Abstract
Purpose
Patients with lumbosacral agenesis characteristically sit on their iliac wings with their torsos bent forward, which yields an increase in intra-abdominal pressure and, subsequently, negative effects on their diaphragm. The sacrum is not available as an anchor point for instrumentation. Dunn-McCarthy rods or Galveston fixations cannot be performed due to these limited anatomic properties. On the other hand, the absence of necessary bone mass for fusion anteriorly limits the fusion interventions to the posterior. Therefore, a secure and rigid fixation is essential to preclude the need for an external support. There are limited publications discussing different techniques due to the relatively rare incidence of the disease. We report the clinical and radiological results of a new technique applied to three patients in which previously recommended methods are modified.
Methods
Two 6-year-old female patients and one 5-year-old male patient with lumbosacral agenesis underwent posterior lumbopelvic instrumentation and fusion. Together with standard pedicle screw spinal instrumentation, pelvic fixation is obtained with a combination of supero-inferior directed rod and/or screw to overcome deforming forces created at the flexion–extension pivot points of the lumbopelvic junction. Autogenic anterior tibial cortical structural graft is used for laminopelvic bridging, and demineralized bone matrix is used for the augmentation of osteoinduction. A single leg hip spica is applied for 4 months to protect the fixation.
Results
Total correction yielded an aligned spine with a posture that allows for sitting on the ischial spines for all three patients. Solid fusion was observed to maintain this correction at the final follow-up.
Conclusion
The use of new-generation pediatric spinal instrumentation systems with a new technique without knee disarticulation provides a safe and effective fixation and fusion in lumbosacral agenesis.
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References
Lubicky JP (1992) Congenital absence of the lumbar spine and sacrum: one-stage reconstruction with subsequent two-stage spine lengthening. J Pediatr Orthop 12(5):675
Dumont CE, Damsin JP, Forin V et al (1993) Lumbosacral agenesis. Three cases of reconstruction using Cotrel-Dubousset or L-rod instrumentation. Spine (Phila Pa 1976) 18(9):1229–1235
Rieger MA, Hall JE, Dalury DF (1990) Spinal fusion in a patient with lumbosacral agenesis. Spine (Phila Pa 1976) 15(12):1382–1384
Mayfield JK (1981) Severe spine deformity in myelodysplasia and sacral agenesis: an aggressive surgical approach. Spine (Phila Pa 1976) 6(5):498–509
Marsh HO, Tejano NA (1973) Four cases of lumbo-sacral and sacral agenesis. Clin Orthop Relat Res 92:214–219
Phillips WA, Cooperman DR, Lindquist TC et al (1982) Orthopaedic management of lumbosacral agenesis. Long-term follow-up. J Bone Joint Surg Am 64(9):1282–1294
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Yazici, M., Akel, I. & Demirkiran, H.G. Lumbopelvic fusion with a new fixation technique in lumbosacral agenesis: three cases. J Child Orthop 5, 55–61 (2011). https://doi.org/10.1007/s11832-010-0322-2
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DOI: https://doi.org/10.1007/s11832-010-0322-2