Sacral rib: an uncommon congenital anomaly

• Published in: The spine journal Vol. 15; no. 6; pp. e35 - e38
• Main Authors: Miyakoshi, Naohisa, MD, PhD, Kobayashi, Akira, MD, PhD, Hongo, Michio, MD, PhD, Shimada, Yoichi, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2015
• Subjects: Adolescent; Buttocks - diagnostic imaging; Buttocks - pathology; Congenital anomaly; Female; Humans; Low Back Pain - congenital; Low Back Pain - diagnostic imaging; Low Back Pain - pathology; Magnetic Resonance Imaging; Orthopedics; Pelvic rib; Radiography; Ribs - abnormalities; Ribs - diagnostic imaging; Ribs - pathology; Sacral rib; Sacrum - abnormalities; Sacrum - diagnostic imaging; Sacrum - pathology; Supernumerary rib; Congenital anomaly; Supernumerary rib; Sacral rib; Pelvic rib
• DOI: 10.1016/j.spinee.2013.08.055
• ISSN: 1529-9430

Abstract Background context Sacral rib represents an uncommon pathology in which rib-like structures arise from the sacrum. Supernumerary ribs may occur at any level of the spine, but supernumerary ribs in the sacrococcygeal area are extremely rare. Purpose To present the case of a patient with sacral rib and to discuss this entity with reference to the literature. Study design A case report and literature review. Methods A 17-year-old girl presented with low back pain and discomfort in bilateral gluteal regions. Radiographs and computed tomography (CT) of the pelvis showed a smooth-surfaced, rod-like bony structure attaching to the sacrum on the left side. The appearance was consistent with sacral rib. The sacrum was hypoplastic and deviated to the right. Magnetic resonance imaging (MRI) showed insertion of the gluteus maximus (GM) onto the coccyx only on the right side. The sacral rib existed beneath the left GM muscle and received a partial insertion from the left GM muscle. No ligamentous continuation between the sacral rib and coccyx was observed. Results Conservative treatment relieved symptoms, so no surgical intervention was performed. Conclusions Sacral rib is a rare congenital anomaly for which surgical intervention is usually unnecessary. However, appropriate workups with CT and/or MRI should be considered for women, because sacral rib may cause complications during childbirth. In the literature, sacral/coccygeal rib is sometimes called “pelvic rib.” However, sacral/coccygeal rib should be distinguished from pelvic rib, because pelvic rib originating from the ilium is considered to represent a different entity.