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Location of the Apex of the Sacral Hiatus. The apex of sacral hiatus is most commonly located at the S4 level (65-68%), followed by the S3 and S5 level (around 15% at each level) and the S1 to S2 level in 3-5% of cases [6, 8].
Distance between the Dural Sac Termination and the Apex of the Sacral Hiatus. The distance between the dural sac termination and the apex of the sacral hiatus was the interest of several studies, because the risk of dural puncture is perceived to increase as this distance decreases.
A line is draw to connect the bilateral posterior superior iliac crests and used as one side of an equilateral triangle; then the location of the sacral hiatus should be approximated.
Location of the apex of sacral hiatus in relation to level of sacral vertebra varied from S2 to S5 vertebra level.
Mean (SD) Length (mm) of sacral hiatus was 22.5 (9.1) with a range between 10 and 50.
Line joining the two posterior superior iliac spines would be the base of the equilateral triangle whose apex is at the location of sacral hiatus.
Near the cephalad margin of the gluteal crease, sacral cornua should be felt and sacral hiatus is present immediately inferior and in midline.
Identification of the caudal epidural space is easy in children younger than 7 years, later it may be difficult because as the child grows there is a reduction in the size of the sacral hiatus and the sacral vertebrae fuse.