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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Sacral Morphometry in Sacralised and Non Sacralised Dry Human Sacra: A Cross-sectional Study from Northern India
Correspondence Address :
Dr. Ankita Saha,
Flat No. 539, Railvihar, Anandapur, Kolkata-700107, West Bengal, India.
E-mail: ankitasaha91@gmail.com
Introduction: Lower back pain is a very common problem among the younger generation today. One congenital cause is a Lumbosacral Transitional Vertebra (LSTV), which occurs at the lumbosacral junction. Variations in the morphology of the sacrum and lumbar vertebrae have clinical relevance because they alter biomechanics. Accurate morphometric data on sacralisation are necessary for orthopaedic, radiological, anatomical, and forensic applications. Despite the recognised prevalence and clinical relevance of LSTVs, limited osteological data comparing morphometric parameters between sacralised and non sacralised sacra are available in the Indian population.
Aim: To evaluate morphometric variations of the sacrum in relation to lumbosacral assimilation and compare measurements between male and female sacra and also between sacralised and non sacralised specimens.
Materials and Methods: The present observational cross-sectional study included 80 dry human sacra (50 male, 30 female) collected from the Department of Anatomy, FMHS, SGT Medical College, Gurugram, Haryana, India, between January 2025 and December 2025. Morphometric parameters measured included mid-Ventral Straight Length (VSL), Ventral Base Width (VBW), Superior Base Width (SBW), Sacral Auricular Lengths (SAL) and Sacral Auricular Widths (SAW). Based on these measurements, Ventral Base Index (VBI) and Sacral Body Index (SBDI) were calculated. Statistical analysis using independent samples t-test and Fisher’s exact test was performed with significance set at p<0.05. Data are presented as mean±Standard Deviation (SD).
Results: Sacralisation was observed in 13 (16.3%) specimens, with complete sacralisation in 9 (69.2%) and partial fusion in 4 (30.8%). Significant sexual dimorphism was observed in VSL (p<0.001), both right and left auricular lengths (p<0.05) and SBDI (p<0.0001). Regarding morphometric comparison between groups, the mean SBDI was significantly lower in sacralised bones than in non sacralised bones (p=0.003). Deep sacral hiatus with dorsal wall defects was found in 9 (11.3%) cases.
Conclusion: According to the findings of the present study sacralised sacra demonstrated larger morphometric dimensions, which were not found to be statistically significant except for SBDI.
Lumbosacral transitional vertebrae, Sacralisation,Sacral skewness, Sexual dimorphism
The sacrum is an inverted triangular axial bone forming the posterior wall of the pelvis, typically comprising five fused sacral vertebrae with four pairs of sacral foramina, articulating superiorly with the fifth lumbar vertebra and inferiorly with the coccyx (1).
The lumbosacral region exhibits several developmental variations, among which sacralisation of the fifth lumbar vertebra (L5) is one of the most frequently encountered anomalies (2). LSTV are congenital anomalies of the lumbosacral region that involve either the transition of the first sacral vertebra to a lumbar arrangement (lumbarisation of S1) or the assimilation of the fifth lumbar vertebra to the sacrum (sacralisation of L5) (3). There may be fusion of the first coccygeal vertebra with the sacrum (coccygeal sacralisation). These variations may be incomplete or complete resulting in altered numbering of sacral vertebrae or pairs of sacral foramina. Morphological manifestations of LSTV range from minimal enlargement of the transverse processes to complete osseous fusion of the last lumbar vertebrae with the sacrum. In cases of lumbarisation, the first sacral segment may display lumbar characteristics, including well-formed facet joints and a normally developed intervertebral disc (4).
In cases where the coccygeal segment is fused with the sacrum, mobility is restricted, which may contribute to a prolonged second stage of labour and increased risk of perineal tears (5). Bertolotti was the first to describe LSTV morphology and relate it to lower back pain (Bertolotti syndrome) (6).
Under normal conditions, the sacrum functions as a fused unit designed to distribute axial load through its broad sacroiliac articular surfaces. Fusion of the sacrum takes place from below upwards between 18 and 25 years of age. During the first stage of sacralisation, there is articulation of the transverse process of L5 with the ala of the sacrum. This leads to compression of the L5 spinal nerve during its course and sciatica. In cases of unilateral or symmetrical sacralisation, there is an increased risk of referred pain and associated scoliosis, leading to painful movement and arthritic changes in the sacroiliac joints (7).
