Patterns of sacral dysmorphism in pelvic CT scans at a national referral hospital in Kenya

ABSTRACT Background Sacral dysmorphism refers to morphological variations found in the first two sacral segments that limit the safe placement of percutaneous sacral iliac screws. The prevalence is documented in European, North American and some Asian populations. However, studies within the African population including Kenya are lacking. The aim of the study was to describe the patterns of sacral dysmorphism in pelvic computerized tomography (CT) scans at a national referral hospital in Kenya. Methods A cross-sectional study carried out at the Radiology Department, Kenyatta National Hospital from March 2020 to March 2021 involving the radiographic evaluation of 293 stored abdominal pelvic CT scans of patients. Sacral dysmorphism was identified based on the sacral dysmorphism score >70 and the presence of any of the six morphological features of sacral dysmorphism. Results A sacral dysmorphism score of more than 70 was found to in 64% of the population. The prevalence of dysmorphic sacra (based on the presence of at least one qualitative feature) was 100%. The most prevalent feature of sacral dysmorphism was the lack of recession of the S1 segment (82%) followed by an unfused sacral segment (76%). Of note is that some qualitative features of sacral dysmorphism were protective against a high sacral dysmorphism score. There was no statistical significance of gender in sacral dysmorphism. Conclusion There is a high prevalence of sacral dysmorphism score in this population. There is a need for further studies to revisit the concept of dysmorphic sacra based on the presence of at least one qualitative feature as all our participants had at least one feature.