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Sacral destruction: foraminal lines revisited.

J K Amorosa, S Weintraub, L F Amorosa

    AJR. American Journal of Roentgenology
    |October 1, 1985
    PubMed
    Summary
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    Plain radiography is crucial for low back pain, but sacral metastases are often missed. Careful observation of sacral foraminal lines on X-rays can improve detection of these bone cancers.

    Area of Science:

    • Radiology
    • Oncology
    • Orthopedic Surgery

    Background:

    • Plain radiography is the standard initial imaging for low back pain.
    • The sacrum presents challenges for accurate radiographic evaluation.
    • Early detection of sacral metastases is critical for patient outcomes.

    Observation:

    • A review of 12 cases revealed an 83% rate of missed sacral metastases on plain radiographs.
    • Radiographs of pelvic specimens demonstrated normal sacral anatomy and foraminal lines.
    • Six cases showed neoplastic lesions, primarily metastatic, causing destruction of sacral lines.

    Findings:

    • Sacral metastases frequently go undetected on initial plain radiography.
    • Destruction of one or more sacral foraminal lines indicates sacral lesions.

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  • Asymmetric appearance of sacral lines is a key indicator of pathology.

    • Implications:

    • Radiologists and clinicians must be vigilant in evaluating the sacrum for metastases.
    • Improved radiographic interpretation techniques are needed to reduce missed diagnoses.
    • Enhanced awareness of sacral line symmetry can improve early detection of metastatic disease.