Accurate morphometric data on the sacrum, including its variability, are essential for Orthopaedic Surgeons, Forensic Experts, and Radiologists. While sexual dimorphism of the sacrum is well documented globally, the literature on the morphometric impact of sacralisation and associated structural variations remains limited.
The primary objective was to evaluate morphometric parameters in dry human sacra and compare morphometric differences between sacralised and non sacralised sacra in the North Indian population.
The present cross-sectional study was conducted on 80 dry human sacra available at the Department of Anatomy, FMHS, SGT University, Gurugram, Haryana, India. The data collection period was January to December 2025. As the study was conducted entirely on anonymised dry cadaveric bones from a routine osteological teaching collection at the department, it did not involve living human subjects or patient data. Formal ethics committee approval was therefore not applicable.
Inclusion and Exclusion criteria: Only intact sacra that were sex identifiable and without any gross deformity were included in the study, while damaged or pathological bones or those with ambiguous sex assignment were excluded.
Study Procedure
Sex was determined using established osteological criteria, including sacral index, morphology of the auricular surface, and pelvic inlet shape as described by Standring S et al., (8).
Each sacrum was assigned a serial number. Measurements were taken by using digital Vernier callipers (CT-ZT-VERNIER by Zhart) with a least count of 0.01 mm (Table/Fig 1).
The following measurements were recorded:
1. Mid-Ventral Straight Length (VSL): Maximum vertical diameter between the midpoints of the sacral promontory and the anteroinferior sacral border.
2. Ventral Base Width (VBW): Maximum transverse diameter between the ala of sacrum passing through sacral promontory.
3. Superior Base Width (SBW): Maximum transverse distance between the dorso-cranial edges of the auricular surfaces and passing through the middle of first sacral body or through sacralised L5 body.
4. Sacral Auricular straight Length (SAL) (right and left): Right/left maximum straight vertical length of the auricular surfaces.
5. Sacral Auricular straight Width (SAW) (right and left): Right/left maximum straight width of the auricular surfaces.
The measurements are provided in terms of mean and SD. Based on these measurements, certain indices were calculated.
• Ventral Base Index (VBI): VBW/SBW ×100
• Sacral Body Index (SBDI): VBW/VSL ×100
All measurements were recorded twice by the same trained observer, and the mean value was used for analysis to ensure intra-observer reliability.
The specimens were assessed for anatomical variations including type of sacralisation (complete or partial), dorsal wall completeness and associated sacral skewness.
LSTV identified in the present study were classified using the Castellvi radiographic system (9). Although originally described for radiographic use, Castellvi classification was adapted for osteological assessment based on the morphology of transverse processes and sacral articulation/fusion patterns. This categorises LSTVs into four major types based on the morphology of the enlarged transverse processes of L5 and their articulation or fusion with the sacrum (10).
A. Type I: Type I includes unilateral (Type Ia) or bilateral (Type Ib) enlarged or dysplastic transverse processes in the craniocaudal dimension which represents the mildest morphologic form of LSTV and typically does not form a pseudo-joint or fusion with the sacrum.
B. Type II: Type II morphology demonstrates partial articulation, characterised by an incomplete unilateral (IIa) or bilateral (IIb) fusion between the enlarged transverse process and the sacrum.
C. Type III: This category represents complete osseous fusion between the enlarged transverse process and the sacrum, occurring unilaterally (IIIa) or bilaterally (IIIb).
D. Type IV: Describes a mixed pattern, where one side demonstrates a Type II articulation and the contralateral side shows a Type III complete fusion.
STATISTICAL ANALYSIS
Statistical analysis was performed using Statistical Package for Social Sciences (SPSS). Sexual dimorphism and morphometric differences between sacralised and non sacralised sacra were compared using the independent samples t-test. The association between sacralisation and sacral skewness was tested using Fisher’s exact test. A p-value <0.05 was considered statistically significant.
Among the 80 sacra examined, 50 were male (62.5%) and 30 female specimens (37.5%). Sacralisation was identified in 13 (16.3%) specimens (Table/Fig 2), while the remaining showed no evidence of transitional anatomy. Among sacralised samples, complete fusion was more frequent 9 (69.2%) than partial sacralisation 4 (30.8%) (Table/Fig 3). Based on the Castellvi classification (11), among sacralised sacra, four specimens belonged to type IIb, four were of type III b, and five were of type IV.
