The surgical treatment of lumbo-sacral coccygeal agenesis

Abstract

Vertebro-pelvic instability and deformities of the lower limbs are the main therapeutic problems in lumbo-sacral agenesis. The first of these can be solved conservatively with the aid of an orthopaedic corset; patients treated in this way have never reported visceral compression disturbances. In regard to the deformities of the lower limbs it is possible and preferable to perform corrective surgery rather than amputation. However, this is complicated by the possibility of ischaemic attacks as a result of stretching of the neurovascular bundle. Surgical treatment should be commenced at an early stage and be performed in the following order: knees, hips, feet. If the deformity is not long-established, extension of the knees can be achieved by simple posterior capsulotomy and tenotomy of the flexors followed by slow, gradual trans-skeletal traction applied over a period of approximately one month. Relapses, however, must be treated by double osteotomy (supracondylar of the femur and metaphyseal of the tibia) with removal of anterior wedges. Flexion relapses of the knees are common and require further surgery. Correction of the hip deformities is easy and we have never observed relapses of this deformity. When the deformities have been corrected and static function restored to the lower limbs, the patients can walk with elbow crutches and orthopaedic calipers by oscillating the trunk.