Peer-reviewed veterinary case report

Spine shape can hide landmarks during laparoscopic sacrocolpopexy

By Sato H et al.·2026·Department of Urology, Japan·View original on Europe PMC →

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Original publication title: Sagittal Double-Hump Deformity of the Lumbosacral Spine: An Anatomical Risk Factor for Surgical Landmark Obscuration During Laparoscopic Sacrocolpopexy.

Plain-English summary

This study looked at a specific spinal deformity called the "double-hump" deformity, which affects the lower back area in women. Researchers wanted to see how this deformity impacted the angle of the spine and the visibility of important landmarks during a type of surgery called laparoscopic sacrocolpopexy, which is used to treat pelvic issues. They found that women with the double-hump deformity had a smaller angle between two vertebrae and that half of these cases made it difficult for surgeons to see the necessary landmarks during surgery. Additionally, these patients experienced more blood loss during the procedure compared to those without the deformity. Overall, recognizing this deformity before surgery could help doctors plan better and keep patients safer during the operation.

Abstract

<h4>Objective</h4>This prospective study evaluated the impact of the "double-hump" deformity-defined by anterior protrusions of the L4-L5 and L5-S1 disks-on L5-S1 angulation and laparoscopic sacrocolpopexy (LSC) outcomes. We hypothesized that this deformity is associated with reduced angulation and impaired sacral promontory visibility.<h4>Methods</h4>The L5-S1 intervertebral angle measured using sagittal computed tomography (CT) was the primary outcome. Intraoperative sacral promontory visibility, postoperative CT findings of mesh malposition, and perioperative surgical measures (operative time, blood loss) were key secondary outcomes. A total of 184 women scheduled to undergo LSC underwent preoperative CT. The double-hump deformity was defined as an L4-L5 angle > 15° and an L5-S1 angle < 50°. CT measurements of disk heights, disk angles, and sacral promontory location were obtained. For double-hump cases (n = 52), intraoperative videos were reviewed by a blinded surgeon who scored sacral promontory visibility. Postoperative CT was performed to assess mesh placement.<h4>Results</h4>Compared with the control group, the double-hump group had a significantly smaller L5-S1 angle and greater L4-L5 angle (primary outcome). In 50% of double-hump cases (secondary outcome), sacral promontory visualization was rated as "difficult." Intervertebral fixation was not identified by postoperative CT. Estimated blood loss in the double-hump group was greater than that in the control group.<h4>Conclusions</h4>The double-hump deformity is associated with reduced L5-S1 angulation, spinal degeneration, and impaired landmark visibility during LSC. Preoperative recognition may facilitate surgical planning and improve intraoperative safety.

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Original publication on Europe PMC: https://europepmc.org/article/MED/41657298