Fisher’s exact test revealed a statistically significant association between sacralisation and sacral skewness (p<0.001). Eight of 13 (61.5%) sacralised specimens exhibited sacral skewness, compared with only two of 67 (3.0%) non sacralised sacra. Additional variations included coccygeal sacralisation in 4 (5%) of specimens (Table/Fig 4) and dorsal wall defects in 9 (11.3%) the majority presenting with deep sacral hiatus up to S3 level (Table/Fig 5).
Male sacra demonstrated significantly greater mid-VSL and auricular surface lengths compared to females (p<0.05). Females had a significantly higher SBDI than males (p<0.0001) (Table/Fig 6).
Comparison between sacralised and non sacralised sacra showed that the sacralised sacra demonstrated larger mean values across all linear parameters (Table/Fig 7). Auricular dimensions were marginally larger in sacralised specimens but differences were not statistically significant. Other rare variations noted in this study include incomplete fusion between adult sacral vertebrae shown in (Table/Fig 8).
A notable finding of the present study is the high frequency of sacral skewness among sacralised specimens (61.5%), compared with only 3.0% in non sacralised sacra. Fisher’s exact test confirmed a statistically significant association (p<0.001), supporting the biomechanical hypothesis proposed by Konin GP and Walz DM that altered load transmission at the transitional lumbosacral level contributes to compensatory spinal malalignment (4). Wu LP et al., examining 208 Chinese adult dry sacra, reported a 23.6% overall incidence of sacral skewness (12).
In the present study, the mean VSL was 99.62 mm (males) and 89.44 mm (females), and the mean SAL was 53 mm in males and 50 mm in females. Kumar B et al., found the mean value of sacral straight length was 104.55 mm in males and 94.66 mm in females, and the mean length of the auricular surface was 56.08 mm and 54.77 mm in males and females, respectively, among the sacra of the Bihar population (1).
In the study of Yadav N et al., the mean VSL was 104.7±5.94 in males and 92.6±6.1 in females, and the sacral index was 98.44±4.69 in males and 113.23±5.61 in females (13). Mishra SR et al., found the mean length of the auricular surface was 62.54 mm and 54.57 mm in male and female sacra, respectively (14).
Dubey A et al., found that the mean sacral index was greater in females (110.63) than in males (93.8), and the difference was highly significant (11). In the present study, the mean SBDI was significantly higher in females, indicating a relatively broader sacral base relative to sacral length.
The absence of sacral hiatus is one of the important anatomical reasons for the failure of caudal epidural anaesthesia (15). In the present study, in one specimen, there was a complete absence of fusion of the laminae of all sacral vertebrae, leading to a complete linear gap in the dorsal wall and in eight specimens, there was a deep sacral hiatus due to the failure of union of the laminae of S3, S4, and S5.
Limitation(s)
The primary limitation is the smaller sample size of sacralised specimens, which reduces statistical power for detecting morphometric differences across subtypes. As a single-centre osteological study from one Institution in Haryana, the findings may not be fully generalisable to broader Indian or South Asian populations. Moreover, this was an observational, cross-sectional osteological study; causal inferences cannot be drawn from the findings. Prospective multicentre studies with larger sample sizes, incorporating radiological-osteological correlation and clinical symptom data, are recommended to validate these findings and refine diagnostic criteria for LSTV in Indian populations.
The present observational cross-sectional study of dry human sacra demonstrated significant sexual dimorphism in sacral length, auricular dimensions and SBDI, supporting their role in anthropological and forensic applications. The findings of the present study reinforce the biomechanical and clinical importance of accurately identifying LSTV during patient assessment. While the morphological variations observed may not independently predict pathology, their association with spinal deformity and known clinical pain syndromes highlights the importance of accurate identification.
DOI: 10.7860/JCDR/2026/87620.24287
Date of Submission: Jan 21, 2026
Date of Peer Review: Mar 25, 2026
Date of Acceptance: May 18, 2026
Date of Publishing: Sep 01, 2026
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? No
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Mar 24, 2026
• Manual Googling: May 14, 2026
• iThenticate Software: May 16, 2026 (15%)
ETYMOLOGY: Author Origin
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