is available regarding the location of the sacral nerve roots relative to the entrance points of sacral pedicle screw placement. Violation of the sacral canal and foramina by a sacral pedicle screw may injure the sacral nerve roots, especially at the level of the S2 pedicle.
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Dyspareunia after heterotopic ossification of the adductor longus is a rare complication. We describe a patient with symptomatic heterotopic ossification of the adductor muscle that developed years after sustaining a fracture of the inferior pubic ramus in association with an injury to the adductor longus muscle. The patient's pain was reduced and his dyspareunia resolved after excision of the adductor longus heterotopic ossification and subsequent physical therapy.